MILK-BORNE SCARLET FEVER 217 



wanting. The inoculation experiments, in so far as they yielded 

 positive results, were also open to the same unreliability. Unfortu- 

 nately, too, there was, on the other hand, circumstantial evidence of 

 various kinds, which, while it proved little, opened up a variety of 

 possibilities by which the milk consumed in London might have 

 become infected. The case was therefore unproved. Nevertheless, it 

 raised many important questions and stimulated much valuable 

 inquiry. When milk becomes infected with scarlet fever the infec- 

 tion is ahnost invariably derived directly from some person suffering 

 from the disease, recognised or unrecognised. 



Scarlet Fever, in not a few milk-epidemics, has shown certain 

 modifications of a more or less marked character. The disease is 

 generally mild, and simultaneously with an outbreak of the specific 

 disease due to milk, there will not infrequently be found a large 

 number of " ordinary sore throats." Even in the scarlatinal cases, 

 the disease has a tendency to remain localised to the throat (Power). 

 Tlie rash may be evanescent, and the desquamation is scanty 

 (Parsons). There is also a marked absence of post-scarlatinal 

 nephritis or any other kidney complication (Parsons, Buchanan, and 

 others). A characteristic which has been frequently noted, and is 

 readily to be understood, is the frequency of vomiting and diarrhoea, 

 rather particularly at the commencement of the disease (the Fallow- 

 field epidemic, 1879, is an illustration). It is probable that these signs 

 of alimentary irritation or poisoning are due to poisonous organismal 

 products contained in the milk. On more than one occasion they 

 have led to an appearance of intoxication rather than infection. 

 Finally, there is a clinical feature, to which reference has already 

 been made, and which may bear a significance not at first appreciated, 

 namely, the comparative indisposition of the disease to spread by 

 contagion. This may be attributable to the mildness of the disease, 

 to the small amount of skin eruption and desquamation commonly 

 present, and possibly to the fact that the poisonous properties of the 

 milk are to a certain extent eliminated from the system by the 

 vomiting and purging. Every clinical sign which has been noted 

 leads to the conclusion that the disease as conveyed by milk is 

 frequently mild, and therefore has both a small mortality, and no 

 tendency to spread by contact. There is one other point deserving 

 of mention. Sir George Buchanan noticed, in a scarlet fever 

 epidemic with which he had to deal, that in persons who had had 

 scarlet fever at some previous time, and who drank the implicated 

 milk, almost the only symptom of ill-health which they presented 

 was a sore throat. There was no rash, no vomiting, no pyrexia, 

 although other members of the family under precisely similar circum- 

 stances suffered from typical scarlet fever. Many other workers have 

 confirmed the occurrence of aberrant forms of milk-borne scarlatina. 



