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39
In this report it is clearly demonstrated that the milk from this dairy farm was the cause of the
occurrences of scarlet fever, and the question is discussed as to how the milk became infected. In
this outbreak, as in many others which have been investigated, there was absence of evidence that the
milk was infected by human agency. Scarlet fever certainly occurred in the family of a man engaged in the
work of the dairy, but in one distant area cases of sore throat, and in other distant areas cases of
definite scarlet fever occurred among the consumers of the milk antecedent to its occurrence in this
family. It is impossible to reconcile with the facts of the occurrences the view that the milk owed
its infection to this family. There appeared to be interruptions to the continued infectivity of the
milk as judged by the dates of attack of the different consumers, and again, the milk appeared on one
day to have been especially operative in causing scarlet fever. These variations find explanation when
the details of treatment and distribution of the milk from the depot come to be studied. Varying amounts
of the infected milk were pasteurised on different days, and on the day when the most mischief was
done the whole of the infected milk was sent out unpasteurised. The report shows, as in some other
outbreaks, that a vesicular disease was found on the teats and udders of some of the cows and the
property of infectivity of the milk was first manifested when the milk of one of these cows, which had
recently calved, was brought into use after the death of the calf.
In a few of the annual reports information is supplied as to the number of cases in which a probable
source of infection was ascertained. Thus :—

The difficulty of identifying the source of infection is obvious when the mildness of the prevailing
type of scarlet fever is considered, prevalence being no doubt maintained in the main by unrecognized
and probably often unrecognizable cases.
The number of houses in which there were multiple cases is shown in some of the reports as
follows:—

Thus of 1,465 houses invaded in these districts, multiple cases occurred in '235.
A number of reports give account of the steps taken by way of closure of school departments
or classes, or disinfection of schoolrooms, to limit the spread of infection through school attendance.
Outbreaks in residential institutions are reported in Chelsea, where scarlet fever occurred among the
pupils of the Duke of York School; in Lambeth, where 18 cases occurred in the Lambeth Workhouse
and Infirmary, and in a general hospital where cases occurred among the nurses, the attacks being due
to the infected milk supply already referred to ; the patients of this institution who had pasteurised
milk from the same source escaped.
Reference will be found on page 106 to a memorandum issued in 1909 by Dr. Newsholme and
Dr. Newman, medical officers of the Local Government Board and Board of Education respectively,
dealing with the administrative measures necessary for the prevention of the spread of infectious
diseases among children attending elementary schools.
Return cases are mentioned in the reports relating to Paddington 40 cases, Kensington 6, Fulham
14, Chelsea 5, Stoke Newington 4, Holborn 1, Finsbury 6, Shoreditch 2, Stepney 16, Bermondsey 12,
Wandsworth 46, Camberwell 2, Greenwich 10, and Woolwich 58. Concerning the Wandsworth cases,
Dr. Caldwell Smith states that there has been a decrease of return cases since 1908, when parents were
advised to prevent the early association of the returning child with others; and with reference to the
cases in Bermondsey, Dr. Brown writes that the facts concerning them do not support the view that
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