MILK-BORNE SORE THROAT 221 



trace the cases at the school to one of their number, who had come 

 into the way of infection derived from a milk s\ipply contaminated 

 by infectious disease in three families connected with the dairy.* 



In 1902 an outbreak of milk-borne sore throat occurred at 

 Lincoln (199 cases). Of the total 168 or 85 per cent, had consumed 

 the suspected milk. The outbreak commenced suddenly, lasted a 

 few days, and then suddenly terminated. The majority of the 

 victims were adults or persons over twelve years of age. Females 

 were much more affected than males. The symptoms of the disease 

 simulated scarlet fever. There was marked sore throat and swelling 

 of the tonsils, which were in many cases furred. On the third or 

 fourth day of the disease there was enlargement of the cervical 

 glands, rash (hke rotheln), and fever. The commonest complications 

 were gastritis and rheumatism, but there were a number of irregular 

 conditions and varieties of rash. The poison in the milk seems to 

 have existed in the highest degree in the cream, and Klein isolated 

 a yeast which he considers related to a yeast known heretofore to 

 have been associated with throat illness and thrush. It has been 

 suggested that some relationship may exist between this yeast and 

 the spores of rusts, smuts, and mushroom fungi consumed by the 

 cows. The whole circumstances of the case of this outbreak furnish 

 one of the most interesting modern chapters in milk epidemiology.f 

 lu 1903 another outbreak occurred (56 cases) at Lincoln of a somewhat 

 similar kind. In 1902 an outbreak occurred at Bedford (42 cases) 

 consisting of sore throat, malaise, headache, giddiness, etc. Here also 

 the cream seemed more infective than the milk. Indeed, in several 

 families only those who had taken the cream suffered. The incidence 

 was chiefly upon young adults.J 



A somewhat similar outbreak occurred in October and November 

 1903, at Woking, in which persons were infected in ninety-eight 

 different houses. The illness was sore throat, with glandular enlarge- 

 ment and general symptoms. Of the ninety-eight households affected, 

 seventy-six obtained their milk directly from a source open to 

 criticism. Dr Pierce, the medical officer of health, examined four cows 

 yielding the milk, and a bacteriological examination was made of the 

 milk. In the result it was found that two of the cows suffered from 

 suppurative mammitis, and the Liquid yielded by these two cows 

 " consisted of the most part of pus such as would be contained in an 

 abscess." This was the character of the milk which had been con- 

 sumed by the persons suffering from the illness. § 



* Jour, of Hygiene, 1902, vol. ii., pp. 150-169. Armual Beport of Medical Officer 

 of Health of Brighton, 1901. 



t Report to the Local Government Board, No. 190, Oct. 1903 (Dr L. W. Darra 

 Mair). 



J Report of Medical Officer of Bedfordshire County Council, 1902, pp. 60-62. 



§ Brit. Med. Jour., 1903, ii. p. 1492. 



