v ACUTE INFECTIOUS DISEASES 87 



organisms of scarlet fever are varied, but all the means of 

 infection in the recorded outbreaks fall under one or other of 

 the following headings : 



1 . From a recognised case of scarlet fever insufficiently isolated 

 from direct or indirect contact with the milk. 



2. From an unrecognised case of scarlet fever amongst those 

 coming into direct contact with the milk. 



3. Through the infection of milk vessels, bottles, etc., with the 

 specific organism of scarlet fever. The place of infection may be 

 anywhere in the course of passage of the milk to the consumer. 



4. From specifically infected or infective cows. 



In nearly all the outbreaks in which the actual means of 

 infection have been traced the milk has been infected directly 

 from a human source, recognised or unrecognised. The question 

 of bovine scarlet fever will be discussed in Chapter VI. As 

 illustrations of the other ways of spread the following may 

 be given. 



1. Mussen 1 reported an outbreak of 59 cases of scarlet 

 fever in Liverpool in 1904. Between January 30 and 

 February 6, 16 cases of scarlet fever were notified in a 

 suburban district which had previously been comparatively 

 free from the disease, and on investigation the only circum- 

 stance in common was the milk supply. One of the dairy- 

 man's children was found to have been ill, January 16 or 17, 

 was kept in bed for a few days, then allowed to come down- 

 stairs about a week previous to the notification of the first 

 case. No medical man was called in. When examined 

 February 6, there was slight oedema of feet and ankles, and 

 copious desquamation from hands and feet, showing clear 

 evidence of recent scarlatina. The child was removed to 

 hospital February 6, and other precautions were taken. A 

 number of persons were attacked after this date, but none 

 after February 10 in houses not previously invaded. In 

 other words, there were no fresh centres of invasion after four 

 days from the child's removal to hospital. The cows were 

 examined by a veterinary surgeon and found to be healthy. 



2. Walford, 2 medical officer of health, Cardiff, reported an 

 interesting outbreak of milk-spread scarlet fever in that city 



1 Public Health, 1904, xvi. p. 687. 

 2 Annual Report, Cardiff, 1907. 



