SCARLET FEVER MILK-BORNE OUTBREAKS 



297 



outbreak to a cow that was ill, with 

 scabs on udder and teats, and yielding 

 ropy milk. Epidemic affected seven 

 different areas, and began within a 

 day or two of commencement of cow's 

 illness. Fresh cases ceased to occur, 

 except in two localities to which alone 

 this cow's milk was distributed in the 

 second week of the illness ; cases 

 entirely ceased after the cow was 

 totally excluded from the dair}' busi- 

 ness. Dr Hamer pointed out that the 

 6 days on which this cow suffered 

 ffirom "a cold" and was "off her food" 

 ' and yielded ropy milk, and yet during 

 which time her milk was being distri- 

 buted, were the 6 days of maximum 

 infective power of the milk supplied 

 by the implicated vendor. After this 

 cow's milk was excluded from distri- 

 bution, the outbreak declined. A large 

 number of children were affected in 

 Plumstead, owing to the distribution 

 being in the immediate vicinity of 4 

 schools. The disease afterwards 

 spread from child to child "by means 

 of slight undetected cases," and from 

 them to other children in the district. 

 Dr Hamer's report is full of interest 

 and suggestion respecting the investi- 

 gation of milk-borne disease. One of 

 the points which he brings out clearly 

 is the incidence of disease on drinkers 

 of the milk from a particular shed. 

 From i2th to 25th March, 10 per cent, 

 (normal) ; from 26th March to ist 

 April, 91 per cent. ; and for the period 

 of two weeks in April, 24 per cent. He 

 resolves the matter therefore into three 

 periods in relationship to the cow 

 disease — {a) cow began to be ill, but its 

 milk was distributed — epidemic began 

 within 2 to 3 days ; {b) cow under treat- 

 ment, its milk sometimes distributed 

 and sometimes discarded, but only in 

 Greenwich and Deptford. Cases 

 attributable to milk ceased, except in 

 Greenwich and Deptford ; ic) all 

 suspicious milk excluded- -complete 

 cessation of disease. Incubation 



period was demonstrated to be very 

 short, about 24 hours. Mortality' was 

 slight. 



Apparent exciting cause. — (?) Cow 

 disease. 



Reporter and reference. — Dr Hamer 

 {Rep. of Medical Officer of London 

 County Council)^ 1892, p. 17 ; also 

 Public Health, 1891-92, p. 366; and 

 Special Rep. to London County Council, 

 by Dr Hamer. 



Lan^rham, Sssex, 1892 {October). 



Total number of cases . . 5 

 Number of cases amongst 



drinkers of suspected milk . 5 

 Percentage on total cases . .100 

 Number of families supplied by 



milkman ..... 2 

 Number of such families in- 

 vaded 2 



Percentage 100 



Number of polluted milk sources i 

 Number of milkmen . . . i 



Circumstances implicating the milk 

 supply. — Suspicious udder eruptions on 

 two cows at farm. The milk was used 

 only at this farm and another dwelling. 

 Both houses were invaded, 4 cases 

 occurring in i day. A visitor at one 

 of the houses stayed one night, partook 

 of the milk, and afterwards developed 

 scarlet fever. 



Apparent exciting cause. — (?) Cow 

 disease. 



Reporter and reference. — Dr J. Cook 

 (Med. Off. of Health). Report of 

 Medical Officer. 



No. of 

 persons 

 attacked 



Upper Clapton, 1892 



scarlet fever . .178 

 drank implicated milk 78 



sore throats. . . 155 

 drank implicated milk 145 



Circumstances implicating the milk 

 supply. — A sudden outbreak of scarlet 

 fever occurred in a localised area of 

 Upper Clapton amongst houses of 

 good class, supplied most largely by 



