INLETS FOR INFECTION. 81 



used by all the evening guests, among whom there was but little scar- 

 let fever ; the former, or four-o'clock, cream was distributed essen- 

 tially to the family and to the dinner guests. It was again used at 

 luncheon the next day, and thirteen persons who were known to have 

 had opportunity of partaking of it suffered from scarlet fever within 

 five days. The bulk of this four-o'clock cream was used in the prep- 

 aration of articles which had to be boiled previous to their being used 

 in a cool or frozen form, and those persons who partook of such articles 

 alone were not specially attacked. But of this cream some that was 

 in excess of the cook's requirements was put into at least one jug 

 along with the five-o'clock cream. 



This mingling of the two creams added materially to the difficulty 

 of the investigation, because it was that remnant of the four-o'clock 

 cream which had not been boiled previous to use to which interest was 

 now found specially to attach. For " no less than seven ladies w^ho 

 were at the dinner, and who took cream in their coffee in the drawing- 

 room, afterward became ill, none of them who took that cream hav- 

 ing escaped." There was, however, no such incidence of disease on the 

 gentlemen who took coffee down-stairs. And further, whereas all who 

 partook of cream on the day following the dinner were ill, none of 

 those who did not partake of it suffered. Now, it was known that it 

 was the four-o'clock cream that was used at the luncheon on the 10th, 

 and if it so happened that the cream which was sent up into the draw- 

 ing-room with coffee for the ladies who had left the dinner-table was 

 the jug of mingled cream, then that four-o'clock supply from the Lon- 

 don dairy comes strongly under suspicion. 



The complicated nature of the conditions which had to be con- 

 tended with in pursuing such an investigation in the metropolis for- 

 bade any conclusive demonstration as to the exact method by which 

 this special cream-supply may have become infected. It was, how- 

 ever, ascertained that upon one section of the London dairyman's cus- 

 tomers there had been a large incidence of scarlet fever, and a suspi- 

 cious history as to scarlet fever in the person of one of the dairy-staff 

 who was engaged in milking and carrying out the milk was also 

 elicited. In short, there is little doubt that the cream supplied from 

 this dairy was the vehicle by which the infection of scarlet fever was 

 conveyed to that household in South Kensington. 



Some years ago I conducted a somewhat similar inquiry. The 

 same disease had attacked a large proportion of persons who had met 

 at a London dinner-table, and the source of infection must have been 

 some article of food. In this case, fruit as well as cream came under 

 suspicion, and the employment as strawberry-gatherers of persons in 

 the desquamative stage of scarlet fever seemed as likely a source of 

 infection as that which might have operated through the agency of a 

 dairy. The circumstances were, however, too complex to be unraveled, 

 and further inquiry was abandoned. 



VOL. XXIV. — 6 



