loo MILK AND THE PUBLIC HEALTH chap. 



and ceased about April 29, the maximal incidence being on April 

 21 and April 22. The bacteriological investigations showed that 

 the sore throats were presumably due to streptococci, while na 

 diphtheria bacilli were present. The fluid from the mastitis quarter 

 of the cow showed abundant streptococci. 



(18) Leith [18], June to October 1904 (reported by Dr. W. 

 Robertson). — A long-drawn-out mixed outbreak of diphtheria and 

 septic sore throat. The actual diphtheria notifications in con- 

 nection with this outbreak were 2 at the end of June, 2 in July,. 

 5 in August, 9 in September, and the last on October 16. The 

 connection of the cases with the incriminated milk supply is not 

 clearly set out in the report, but apparently all the diphtheria cases 

 had a common milk supply. The relationship of the sore throat 

 cases to the milk supply is not established in the report, but ap- 

 parently there was a close relationship. An examination of the farms- 

 failed to find any cases of sore throat or suspected sore throat. Of 

 the 45 cows 5 were found by the veterinary inspector to be suffering 

 from ulcers on their teats. Drying pustules were found on some of 

 the ulcers, and the veterinary surgeon diagnosed the condition as one 

 of cow-pox. A further detailed examination a week later showed 

 1 5 cows suffering from ulcerated teats. A dairymaid was affected 

 with pustules on her hands, and the farmer's son was also affected. 

 Although swabs were taken repeatedly from the ulcers and examined, 

 the Klebs-Loffler bacillus was never isolated, although " now and 

 again an organism possessing the microscopical and cultural char- 

 acteristic of the Klebs-Loffler was detected." They were, however, 

 non-pathogenic to animals. 



The above recorded outbreaks are all which the writer has. 

 been able to find in the British Isles. Foreign literature has not 

 been searched, but very few such outbreaks appear to have been 

 recorded. The following outbreak at Christiania is of interest. 



(19) Christiania [19], 1908 (recorded by Dr. Somme). — An 

 extensive outbreak which began in almost every case with a sore 

 throat. In addition to sore throat with red tonsils and pharynx, 

 the usual symptoms were swelling of the glands of the neck and 

 high temperature. Complications, chiefly of a pyaemic character, 

 were numerous, but gastro-enteritis and diarrhoea were apparently 

 not common. A number of the cases died. Adults were affected 

 about three times as commonly as children. The number of cases 

 of the epidemic notified was 548, but as notification was voluntary, 

 it is probable that the total number was considerably higher. The 

 means of spread of the outbreak was quickly traced to the milk 

 supplied by one dairy, and thence to a cow with a diseased udder. 

 The cow was slaughtered, and a bacteriological examination of the 

 abscess found in the udder led to the isolation of streptococci in 

 every way identical with the streptococci obtained from patients- 



