ACUTE INFECTIOUS DISEASES 89 



Outbreaks of scarlet fever spread by milk are not in- 

 frequently milder in character than those spread by direct 

 contact or other agencies. There would also appear to be less 

 tendency to spread by infection of secondary cases. 



The occurrence of cases of an anomalous character has been 

 a feature in several epidemics. Indeed in some epidemics 

 spread by milk a number of the cases have shown so few of 

 the symptoms of scarlet fever that, apart from their obvious 

 relationship to other and undoubted cases, a certain diagnosis 

 of scarlet fever would not be possible. The outbreak of sore 

 throat and scarlet fever spread by milk at Brighton in 1902, 

 reported by Newsholme,'^ may be mentioned as an illustration. 

 In this outbreak there was a considerable number of known 

 cases of sore throat without any scarlatina rash, while there 

 were probably a number unnotified. Dr ISTewsholme asks the 

 question, " Were all the sore throats as well as the officially 

 notified cases scarlatinal, or were two infections operating ? 

 The gradually increasing virulence of the cases, first sore 

 throats, then sore throats mixed with undoubted scarlet fever, 

 then a group composed entirely of cases of severe scarlet 

 fever, supports the first view." " If the same contagium 

 caused the sore throats and the attacks of scarlet fever it is 

 evident that infected milk may carry the scarlatinal contagium 

 in such an attenuated form or in such minute amount that it 

 is not capable of causing all the phenomena of scarlet fever." 



The same peculiarity had been previously recorded by 

 Buchanan^ in an outbreak in Kensington in 1875 in which 

 12 persons were attacked with scarlet fever and 6 others 

 with sore throat or with sore throat and other symptoms 

 resembling scarlatina. This outbreak was due to infected 

 cream. 



SoEE Throat and othee Septic Conditions speead 

 BY Milk 



Compared with scarlet fever, enteric fever, and other noti- 

 fiable diseases the number of sore throat and similar outbreaks 

 spread by milk which have been recorded is very small. 

 This may be due to their actual rarity, but it is highly 



' Jotim. of Hygiene, 1902, ii. p. 150. 

 - Report of the Medical Officer, Local Government Board, 1876, vii. p. 72. 



