SCARLET FEVER 225 



lute. That is, second attacks are extremely rare, 

 although not unknown. 



The fact that adults rarely contract the disease is 

 to a large extent due to the protection afforded by 

 an attack during infancy or childhood. That adults 

 may suffer fatal attacks of the disease is amply 

 proved by the mortality statistics of this and other 

 countries. The greatest number of cases, however, 

 occur between the ages of two and ten years. 



In the United States the mortality from this dis- 

 ease during the census year 1900 (6333) was some- 

 what less in proportion to the population than 

 during the previous census year. The proportion 

 to 1000 deaths from all causes was 6.3 in 1900 and 

 7.1 in 1890. These rates are considerably below 

 the rates in England and Wales, where during the 

 year 1899 scarlet fever caused 11.7 in every 1000 

 deaths. The mortality rate is higher in cities than 

 in the country. The States of New Jersey and 

 Massachusetts show the highest mortality rate and 

 the State of Vermont the lowest (this applies only 

 to the registration States, viz. : Connecticut, District 

 of Columbia, Maine, Massachusetts, Michigan, New 

 Hampshire, New Jersey, Rhode Island, New York, 

 Vermont). 



Scarlet fever is a disease in which the evil influ- 

 ences of overcrowding and insanitary surroundings 



