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The medical officer of health of Lewisham also urges that steps should be taken to ensure that
children who have been exposed to infectious diseases should not return to school at the termination
of the holidays, and he suggests that parents of children returning to school should for this purpose
be required to make a declaration on a prescribed form that the children have not been so exposed
within a certain period.
The prevalence of scarlet fever among school children is commented on in many of the reports
and closing of class-rooms in school departments is recorded in the reports relating to Shoreditch,
Bermondsey, Deptford, Battersea, Wandsworth, Lewisham and Woolwich. In Hampstead, some
two-thirds of 62 children resident in a boarding school were attacked, the source of infection being
eventually found to be a boy who was observed to be desquamating. A localised outbreak in Bethnalgreen
was found to be due to children playing with a child, the nature of whose illness was not recognised
until the subsequent cases occurred. An outbreak of scarlet fever occurred in Wandsworth in a
childrens' residential home due to infection from a nurse, who was the first person to be attacked, and an
outbreak which occurred in a Poor Law School in W oolwich had its origin in infection received by the
children while attending a public elementary school. The distribution of cases in invaded homes is shown
in the reports relating to Westminster and Paddington. Thus, in Westminster, where 418 were notified,
two cases occurred in one house in 25 instances, three cases in one house in 10 instances, and four cases in
one house in one instance; and, in Paddington, where 579 cases were notified, two cases occurred in one
house in 63 instances; three cases in one house in 21 instances, four cases in one house in seven
instances, five cases in one house in two instances, six cases in one house in two instances, and seven
cases in one house in one instance.
Proportion of cases of scarlet fever removed to hospital.
It will be seen from diagram IX that the proportion of cases of scarlet fever admitted to the
hospitals of the Metropolitan Asylums Board was about the same as in the preceding year.
Diphtheria.
The cases of diphtheria (including membranous croup) notified in the Administrative County of
London in 1907 (52 weeks) numbered 8,771, compared with 8,045 in 1906. The number of deaths
registered from this cause was 781 in 1907 (52 weeks) compared with 691 in 1906. The increase
in the number of deaths has been proportionately greater than the increase in the number of cases.
It must be always remembered that variations in case-rate and case-mortality may be affected
by variations in the extent of use of bacteriological methods of diagnosis, the effect of which would be
to increase the number of clinically mild cases of the disease.
The diphtheria case-rates, death-rates, and case-mortality in 1907, and preceding periods, are
shown in the following table:—

The death-rate in each year since 1858 in relation to the mean death-rate of the period 18591907
is shown for diphtheria and also for diphtheria and croup combined in diagram XI.
The monthly case-rate and case-mortality in each of the years 1891-1907 in relation to the mean
of the period is shown in diagram XIII.
If the London diphtheria death-rate be compared with the death-rates of the following large
English towns, it will be seen that in the decennium 1897-1906 the London rate was higher than
that of any except Leeds, Sheffield, West Ham, Salford and Leicester, and in 1907 was exceeded
by the rates of Birmingham, Bristol, West Ham, Newcastle-on-Tyne, Hull and Salford.

1 The Infectious Disease (Notification) Act came into force in 1889.
See footnote (1), page 8.