96 MILK AND THE PUBLIC HEALTH chap. 



onset of all was between April 27 and May 7. All the illnesses 

 started with sore throat, and 32 were reported as having a scar- 

 latiniform rash. The 5 6. sufferers comprised 18 children under 

 twelve and 38 persons over that age. In one house as many as 

 14 cases occurred. The diagnosis of the illness in this second 

 outbreak again led to differences of opinion, although on this 

 occasion the preponderance of opinion was much more in favour of 

 scarlatina. At least 8 secondary cases were known. The outbreak 

 was in a quite different part of Lincoln to that affected by the 1902 

 epidemic, and concerned a different milk supply. Twenty-five 

 per cent of the houses supplied with the incriminated milk were 

 invaded. The implicated milkman had five cows. Klein examined 

 the cows on May 6 and found that two of them exhibited a vesicular 

 eruption on the udders and teats somewhat similar to the " Hendon 

 disease." No illness was detected among the milkers or their 

 households. The bacteriological examination of swabs showed 

 neither Streptococcus scarlatinae nor the pathogenic yeast found in 

 the first outbreak. 



(13) Guildford [13], 1903 (reported by Dr. E. W. C. Pierce). 

 — Extensive outbreak, cases starting early in the last week in 

 September and continuing until the middle of November. The 

 chief symptoms were sore throats of different grades of severity, 

 but for the most part cases of ulcerated sore throat or follicular 

 tonsillitis. In some cases there was marked glandular enlargement, 

 while a number were cases of quinsy. Considerable constitutional 

 disturbance was present, shown by headache, pains in the back 

 and limbs, and fever. In several instances there were joint pains 

 after the acute symptoms had subsided. Five cases developed 

 erysipelas after the sore throat. A few cases were fatal. A con- 

 siderably larger number of adults were affected than young children. 

 Information was obtained altogether of ninety - eight infected 

 houses, and seventy-six of these were supplied direct by two 

 milkmen obtaining their milk from a common source. The 

 remaining twenty-two households derived their supply from nine 

 other different dealers. With the stoppage of the milk the outbreak 

 ceased. The incriminated farm was visited on November 13 by 

 Pierce and a veterinary inspector. Of the twenty cows on the farm 

 no less than four were affected with mastitis and yielded purulent 

 milk. The farmer suffered from quinsy sore throat about the 

 middle of September, and had pains in his joints subsequently, and 

 was disabled for at least a month. The other members of his family 

 also had sore throats. The first cases, as far as is known, occurred 

 the last week in September, the illness of the farmer therefore 

 probably preceded the outbreak. He occasionally assisted the two 

 men at the milking, and in this way he may have infected the 

 cows and the milk. The bacteriological investigations showed the 



