V ACUTE INFECTIOUS DISEASES 95 



considerable temperature. In every instance the milk was obtained 

 from the same dairy, while no cases of sore throat connected with 

 a different milk supply were observed. In some families the 

 children who drank boiled milk escaped. Nash visited the 

 premises, but could obtain no information as to illness amongst 

 the cows or milkmen. No examination by him or by a veterinary 

 surgeon of the milkers or of the cows appears to have been made, 

 and the source of the infection of the milk was not ascertained. 

 The bacteriological examinations made of the milk after the 

 outbreak were negative. 



(11) Lincoln [11], May 1902 (reported by Dr. L. W. Darra 

 Mair). — An explosive outbreak of 168 cases, sufficiently ill to 

 require medical treatment, all but 5 of which started between 

 May 9 and May 15 inclusive, and all between May 9 and May 19. 

 Of 156 sufferers, the age of whom was recorded, 133 were adults 

 or children over twelve, and only 23 were under twelve. The 

 epidemic came to a sudden termination in spite of the fact that the 

 distribution of the suspected milk was not prohibited. All the 

 cases were characterised by sore throat, well-marked swelling of 

 the tonsils, uvula, and mucous membrane of the pharynx. The 

 cervical glands were enlarged. A rash was present in many cases, 

 but it was unlike the rash of scarlet fever. Mair concluded, after 

 very careful investigation, that the disease was not scarlet fever. 

 There were three deaths. No definite secondary cases at all could 

 be met with. The outbreak was clearly due to a particular milk 

 supply. In the period of five weeks ending May 25, of 199 cases 

 of illness associated with sore throat, 168, or 85 per cent, consumed 

 the suspected milk, while if the cases which started after May 8, 

 when the true epidemic begun, only are considered, the percentage 

 of milk consumers is 87. Also the number of houses habitually 

 supplied with the suspected milk at the commencement of the 

 epidemic was 141 ; and of these no fewer than 85, or 60 per cent, 

 were invaded. The incidence of disease was exceptionally heav}- 

 on households using much milk. The source of infection of the 

 milk could not be traced although the most minute inquiries were 

 made. No sore throat or other illness could be traced amongst 

 those handling the cans or the milk. The cows were examined on 

 May 1 4 by a veterinary surgeon at the request of the Town Council, 

 and he reported them all healthy, while on May 30 Klein examined 

 the cows and found no symptoms of ill-health in any of them. 

 Klein and Gordon examined swabbings from 17 of the cases of 

 illness. In no instance was the Streptococcus scarlatinae found, but 

 in 3 eases a pathogenic yeast was isolated, and it was suggested 

 that this was the cause of the outbreak. 



(12) Lincoln [12], May 1903 (reported by Dr. L. W. Darra 

 Mair). — There were altogether 56 known cases of illness, and the 



