ADDENDUM 

 I. MILK-BORNE SORE THROAT OUTBREAKS 



(1) ABERDEEN [1], 1881. About 300 cases with three deaths. 

 Symptoms characteristic. Sudden onset, with severe rigor or series 

 of rigors followed by fever. Inflammation of throat and tonsils 

 with swelling of the lymphatic glands in the neck and above the 

 clavicle. Fever usually subsided after two to three days, leaving 

 the patient very weak and prostrate. Outbreak clearly spread by 

 milk. The total number of families supplied with milk from the 

 incriminated supply was 110, and of these at least 90 families 

 were affected. No cases occurred in any families obtaining their 

 milk from other sources. Outbreak ceased when supply of milk 

 stopped. Outbreak ascribed, on what would now be considered as 

 quite insufficient grounds, to the water supply of the dairy. No 

 mention made as to the condition of the cows or of any examination 

 of, or cases of illness amongst, the milkers. 



(2) RUGBY [2], 1880 (reported by Dr. George Wilson). Over 

 100 cases in all. Mostly among the boys at Rugby School. Cases 

 of sore throat, but clinical particulars not given. Outbreak clearly 

 spread by milk. Sudden onset in the three (out of eight) boarding- 

 houses connected with the school supplied from the one milkman ; 

 in fifteen out of the thirty-seven families which he also supplied in 

 the town there were one or more cases of the disease. All the 

 cases were supplied with milk from the one milkman. Onset, 

 March 16 and March 17. No cases of suspicious illness on the 

 four farms from which the supply was obtained. Wilson came to 

 the conclusion that the probable cause was a cow suffering from 

 garget on one of the farms. 



'(3) DOVER [3], February 1884 (reported by Dr. M. K. Robin- 

 son). Within four days 188 persons attacked; in all 205 persons 

 affected. Symptoms, those of local inflammation of the throat, 

 enlargement of the lymph glands of the neck, and in some cases 

 vesicular eruptions. Erysipelas was also met with. Four fatal 

 cases. In nineteen out of the forty-two affected streets every 

 house supplied by the implicated milkman was invaded, while in the 



