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108 Medical Officers of Health Annual Report.
(1) That of 117 cases, 110 must have been infected
on or about the same day, and (2) that the outbreak has
been an exceptionally mild one, so far no death having
been reported, this being quite a characteristic feature
of epidemics of Scarlet Fever caused by contamination
of milk supply. I attribute the fact of the exceptional
mildness of the outbreak also to the partial sterilization
of the milk before use. The best authorities agree that
it requires an hour's (some say many hours) exposure of
milk to a temperature of 212° F. to completely sterilise
it, and in this case the exposure for 20 minutes to a
temperature of 180°F must have to some extent
weakened the virulence of the germs. The actual germ
of Scarlet Fever has not yet been isolated, but judging
from the fact that it can remain virulent for months or
even years in clothing it may be assumed that it is a
spore bearing organism, and that although exposure of
20 minutes to 180° F. may be sufficient to destroy the
germs themselves, it is not sufficient to destroy, although
in may diminish, the virulence of the spores.
I have had an interview with the Managers and Secretary
of the Patriotic Asylum, and have advised them
that in future the individual farm from which the milk is
obtained should be stated and noted daily, so that there
would be no difficulty, as there has been in this outbreak,
in tracing the source of the milk and of ascertaining the
sanitary conditions of the farm, and the state of the health
of the employees as well as of the cows.
From the beginning of the outbreak isolation has
been carried out as completely as was possible under the
circumstances. Of the 117 cases, 15 were removed to
the Metropolitan Asylums Board's Hospitals, these 15
being cases in which the symptoms of fever, sore throat,
&c., were definite. In the other 102 cases the symptoms