ACUTE INFECTIOUS DISEASES loi 



attacked by the epidemic. The streptococci were long chain forms, 

 pathogenic to mice after intraperitoneal injection. 



II. Outbreaks of Diarrhoea, or G-astro - Enteritis spread 



BY Milk 



Eecords of such outbreaks are even rarer in the literature 

 than those of sore throat. The following have been recorded : — 



(1) YouLGREAVB [20], (recorded by Dr. Knox, M.O.H., Bakewell, 

 R.D.). On Friday, August 28, 1908, upwards of 30 persons were 

 seized with violent sickness and diarrhoea. There was also much 

 headache and depression, with elevation of temperature (102°-104°). 

 No deaths. On investigation it was ascertained that all the persons 

 attacked had their milk from the same dairy, and that a cow calved 

 on the previous Sunday (August 23) had her milk added to 

 the usual supply on the Wednesday and Thursday, and that all 

 the cases occurred within the next day. The cow had been sold 

 previous to calving, but was not delivered until the Thursday 

 evening. No fresh cases occurred after her removal. The cow 

 was believed to have been healthy by the dairyman. No bacterio- 

 logical examinations were made. 



(2) Aberdeen [21], November 1908 (recorded by Dr. Matthew 

 Hay). — An extensive but circumscribed outbreak. The illness 

 usually began with severe headache, shivering, and backache. More 

 ■or less severe vomiting or belching, followed with abdominal pain 

 in severe cases. In most cases diarrhoea was present and continued 

 for several days. Usually some fever, and in a few cases cramps 

 in the legs were complained of. All the cases recovered. Inquiry 

 soon showed that it was due to a particular milk supply. For 

 example. Hay found within a short street in which the dairy was 

 situated nearly 70 cases, all of which, except 2, were supplied 

 from the incriminated dairy. In the other houses with a different 

 supply, which constituted more than half the total number, there 

 were only 2 cases and these were of an ill-defined nature. The 

 milk was obtained from 3 farms. On one of these there had been 

 a number of cases of illness. The first persons sickened at the 

 farm on November 5, while, with one exception, all the illnesses of 

 the group investigated in the city commenced on November 6 to 

 November 8. Hay attributed the outbreak to the occurrence of 

 cases of disease at the farm, which infected the milk. No mention 

 is made of thei cows, or indeed whether they were examined at all. 



Jensen {Milk Hygiene) mentions the two following outbreaks : 



(3) Stockholm. — In Stockholm the members of 9 families 

 became ill with nausea, vomiting, diarrhoea, fever and weakness, 

 together with cramps in the legs. The disease was traced to the 

 use of milk from a certain herd. The herd comprised 14 cows, 



