352 PATHOGENIC BACTERIA IN MILK 



D. Throat Illnesses 



In several outbreaks of disease due to an infected milk supply 

 it has appeared that the only condition present has been " sore 

 throat." Under the heading of "throat illness" we propose to 

 make brief reference to such outbreaks which were apparently 

 not diphtheria on the one hand, or scarlet fever on the other. 

 Although it is true that records of such outbreaks are few and far 

 between, it must not be supposed that they are rare. We think 

 in all probability they are comparatively common. But as the 

 condition is not notifiable, it is but seldom that a record is obtained 

 of the cases occurring. We think it safe to assume that a year 

 never goes by in which there are not outbreaks of sore throat or 

 tonsillitis due to milk or cream. There is some evidence to show 

 that the latter is more a vehicle in such epidemics than the former. 



Signs and symptoms. — The usual symptoms are congestion of 

 the tonsils and mucous membrane of the throat, with sometimes 

 ulceration, enlargement of the cervical glands, and some pyrexia, 

 and general malaise. In not a few instances there has been ob- 

 served various kinds of rash which have generally been of an 

 evanescent character. Where the throat illnesses have occurred 

 contemporaneously with outbreaks of scarlet fever or diphtheria, it 

 is not unlikely that the condition was in reality one or other of 

 these diseases. In South Kensington, in 1875, there was an out- 

 break of disease which attracted much attention at the time, and 

 was officially investigated.^ The illness was traced to some cream 

 consumed at a dinner party, and in all twenty persons suffered, 

 some of whom had scarlet fever, and others only sore throat. But 

 the investigation showed that in the district from which the cream 

 was obtained 1 19 cases of sore throat had occurred. Dr Darbishire 

 described an outbreak of 18 cases of sore throat at Oxford in 

 1882, the condition being characterised by marked severity of 

 throat symptoms and a disproportionate amount of constitutional 

 symptoms.^ 



In 1892 there was an extensive outbreak of sore throat in 

 Upper Clapton. Dr King Warry, describing the symptoms in the 

 Practitioner, at the time held that the pathological condition was 

 scarlet fever in a mild form. His reasons for this view were three : 

 {a) scarlet fever attacked one member of a family, and the sore 

 throat disease other members who had previously had scarlet 



1 Report of Medical Officer of Local Government Board, 1875, vol. vii., p. 80. 

 * St Bartholomew's Hospital Reports, vol. xx. 



