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It will be seen from the foregoing table that the scarlet fever death-rate in 1903 was
highest in Bermondsey (0.19) and lowest in Stoke Newington (—). The scarlet fever
death-rates obtaining in London during the four quarters of the year were as follow—first
quarter 0.09; second quarter 0.07; third quarter 0.08, and fourth quarter 0.08 per 1,000 living.
The low fatality (2.9 per cent.), and probably also the low case-rate (2.7 per 1,000) are
indicative of the mild character of the disease which prevailed in 1903. With disease of this
nature the difficulty of finding explanation for the occurrence of cases which are recognised
is very great, inasmuch as mild and unrecognised cases must often give rise to cases in which
the symptoms are sufficiently pronounced for the purposes of recognition, the cause infection
being thus undiscoverable. In a population like that of London the chances of exposure to
unidentified cases must be much greater than in sparsely inhabited districts. It is therefore
interesting to note that Dr. Newman was able to trace exposure to an antecedent case in 90 of
the 283 cases occurring in Finsbury in 1903, and similarly Dr. McCleary found, in 96 cases
out of 448 cases occuring in Battersea, a history of personal contact with a previous case of
scarlet fever.
In the majority of the reports no reference is made to any large diffusion of the disease
which might be characterised as an outbreak, but in a few instances the disease has spread among
the children in an institution. Thus in Bermondsey 18 cases occurred in the Parish-street Workhouse,
St. Olave; in Lambeth 26 cases occurred among the children in the Licensed Victuallers'
school ; in Chelsea 82 cases occurred in the Duke of York's school. Of outbreaks associated with
dav schools may be mentioned the occurrence of a number of cases among children attending the
infants' department of Alverton-road Board school, Deptford, which was closed from 7th July
to the end of the summer holiday ; and the occurrence of a number of cases among the children
attending the St. Luke's Church school, Poplar, which was also closed. In a few reports reference
is made to attendance at school as being the probable cause of other cases. Dr. Kenwood
states that in Stoke Newington, in 12 cases, school was believed to be the place where the disease
was contracted, and Dr. Newman writes that the disease was traceable to school attendance in
15 cases.
The only outbreak which was attributed to milk occurred in Wandsworth. Dr. Caldwell
Smith states that cases occurred in houses supplied by a particular milk, as follows—One in the
last week of August, another on the 1st September, one on the 2nd, two on the 5th, five on
1 See footnote (1), page 7.