MILK-BORNE SORE THROAT 219 



instances there has been observed 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 

 scarlet fever or diphtheria. In South Kensington, in 1875, there 

 was an outbreak 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 119 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.f 



Similar outbreaks occurred in 1881 at Aberdeen (300 persons 

 affected), and Eugby school (90 boys) in three school-houses supplied 

 by one milkman, who did not supply any other houses in the school. 

 But he supplied houses in the town, of which nearly 50 per cent, 

 were attacked with sore throat. Inquiry showed that some of the 

 milk used had been obtained from a cow suffering from mastitis.^ 

 A similar outbreak took place in Edinburgh in 1888, and was 

 investigated by Cotterill and Woodhead ; and another at Dover in 

 1884, where there was a sudden and severe outbreak of sore throat 

 in a localised area of good-class houses, affecting 205 persons, who 

 all obtained milk from one particular farm. The chief symptoms 

 were local inflammation of the throat, enlargement of lymphatic 

 glands in neck, and vesicular eruptions preceding and accompanying 

 the inflammation. The dairyman obtained his supply from 12 cows 

 of his own, and from three farms in the country. On one of these 

 latter apthous fever had broken out, and it was from this farm that 

 the dairyman obtained his implicated milk and cream. Moreover, 

 when the supply from this farm was diverted temporarily, it set up 

 a simultaneous second outbreak of sore throat.§ In 1890 there 

 occurred an epidemic of sore throat at Craigmore, which was referred 

 to milk infection. The number of cases was 80. The disease 

 manifested chiefly in the form of severe sore throat, but in a 

 number of the cases erysipelas developed in addition. The milk 

 appears to have been infected by two milkmaids who were suffer- 

 ing from sore throat. Those attacked most severely had drunk 

 most of the implicated milk. A dog and cat which had a good 



* Report of Medical Officer of Local Oovernment Board, 1875, vol. vii., p. 80. 



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



% Brit. Med. Jov/r., 1881, vol. i., p. 657 ; vol. ii., p. 415. 



§ Practitioner, 1884, vol. i., p. 467 (Dr M. K. Robertson). 



