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incidence of attack was upon both males and females of four years of age. The greatest incidence of
death was upon males of three and females of two years of age. The fatality, it will be observed, was
highest in both sexes among children under one year of age:—

Scarlet Fever and Elementary Schools.
In connection with the reduction in the number of notified cases during the summer
holiday of the schools it may be stated that the summer holiday of the London County Council
schools began in 1907 on Thursday, the 25th July, i.e., the latter part of the 30th week, and the
schools re-opened on Monday, the 26th August, i.e., at the beginning of the 35th week.

The medical officer of health of Hackney comments on a steady and rapid rise in the notifications
of scarlet fever in his district, extending from the first week in September until the third week of October,
and which is illustrated by a chart contained in his report. Dr. Warry thus writes:—
"The special feature connected with this outburst of scarlet fever is its relation to schools and school attendance
The outbreak may be said to have begun in the first week in June, steadily increasing until the last week
in July, when a considerable fall took place which was continued until the last week in August, after which the disease
rapidly increased, as described above. The period of remission during the month of August corresponded very
closely with the summer closure of the schools, and subsequent increase with their re-opening. Other evidence
pointing to this outbreak being largely due to school attendance is forthcoming in the fact that not a few cases of
desquamation were found amongst scholars still attending school—the discovery of such cases usually following
notification of some case of scarlet fever. An examination of the chart seems to show that the outbreak began before
the midsummer holidays, but that these holidays were insufficient to stay the course of the outbreak. From
the point of view of preventive medicine, I think this outbreak affords an illustration where the medical inspection
of scholars prior to the resumption of school-work, would have been of immense value in preventing the spread
of infectious disease. One is constantly meeting with this rise in the incidence of infectious disease immediately after
the long summer holidays, and in this particular case I am of opinion that if it had been possible to examine all the
children attending the infants' departments at the opening of the schools, the outbreak would not have assumed
the proportions it did. In private schools, after long holidays, no child is taken back unless provided with a certificate
that the child is free from infectious disease, and has not knowingly been exposed to such during the holidays
I do not think it is practicable to apply this system to the Council's schools; but I think the children, at least, of the
infants' departments should be medically examined after the summer holidays before being allowed to commence
school-work. If this were done, I believe it would result in a diminished prevalence of infectious disease."
In the preparation of this table the rates and 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.