94 MILK AND THE PUBLIC HEALTH chap. 



sore throat with ulcerated tonsils, enlarged cervical glands, high 

 temperature, and great prostration. In all cases convalescence was 

 protracted. In one case acute septicaemia supervened, followed by 

 acute septic pneumonia and death. There was a marked tendency 

 for multiple cases to occur in families, and while no age or sex was 

 exempt, a very large number of the sufferers were children. The 

 facts ascertained by Dr. Warry (Medical Officer of Health) proved 

 conclusively that the vehicle of spread was the milk of a certain 

 milk vendor (X.). The returns of cases by medical men showed 

 that 138 cases in seventy-five households were supplied with milk 

 by X., and the remaining 13 cases with milk by seven other dealers; 

 that is, over 85 per cent of the households in which sore throat 

 illness occurred were supplied with milk by X. It was shown that 

 X. supplied a very much smaller proportion of the houses than 85 

 per cent. House-to-house inquiries also showed that the persons 

 attacked were those who consumed X.'s milk. There is no evidence 

 in the report as to how the milk became infected. The bacterio- 

 logical examination threw no light upon the origin of the disease. 

 The vendor X. had a few cows of his own, but also received his 

 milk from seven different country dealers. The cows of the dairy- 

 man were examined by a veterinary surgeon, who found them to be 

 in good health. There does not appear to have been any investiga- 

 tion or inquiry as regards the outside farms either as to human 

 illness on the farms or as to the condition of the cows. 



(9) Brighton [9], November 1901 (reported by Dr. A. 

 Newsholme). — A small outbreak of sore throat involving 18 cases, 

 and followed by a number of cases of scarlet fever. It is not clear 

 how far the sore throat cases were aberrant scarlet fever cases, and 

 Newsholme considered that some of them were of this nature, 

 occurring among girls unprotected by a previous attack of scarlet 

 fever. The symptoms were those of sore throat with greyish 

 exudation on the tonsils, high temperature, and general constitu- 

 tional disturbance. By careful inquiry the outbreak was traced to 

 a particular milk supply. The cause of infection appears to have 

 been unrecognised cases of infectious sore throat in several families 

 connected with the farmer who supplied the milk. The relationship 

 was not, however, completely established. When the facts were 

 investigated early in December (the cases were mostly in November) 

 no evidence of udder disease was found, and fairly frequent 

 veterinary inspections of the dairy had been made. 



(10) Bedford [10], 1902 (reported by Dr. W. G. Nash).— 

 The number of cases was 42, occurring in twenty-two families. In 

 addition there were some milder cases not medically attended. 

 The first case was on June 27. The symptoms were marked 

 swelling and redness of the tonsils, fauces, palate, and uvula, with 

 exudation on the tonsils, marked constitutional disturbance, and 



