88 MILK AND THE PUBLIC HEALTH CHAP. 



which illustrates a very common method of infection. The 

 outbreak occurred in May 1907, and consisted or 37 cases. 

 Twenty of the persons attacked were regular customers of 

 a milk-dealer, W. E., who kept no cows but obtained the 

 greater part of his milk -supply from a farmer, E. J., in the 

 surrounding rural district, and who supplied no other dealers 

 or persons but W. E. Out of the 238 houses supplied with 

 the infected milk 18 were infected, or 7*5 per cent as com- 

 pared with 0*2 per cent amongst the houses in those districts 

 supplied with milk from other sources. The outbreak at 

 once ceased when the supply from the farm was stopped. 

 The twenty cows on the farm were inspected by a veterinary 

 surgeon, who stated that they were all in good health. When 

 the farm was visited it was found that the farmer, E. J., had 

 recently suffered from a slight sore throat, and his niece had in 

 the early part of May also suffered from sore throat, and had 

 been confined to bed for two days. No rash was admitted to 

 have been noticed in either case, and a doctor was not called 

 in. Both the farmer and his niece took an active part in 

 milking and attending to the cows. The daughter of the farmer 

 E. J. was notified as suffering from scarlet fever May 23. 



It was subsequently found that shortly before the outbreak 

 several cases of scarlet fever had occurred amongst children 

 living in the village in which the milk purveyors lived, and 

 that these cases were imperfectly isolated. It is probable that 

 the niece derived her infection in this way, subsequently 

 infecting the milk. 



3. Kobertson l recorded an outbreak of over 40 cases of 

 scarlet fever due to the contamination of milk in a milk-shop. 

 The premises were badly constructed in that the shop com- 

 municated directly at the rear, by means of a short passage, 

 with a servant's bedroom and the kitchen. Infection was 

 derived from the woman of the house, who was suffering from 

 a sore throat, and who was an unrecognised case of scarlet 

 fever. She infected her two children, a week after the onset 

 of her sore throat, with undoubted scarlet fever. With the 

 removal of the mother to hospital the epidemic suddenly 

 declined. While she was ill and suffering from sore throat 

 she served the customers coming to the shop for milk. 



1 Public Health, 1905, xvii. p. 445. 



