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the curve of prevalence results in large degree form "interplay between the deflecting energy due
to new infections and the restoring inertia due to resistance to spread of disease caused by acquirement
of immunity and consequent increase in the amount of insusceptible material." It may be added that
the failure of the flea curve in the latter part of 1921 to rise, in correspondence with the marked rise
of scarlet fever, may no doubt in part be regarded as having been specially emphasised by the phenomenal
rise in the birth-rate of the latter part of 1919 which continued in 1920. This latter happening threw
fresh fuel in to the flame, and materially helped to accelerate the rise to the maximum point which was
actually attained about a fortnight subsequent to the maximum reached by the flea curve. It was the
tossing of this sword of Brennus upon the already weighted scale of the additional susceptible material,
maturing from the higher number of births of the preceding 12 or 18 months, which decided the issue, and,
despite the fall shown by the flea curve in the late months of 1921, determined the disturbance of the
balance, and the lifting of the maximum of 1921 higher even than that of 1920.
The incidence of scarlet fever among girls of school age is considerably higher than among boys,
and this circumstance has generally been ascribed to the closer association of girls with infants. Under
the age of five years there is not much difference in the attack-rates for the two sexes, but after five years
there is a pronounced excess in attack among girls, increasing with age up to the end of school life. The
excess as compared with boys at age 13-15 is smaller than at 10-13 ; yet the association with infants
must if anything be rather more constant at the higher of these two age groups. At the age 15-20 the
attack rate among males actually exceeds that among females.
The geographical distribution of the 17,030 cases reported by head teachers may be compared
with that in 1920, when the districts mainly attacked were in the east end, Stepney, Poplar and Bethnal
Green, in the area contiguous to these boroughs on the south side of the river, Bermondsey, and to a less
extent, in Fulham, Hammersmith, Stoke Newington and Hackney. Towards the end of the year Greenwich
and Deptford were also affected. During 1921 the same areas were specially involved as were also
Islington, Battersea and Woolwich. In the latter year 448 schools were affected, and 1,112 special
investigations were conducted by the assistant medical officers into outbreaks of scarlet fever.
Scarlet fever
distribution.
Cases of diphtheria among children in the public elementary and secondary schools during the
year numbered 6,661 as compared with 16,288 (uncorrected) among persons of all ages. The total number
of deaths recorded was 1,131, of which 495 occurred among children of school age The geographical
distribution of diphtheria closely corresponds with that of scarlet fever. During the year, 287 investigations
were conducted by assistant medical officers into outbreaks of diphtheria affecting 192 schools.
Bacteriological examinations made in the department during the year numbered 6,606. In 609
Diphtheria.
bacilli indistinguishable from diphtheria bacilli were found, whilst 456 aroused some suspicion. The
remainder gave a negative result.
Bacteriological
investigations.
Following upon the epidemic year 1920, measles was quiescent in 1921, only 8,317 cases being
reported among school children, by far the lowest total for more than 15 years. " Unprotected " children
were excluded, for periods varying from a few days to three weeks, from 165 classrooms during the
course of the year, whilst in 7 schools all " unprotected " children under 5 years of age were similarly
excluded.
Measles.
The number of cases of whooping cough reported in school children during 1921 was 9,584, as compared
with 8,779, 3,397, 11,671, 7,117, 8,595, 10,959, 9,977, and 9,762 in previous years down to 1913.
Notification of whooping cough is compulsory in Holborn, Wandsworth and Greenwich.
Whooping
cough.
There was a marked drop in the number of cases of ringworm reported during 1921 as compared
with 1920. There were 3,983 cases in 1920 and 3,473 in 1921. In 1911 the new cases numbered 6,214,
whilst in 1918 there were only 2,639, the lowest number. Similarly the cases outstanding at the end
of each year as still under treatment, fell from 2,458 in 1911 to 979 in 1918, rising in 1920 to 1,332,
finally declining to 999 at the end of 1921. In 1911 only 30 per cent. of the cases received X-ray
treatment, whereas in 1921 over 60 per cent. of the cases were cured during the year by means of
X-rays at the Council's treatment centres. During 1921 the number of hair specimens examined in
the laboratory was 3,071, of which 1,577 proved to contain ringworm fungus, 19 favus fungus and
the remainder were free from disease.
Ringworm.
During the year 13 fresh cases of favus were discovered, 12 as a result of microscopic examination
of specimens sent up by school nurses and one at a treatment centre. Of these cases 7 occurred in the
•eastern division, four in the north-eastern and two in the south-western division.
Favus.
An outbreak of innuenza on a large scale began in me scnools in sporadic fashion in the late
autumn of 1921, but its effect upon attendance was not specially noted until about the last week of the
winter term (i.e., just before Christmas), when there was a considerable reduction, ascribed to influenza,
in attendance in the western area (Kensington, Hammersmith and Fulham). Other districts were
also affected. Cases reported from the schools during the weeks ending 14th, 21st, 28th January, and
4th. 11th. 18th February numbered 3,848, 5,791, 3,924, 1,343, 650 and 366 respectively.
Influenza.
The type of illness was not so severe as in the pandemic of 1918-19. Certain special symptoms
were reported from various quarters, e.g., gastric and intestinal disturbances, rashes conforming to the
character of scarlet fever, roseola or rubella (German measles), jaundice, etc.
An interesting report on an outbreak of " jaundice " at Gipsy-road School (Norwood) in November,
1921, was made by Dr. AV. Slowan. He found that of 25 cases of infants to whom his attention was
directed only 10 could be regarded as having suffered from jaundice, the remainder were absent from
an indefinite condition described as "chill on the liver," or in some instances as "influenza." The
affected children were from five different classrooms and eight different roads. In one group of three
cases there was strong presumptive evidence of personal infection.
Investigation was confined practically to the infant, junior mixed and girls' departments, the boys'
department not appearing to have been affected to any appreciable extent, either by jaundice or influenza.