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fever death-rates obtaining in London during the four quarters of the year were as follows—First
quarter, 0-13; second quarter, 0-12; third quarter, 012; and fourth quarter, 0*11 per 1,000 living.
During the year no outbreaks of scarlet fever of any considerable extent occurred.
Mr. Jackson reports that in Fulham " the disease attained its maximum prevalence in the
third week of August, a period when, owing to the schools being closed for the summer holiday,
it is usually at its lowest. This was largely due to the occurrence of some unrecognised
attacks of scarlet fever among children sent into the country by the managers of a children's
holiday fund. In one instance, a child who was sent to a village in Berkshire developed the
disease shortly after its arrival there, having probably been infected before leaving Fulham, and
communicated it to three other children also from Fulham, but the nature of the illness was not
recognised until after their return home, when, on the occurrence of several cases in their homes
and some neighbouring houses, they were examined and found to be evidently recovering from
mild scarlet fever. In another instance, a child who had been sent to a village in Middlesex,
contracted scarlet fever while there, but it was not until her return home, and the occurrence
there of some secondary cases, that the nature of her illness was recognised/'
Such evidence as is afforded by the reports of medical officers of health does not show that
the disease during 1902 was spread in any other way than by infection from person to person. In
Finsbury, Dr. Newnfan was able to associate 103 cases among 381 cases notified in the borough
with antecedent cases of the disease. In Bermondsey, however, the source of infection could
only be definitely traced in 49 cases among 460 cases notified.
It will be seen from Diagram X. that the number of admissions to the hospitals of the
Metropolitan Asylums Board per cent, of the total cases of scarlet fever notified in London was
greater in 1902 than in any previous year.
In the annual reports relating to the following districts the number of cases is stated
which followed the return home of a patient who had been discharged from a fever hospital, viz.—
Fulham, 1G cases ; Stoke Newington, 3 cases; Finsbury, 11 cases ; Southwark, 46 cases;
Bermondsey, 10 cases; "Wandsworth, 48 cases; Greenwich, 24 cases; Lewisham, 50 cases;
Woolwich, 19 cases.
Scarlet fever and elementary schools.
The subject of scarlet fever in relation to school attendance is referred to only in a few
reports. In the City a school was closed in October for 21 days on account of the prevalence of
this disease among the pupils. In Stoke Newington the disease was in 9 cases attributed to
exposure to infection at school, and in Finsbury 10 such cases occurred. The effect, however, of
the summer holiday of the schools in causing a reduction in the number of cases of scarlet fever
was, as usual, manifest.
The summer holiday of the London School Board schools began in 1902 on Thursday, the
24th July, i.e., the latter part of the 30th week, and the schools re-opened on Monday, the 25th
August, i.e., at the beginning of the 35th week. If the number of cases notified in the four weeks,
which would be most subject to holiday influence, be compared with the number of cases notified
in tie four preceding and four subsequent weeks, the results shown in the following table are
obtained. It will be seen that the decrease during the period of holiday influence is most marked
at ages 3—13, ages 0—3, and 13 and upwards showing increase in this period, and the increase
subsequent to the period of holiday influence is particularly marked at the school age, while the
number of cases at other ages show decrease.

Scarlet fever—Age and sex distribution.
The following table shows the cases, deaths, case-rates, death-rates, and fatality of scarlet
fever during the year 1902. It will be seen that the case-rate, death-rate, and fatality were higher
among males at "all ages" than among females. In the age groups adopted for the purposes
of the table, the greatest incidence of attack was upon both males and females of four years of
age. The greatest incidence of death was upon males of two and upon females of three years of
age. The fatality, it will be observed, was greatest both among males and females under one
year of age.