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received their milk supply from this source, were resident
in the districts of St. Giles and St. George's, Bloomsbury,
while a smaller number resided in St. Pancras and in
Marylebone.
As soon as it became obvious that the out-break had a
relation to other districts, and possibly to a milk farm,
situated in Surrey, the Vestry thought it advisable to call
the attention of the Local Government Board to the subject,
and as a result, an Inspector of that Board was instructed to
investigate it. Among the sufferers were two children of a
milk carrier in the service of a dairyman, but evidence showed
that these were the effect rather than the cause of the infection
of the milk. Attention was then directed to a farm in Surrey
from which the milk generally came. I visited this farm
together with the Medical Inspector from the Local Government
Board, and the Medical Officer of Health to St. Giles,
but no evidence could be found of scarlet fever having
existed there, nevertheless, further evidence was obtained
which tended to prove the milk responsible for the disease,
for another supply of this milk which was sent directly from
the same farm to a district in the South of London, was accompanied
by the appearance of the disease in that district
amongst those drinking it.
The conditions under which milk can give rise to infectious
disease are not fully understood, but the present case raises
the suspicion that milk may become infected with scarlet
fever poison from other source than an antecedent case of
the disease.
The most marked characteristic of the outbreak was the
large number of persons attacked with scarlet fever or throat
illness within a short period of one another and the mild form
of the disease. But one death occurred, that of an old lady
who was suffering at the same time from a severe attack of
bronchitis.
During September, the rapid increase of scarlet fever in the
Metropolis, for a time deprived the Vestry of the opportunity
of removing to the London Fever Hospital persons suffering
from scarlet fever who were not paupers. This period may
be referred to as one which affords good evidence of the unsatisfactory
position of the Metropolitan Sanitary Authorities
with regard to hospital provision for cases of infectious
disease. As soon as it became known that all the beds in