356 PATHOGENIC BACTERIA IN MILK 



medical man in whose practice the first cases appeared, informed 

 the Medical Officer of Health (Dr King Warry), who, in due course, 

 made a full investigation and reported to his Authority.^ The 

 leading symptoms of the illness were as follow : — 



Symptoms. — {a) In every case there was tonsillitis (not follicular). 

 {b) In two cases there was in addition superficial ulceration of the 

 tonsil, {c) In every case there was considerable swelling of the 

 cervical lymphatic glands, more marked on the one side than the 

 other — in two cases the swelling was very great, {d) In one case 

 the lymphadenitis proceeded to suppuration, {e) In every case 

 the temperature was raised, in a few cases it was 105° R, and there 

 were rigors. In all the cases the temperature persisted after the 

 tonsillitis had disappeared, lasting in nearly all for at least a 

 fortnight. (/) The temperature assumed the remittent type, and 

 there was in every case profuse sweating at nights. (^) There was 

 great prostration in most cases, and considerable cachexia in all. 

 (//) In one case acute septicaemia supervened, followed by acute 

 septic pneumonia and death, (z) In two cases in the same family 

 acute nephritis with haematuria came on about a week after the 

 onset of symptoms. (J) In one case a child had an attack of 

 purpura haemorrhagica. {k) In all cases convalescence was pro- 

 tracted. In addition there was a marked tendency for multiple 

 cases to occur in families, and while no age or sex was exempt, a 

 very large number of the sufferers were children ; these features 

 helped to direct suspicion to the milk. 



The medical officer addressed himself to obtaining information 

 from the medical men in the district, a bacteriological examination 

 of milk from the implicated dairy, and a house-to-house visitation 

 in the affected area. Septic and infectious sore throat being not 

 notifiable, special inquiries were necessary to discover the preval- 

 ence of the disease. 



No less than 151 cases of sore throat illness in 88 households 

 occurred, with very few exceptions, in Upper Clapton and Stamford 

 Hill. Of these totals, 138 cases occurred in 75 households, all of 

 which were supplied with milk by one particular milkman who 

 shall be termed X, the remaining 13 cases occurring in 13 house- 

 holds supplied with milk by seven other dealers. That is to say, 

 over 85 per cent, of the households in which sore throat illness 

 occurred were supplied with milk by X, and less than 15 per cent, 

 by other dealers. One or two remarkable instances occurred 



^ Annual Report of Medical Officer of Health for Hackney, 1900, pp. 60-69 

 (J. King Warry, M.D.). 



