MILK-BORNE SCARLET FEVER 215 



December attacked them again in larger numbers, and continued to 

 do so up to date of inquiry. 



The chief facts concerning the distribution of the milk may be 

 set out as follows : (a) The Marylebone customers suffered at the end 

 of November and up till the end of the third week in December. (5) 

 The Hampstead cases occurred in two groups, one small group at the 

 end of November and a larger group in the latter part of December. 

 (c) The St Pancras customers suffered like the Hampstead ones, but 

 in a less degree. They obtained milk from the same vendors, (d) 

 The St John's "Wood customers did not suffer until after the end of 

 the year, (e) The few persons affected at Hendon suffered early in 

 December, having consumed milk which had been returned from 

 Marylebone, and at the same time new cases of scarlet fever ceased 

 to occur in Marylebone. Examination was then made to ascertain 

 if there had been any possible infection of the milk to explain this 

 incidence and intermission. 



When Mr Power came to inquire as to the movements of the 

 cows, he learned that on 15th November three newly-calved cows 

 arrived at the Hendon farm from Derbyshire, this event shortly pre- 

 ceding the first attack of scarlatina. It happened that these three 

 animals were placed in a shed by themselves, and their milk was dis- 

 tributed in part to South Marylebone, Hampstead, and St Pancras, 

 immediately preceding the outbreak of scarlatina in those districts. 

 On examination it was found that the implicated cows were suffering 

 from some kind of disease of the udders, which had spread to other 

 cows in the herd. It would appear that the diseased condition, what- 

 ever it was, had been introduced by one of the Derbyshire cows, and 

 had then spread through various sheds at the Hendon farm. Mr Power 

 was able by the most minute inquiry to trace the movements of those 

 cows and the various sheds in which they were placed from time to 

 time, and he held that the various recrudescences of the outbreak in 

 North London corresponded with the movements of the affected cows. 



The exciting cause, then, of this outbreak was believed by Mr 

 Power to be a condition of certain milch cows which had for its outward 

 manifestation an eruption on teats and udders, and which was com- 

 municable from cow to cow. Subcultures of the ulcerous discharges 

 of the affected animals inoculated into calves produced a disease 

 having unmistakable affinities, under some conditions, with the 

 disease in the milch cows, and under other conditions with scarlet 

 fever in the human subject (Klein). Now, it must be added, that 

 scarlet fever appeared simultaneously in all but one of the five 

 localities to which the milk was distributed. The exception received 

 none of the milk from the affected cows until later, when the disease 

 also appeared in this district, owing to some of the milk from the 

 affected cows being sent there. When the sale of the milk was pro- 



