336 PATHOGENIC BACTERIA IN MILK 



Dublin, 1896; Kirkcaldy, 1896; Reu- 

 land, 1897; Auro, 1898; Aberdeen, 

 1898 ; South Witham, 1899 ; Bleialf, 

 1899 ; Coleford, 1899 ; Market Har- 

 borough, 1899 ; Biillingen, 1899 ; 



Coleford and West Dean, 1900 ; 

 Folkestone, 1900 ; Salford, 1900 ; Ply- 

 mouth, 1900 ; Gildersome, Yorks, 

 1901 ; Northampton, 1902 ; Forth, 

 South Wales, 1903 ; Ealing, 1903. 



C. Diphtheria 



It was not until 1878 that evidence was forthcoming in support 

 of the view that diphtheria, like scarlet fever and typhoid fever, 

 might on occasion be spread by means of milk. In that year, Mr 

 W. H. Power made an inquiry into an outbreak of diphtheria in 

 North London, chiefly in Kilburn and St John's Wood. There 

 were as many as 264 persons attacked and 38 died. The infection 

 invaded some 118 different households. 



The epidemic was most severe in May (first four weeks), when 

 about 190 cases occurred. The outbreak terminated abruptly. 

 The area infected, and time of infection, clearly showed that there 

 was some factor at work over a circumscribed area, and operative 

 during a limited time. There was no antecedent throat illness, and 

 no school infection or contact contagion traceable. The houses were 

 sanitarily good, and had a good water supply. With the exception 

 of a " special sewage area," there was but one thing common to 

 most of the cases, and this was the milk supply. It was found that 

 within the area of the greatest prevalence of throat illness, about 

 one-fifth of the households were supplied by a common milk 

 supply. The " special sewage area " was also found to be supplied in 

 the main from the same milk supply. The incidence of the disease 

 fell, actually and relatively, upon consumers of the suspected milk. 

 Further, in regard of each business (the milkman in question 

 owning two, one at Kilburn and one at Muswell Hill), the above 

 relation of milk service to throat illness was observed for a limited 

 period only, that period beginning for one business only about the 

 time that it ceased for the other. 



Inquiry into the milk supply elicited no evidence of human 

 disease pollution, nor contamination by water or air. Nor was 

 there any definite disease of cows present at the time as far as 

 could be judged. But by a process of exclusion, Mr Power 

 suggested that "there may have been risk of specific fouling of 

 milk by particular cows suffering, whether recognised or not, from 

 specific disease." The affirmation that the cows had not been ill, 



