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124
terms, the districts principally affected being Lambeth, Battersea, and Cainberwell
in the south, and Islington, Bethnal Green, Stepney and Poplar, north of the river.
The number of schools visited by the Council's medical officers for the purpose of
conducting investigations into the occurrence of scarlet fever among the pupils
was 213, entailing 311 departmental visits and the inspection of some 39,000 children.
For many years past scarlet fever has, broadly speaking, been manifested by
a benign type of illness. The mortality from this disease has been very much lower
than diphtheria, measles and whooping cough as will be noted in the following
table showing the deaths from the four most serious diseases of early childhood
during the three quinquennia ending with the year 1925.

The above figures fully justify the decision of the Metropolitan Asylums Board
(referred to on page 129) to give priority to cases of measles during epidemics of
this disease, when the number of beds available is insufficient to provide for the
accommodation of both scarlet fever and measles.
The etiology of scarlet fever was made the subject of a report by Dr. Forbes
in the Annual Report of 1925 (pages 50-52) in which the role of the streptococcus
in relation to throat infection and the transmission of scarlet fever and puerperal
fever was discussed. Reference was also made to the Dick Test and SchultzeCharlton
reaction. Since then no additional contributions of sufficiently outstanding
importance have appeared to warrant further comment on this subject.
At the time the annual report of 1925 was going to press an epidemic of measles
was in full progress, although it had not reached its height, and in that report the
subject was discussed from a general and historical point of view, in addition to
those aspects which were of current interest at a time when the disease had invaded
practically all parts of London.
The general prevalence lasted from November, 1925, to April, 1926, and a
review of the epidemic is now presented.
Incidence.
During the six months ended 30th April, 1926, 39,387 cases of measles were
reported from the schools under the Council's jurisdiction, i.e., about 2,000 cases
less than in the previous epidemic, 1923-24, when, during the six months ended
31st May, 1924, 41,261 cases were reported. The total number of cases occurring
in the general population is not known, as measles is not a notifiable disease, and
even if it were, large numbers of cases would doubtless escape notification. It
has been, however, calculated that the total figure may be taken as somewhere
between two and three times the number of those reported as occurring among school
children. On this basis it is estimated that there were, roughly, between 80,000
and 100,000 cases altogether during the period in question. All parts of London
were involved in the epidemic, although the disease was considerably more prevalent
in some neighbourhoods than in others, as the table below demonstrates. The
case rate in the more densely populated districts was, for the most part, lower than
in the better class residential areas. The East End, for example, emerged with a
considerably smaller ratio, as compared with boroughs like Hampstead, Wandsworth
and Lewisham, as far as the school population is concerned. This is probably
accounted for by the fact that children in the poorer districts contract measles and
other infectious illnesses earlier in life, i.e., before they reach the age of compulsory
school attendance. The following table shows the geographical distribution of