DIPHTHERIA MILK-BORNE OUTBREAKS 



351 



The 49 houses in which the 64 cases 

 occurred were widely separated and 

 situated in districts generally free 

 from the disease. B. diphtherics was 

 isolated, and there can be little doubt 

 that "all the cases reported as 

 diphtheria were true diphtheria, and 

 that some mild cases had been over- 

 looked." 



The town received its milk from 

 one of two sources, X and Y. The 

 cases of diphtheria were entirely con- 

 fined to houses taking Y milk. On 

 inquiry at the Y dairy farm it was 

 found there had been a case of bad 

 "sore throat" with painful swallowing, 

 reddened fauces, congested tonsils, and 

 enlarged throat. The dairy was well- 

 ordered. The patient had assisted at 

 the dair>' work whilst suffering acutely 

 from sore throat. 



The proportion of milk drinkers 

 affected was much greater than in 

 individuals not taking milk, or only 

 drinking it in tea or coffee. Out of 

 the 49 households it ^\•as practicable 

 to investigate 44. It was found that 

 32 of these received their milk directly 

 from the patient having the sore throat, 

 the remaining 12 being served from 

 dair)', but by a different milkman. 

 No evidence of cow disease. 



Probable exciting cause. — Human 

 infection. 



Reporter and reference. — Dr W. T. 

 Howard, Jr. American Jour, of Med. 

 Sciences, December 1897. 



Senshenydd, South Wales, 1898 

 {^December'). 

 Total number of cases . . 39 

 Nimiber of cases amongst 



drinkers of suspected milk . 3 1 

 Number of polluted milk sources i 

 Number of milkmen . . . i 



Circumstances implicating the milk 

 supply. — This outbreak was evidently 

 due to milk, but there is no evidence 

 to show how the milk became infected. 

 " B. diphtheria was isolated from the 

 suspected milk." 



Reporter and reference. — J. W. 

 Thomas, M.R.C.S. (Med. Oflf. of 

 Health). Jour, of State Medicine, 

 November 1899, p. 705. 



Edinburgh, 1900 {June'). 



Total number of cases . . 60 



Number of polluted milk sources i 



Number of milkmen ... 5 



Circumstafices implicating the milk 

 supply. — There appeared to be a com- 

 munity of milk supply in this outbreak, 

 and on visiting the dairj^ situated at 

 Liberton, it was found that a young 

 man assisting in the business was 

 suffering from unrecognised diph- 

 theria. Diphtheria was also some- 

 what prevalent in Liberton. Sixty 

 cases were traced directly to milk- 

 shops supplied from this dairy. A 

 considerable proportion of the patients 

 were adults over 20 years of age. 

 After the stoppage of the suspected 

 milk the cases ceased. 



Probable exciting cause. — Human 

 source. 



Reporter and reference. — Sir H. D. 

 Littlejohn, M.D. (Med. Off. of Health). 

 Annual Rep., 1900, pp. 39, 40. 



Other diphtheria outbreaks traced to 

 milk.—Sunon, 1877 ; Kilbum and St 

 John's Wood, 1878 {see p. 336) ; Wey- 

 bridge, 1878 ; Leatherhead, 1878 ; 

 Addlestone, 1878; Surbiton, 1880; 

 Aberdeen, 1881 ; Cardiff, 1883; Ealing, 

 1887 ; Barking, 1888 ; Hendon, 1889 ; 

 Finchley, 1889 and 1894; HighstowTi, 

 U.S.A., 1893 ; Germantown, Phila- 

 delphia, 1898 ; Leeds, 1903. 



