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whilst actually suffering from scarlet fever, and only one case occurred in the school during his attendance
and the week following his removal. In Battersea six cases occurred in a boarding school; the first
child who was attacked and who infected the other five directly or indirectly, had sickened three days
after receiving a parcel of pancakes from home ; from this home a case of scarlet fever had been removed
before the child referred to sickened. In the borough of Wandsworth a slight outbreak occurred in
November in Roehampton, due to one or two unrecognised cases infecting others at school or in the
street after school hours. In Streatham there was local prevalence due mainly to infection at school.
An outbreak also occurred in a convent school, due to infection from a child who was herself apparently
infected during a railway journey from Bognor. In Holborn a small outbreak occurred among children
attending the St. John School. In Shoreditch in October and November a series of 14 cases occurred
among children attending the Catherine-street School. In Lambeth an outbreak occurred in the
Stockwell Orphanage which began in 1903, and involved the attack of 70 boys ,41 girls, and three officers.
Dr. Kerr's report shows that four class rooms and two departments were closed during the year
on account of prevalence of scarlet fever among the children attending the schools. The annual reports
show " return cases " to have occurred in Finsbury, 5 ; in Bermondsey, 15 ; Battersea, 20 ; Wandsworth
17 ; Woolwich, 18 ; Shoreditch, 7 ; and Greenwich, 3. The medical officer of health of Shoreditch gives
a summary of return cases occurring during the years subsequent to 1893, and which amounted to
1*4 per cent, of Shoreditch children discharged from hospital. The occurrence of three cases in Poplar
upon the return of a child from hospital, led the Poplar Borough Council, to communicate with other
London sanitary authorities as to the steps taken by the hospital providing authority to ensure that
patients are not discharged in an infectious condition.1
The summer holiday of the London County Council schools began in 1904 on Thursday, the
21st July, i.e., the latter part of the 29th week, and the schools re-opened on Monday, the 22nd August,
i.e., at the beginning of the 34th 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 the 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 :— j

Scarlet fever—Age and sex distribution.
The following table shows the cases, deaths, case-rates, death-rates and fatality of scarlet fever
at the several ages and for each sex in London during the year 1904. 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 this table, the greatest incidence of attack was upon both males and females
of four years of age. The greatest incidence of death was upon both males and females of two years of
age. The fatality, it will be observed, was highest among males of one and among females under one
vear of aere.

1 A report has been issued by the Metropolitan Asylums Board giving detailed information of the results of
inquiry into return cases by Dr. A. G. R. Cameron.
2 In the preparation of this table the percentages are calculated on the number of cases notified in London, and
the number of deaths occurring in London and the institutions belonging to London.