MILK AND EPIDEMIC DIARRHCEA 369 



contaminated with sewage and with matter from a tripe-boiling 

 place. The water used for washing the milk-pails was tepid and 

 kept in a foul cistern. The cows drank from a pool which received 

 the drainage from the cowshed midden. The stored milk could be 

 readily contaminated from emanations from the cowshed. Professor 

 Delepine examined the milk and found B. coli communis abundant 

 in the milk, and Dr Niven elicited the fact that a cow affected with 

 inflamed udder (" garget ") had been removed from the farm and 

 slaughtered. The outbreak was attributed to milk in any case, and 

 to the probable infection of it by the diseased cow. But Delepine 

 has pointed out that it is more probable that the milk was contami- 

 nated with faecal pollution rather than infectious disease of the cow.^ 

 In 1895- and 1898^ three outbreaks of epidemic diarrhcea 

 occurred amongst the patients at St Bartholomew's Hospital, 

 London, traceable in the first two instances to milk, and in the third 

 to rice pudding made with milk.* On Sunday night, 27th October 

 1895, an outbreak of diarrhoea affected 59 in-patients, all of whom had 

 recently taken milk, and from the evacuations the spores of ^. enteri- 

 tidis sporogenes was isolated by Klein. The patients suffered quite 

 irrespective of whether or not the milk had been boiled. Some 

 milk also, derived from the same source as the milk which had 

 caused the poisoning, was examined by Klein and found to contain 

 the spores of the same organism. On Sunday, 6th March 1898, a 

 second outbreak of severe diarrhoea occurred in this hospital affect- 

 ing 146 patients, and there was evidence on this occasion also that 

 the medium of infection had been milk. On 5th August 1898, a 

 third outbreak affecting 84 patients and 2 nurses took place at the 

 same hospital, the vehicle of infection in this instance being some 

 rice pudding made with milk, also said to contain an organism 

 similar or identical with the B. enteritidis sporogenes. There can 

 be no doubt that milk was the agent of infection in each of these 

 three outbreaks. It was in these outbreaks that the B. enteritidis 

 sporogenes oi Klein was isolated and held to be the specific organism, 

 and Dr Klein has produced evidence in behalf of this bacillus being 

 the true cause of epidemic diarrhcea.^ 



* Jour, of Hygiene., 1903, vol. iii., No. i, pp. 76, Tj. 



- Report of the Medical Officer of Local Government Boards 1895-96, pp. 

 197-204. 



3 Ibid., 1897-98, p. 235. 



* Ibid.., 1898-99, p. 336. Lancet, 7th January 1899. 



'" Reports of Medical Officer of Local Government Board, 1895-96, 1896-97, 

 1897-98, 1898-99. 



2 A 



