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17
SCARLET FEVER.
(See Tables III., IV. and VI.)
Seven hundred and twenty-seven cases were notified, of which
g ended fatally. The disease was more prevalent than in any of
the preceding ten years. The increase in numbers is noticed in
each of the wards, but the incidence in the South Norwood district
was again exceptionally high. This is the third year in succession
in which this ward has been singularly unfortunate.
On Monday, June 21st, 1909, my attention was attracted by a considerable
and sudden increase in the number of notified cases reported
during the week end. Concerning this particular group of patients, no
community of school or workplace gave any clue to the origin of the
disease, and it at once became, evident that some article of food was in
all probability responsible for the simultaneous attack of some of the
patients. Enquiry as to the milk supply was immediately made of the
adult patients admitted into hospital during the last two days, when it
was found that several had obtained their milk from a dairyman who
bought the supply from a wholesale company. Finally, we were able
to ascertain that 28 cases occurred among customers indirectly supplied
by the same wholesale firm. As the wholesale dairy obtained its
supply from various farms situated in many parts of Hampshire,
Wiltshire and Somersetshire, we should have had considerable difficulty
in investigating the possible source of infection, but on communication
with neighbouring districts it was found that there was a considerable
epidemic of scarlet fever in Kingston and in London among the
customers of retailers who derived their milk from the dairy company
in question. All the information available pointed to infection being
conveyed by milk from a particular farm in Hampshire from which
Croydon was supplied on the 14th and 15th June. Fortunately, the
infected milk only reached Croydon in any considerable quantity on
those two days, but had a little previously given rise to trouble in
London and Surrey. The London County Council had therefore
become cognisant of the danger a day or two before the Croydon outbreak,
and had taken steps to stop the supply of milk from the
incriminated source, and, thanks to the information supplied by
Sir Shirley Murphy and Dr. Hamer, I was able to assure myself by
noon on June 21st that further danger from this source was at an end.
The whole circumstances were fully investigated by Dr. Hamer on
behalf of the London County Council, who was assisted by a veterinary
surgeon and a bacteriologist. They were able to show not only that
the infected milk was derived from a particular farm, but that there
had been a contagious disease 0/ the dairy herd that corresponded in