SCARLET FEVER MILK-BORNE OUTBREAKS 



293 



districts followed the consumption of 

 milk from a particular farm at Hendon. 

 Further, in these four districts wherein 

 scarlatina had shown an extravagant 

 incidence upon the milkman's cus- 

 tomers, the disease had begun its 

 peculiar incidence about the end of 

 November or beginning of December. 

 In one of those districts (South 

 Marylebone), scarlatina continued day 

 by day and with increasing force up 

 to the date of the inquiry to attack 

 the customers of the retail business. 

 In two other districts (Hampstead and 

 St Pancras), after attacking in some 

 numbers, for a few days at the end 

 of November and beginning of De- 

 cember, the customers of the busi- 

 ness, the disease showed no fresh 

 attacks for about 10 days (a short but 

 clearly defined intermission), and then 

 about the middle of December attacked 

 them again in larger numbers, and con- 

 tinued to do so up to date of inquiry'. 



The chief facts concerning the dis- 

 tribution of the milk may be set 

 out as follows : {ci) The Marylebone 

 customers suffered at the end of 

 November and up till the end of the 

 third week in December. {fi) The 

 Hampstead cases occurred in two 

 groups, one small group at the end of 

 November and a larger group in the 

 latter part of December, (c) The St 

 Pancras customers suffered like the 

 Hampstead ones, but in a less degree. 

 They obtained milk from the same 

 vendors. • (</) The St John's Wood 

 customers did not suffer until after the 

 end of the year, {e) The few persons 

 affected at Hendon suffered early in 

 December, having consumed milk 

 which had been returned from Marj'le- 

 bone, and at the same time new cases 

 of scarlet fever ceased to occur in 

 Marj'lebone. Examination was then 

 made to ascertain if there had been 

 any possible infection of the milk to 

 explain this incidence and intermis- 

 sion. 



When Mr Power came to inquire 

 as to the movements of the cows he 

 learned that on 15th November three 

 newly calved cows arrived at the 

 Hendon farm from Derbyshire, this 

 event shortly preceding the first 

 attack of scarlatina. It happened that 

 these three animals were placed in a 

 shed by themselves and their milk was 

 distributed in part to South Maryle- 

 bone, Hampstead, and St Pancras, 

 immediately preceding the outbreak 

 of scarlatina in those districts. On 

 examination it was found that the 

 implicated cows were suffering from 

 some kind of disease of the udders, 

 which had spread to other cows in 

 the herd. It would appear that the 

 diseased condition, whatever it was, 

 had been introduced by one of the 

 Derbyshire cows, and had then spread 

 through various sheds at the Hendon 

 farm. Mr Power was able by the 

 most minute inquiry to trace the 

 movements of those cows and the 

 various sheds in which they were 

 placed from time to time, and he 

 held that the various recrudescences 

 of the outbreak in North London 

 corresjjonded with the movements of 

 the affected cows. 



The exciting cause then of this out- 

 break was believed by Mr Power to 

 be a condition of certain milch cows 

 which had for its outward manifesta- 

 tion an eruption on teats and udders 

 and which was communicable from 

 cow to cow. Subcultures of the 

 ulcerous discharges of the affected 

 animals inoculated into calves pro- 

 duced a disease having unmistakable 

 affinities, under some conditions, with 

 the disease in the milch cows, and 

 under other conditions with scarlet 

 fever in the human subject. Now, it 

 must be added, that scarlet fever 

 appeared simultaneously in all but 

 one of the five localities to which the 

 milk was distributed. The exception 

 received none of the milk from the 



