View report page

17
There is, therefore, in view of differences in the fatality of scarlet fever, considerable difficulty in
estimating the amount of hospital accommodation which may be required for cases of this disease by any
knowledge we possess as to the number of deaths which have occurred in past years, but it is obvious
that demands for hospital accommodation for cases of scarlet fever may in the future be considerably
greater than they were in 1892. During that year as many as 4,067 patients suffering from scarlet fever
were at one time (5th November) in the London Fever Hospital and the hospitals of the Metropolitan
Asylums Board
Of special outbreaks of this disease deserving attention the most important was one occurring in
the months of March and April, due to the distribution of infected milk supplied by a large milk
vendor in Deptford, who derived his milk from various sources among others from cowsheds at Deptford.
This outbreak was first brought to my notice by Mr. Bernays, medical officer of health of Charlton.
The circumstances of this outbreak were the subject of enquiry on behalf of the Council by
Dr. Hamer, whose report I presented to the Public Health Committee. Dr. Hamer found that scarlet
fever due to milk from the Deptford cowsheds had occurred in Charlton, Plumstead, Deptford, Greenwich
and Bexley, and Dr. Butterfield the medical officer of health of the West Kent combined sanitary district
informed me of cases in Sidcup and Chislehurst also due to this supply. But the chief point of interest
which Dr. Hamer's enquiry elicited was the fact that while no evidence of infection of the milk by
human agency could be discovered, scarlet fever was prevalent among drinkers of this milk at a time when
one of the cows in the Deptford shed, a black and white cow, was observed to have a "cold," was "off her
feed," and was yielding milk which was "ropy." A few days later the black and white cow was given
a dose of physic, and her milk was not distributed. During the next few days the distribution of the
milk of this cow appears to have been intermittent, and again a few days later was with that of four
other cows excluded from the business. The five cows which were milked by a particular milkman
presented on examination of their udders and teats, certain scabs and excoriations. In no instance
were the milkers' hands affected. Dr. Hamer pointed out that the six days on which the black and white
cow suffered from a cold, and during which her milk was being supplied, were the six days of maximum
infective power of the milk supplied by this vendor in the various localities, and that "after the 1st
of April, the day when the treatment of the cow was first commenced, and after which date the milk of
this particular cow was on several occasions excluded from the business, the infective property became
less marked." It is difficult to estimate how many cases of scarlet fever resulted directly and indirectly
from this milk supply, but the medical officer of health of Plumstead (Dr. Davies), speaking of the relative
incidence of the disease on children attending four Board schools, says that, "the milk supply which
first originated the outbreak (in Plumstead), was located near to these four schools, and doubtless the
early victims attended these schools ; then the disease spread from child to child by means of slight
undetected cases, and from them to children who attended other schools."
A somewhat similar outbreak in Upper Clapton was the subject of investigation and report by
Dr. Warry, the acting medical officer of health of Hackney. In this case also a particular milk supply
was found to be the cause of numerous cases of scarlet fever and throat illness in the neighbourhood
mentioned. With the exception of two churns of milk which were received daily from another source
and which enquiry excluded from suspicion, the milk was derived from local cowsheds containing 109
cows. No evidence of the infection of the milk by human agency could be discovered, but the child of
one of the milk carriers and several children of one of the cowmen, who themselves received their milk
from this source, were among those who suffered from scarlatina and throat illness. An examination
of the cows showed that several had cracks and abrasions on their teats, and three others had abnormally
high temperature. These three were isolated until their temperature had fallen to the normal, and Dr.
Warry was able to point out a lessened incidence of scarlet fever on the drinkers of milk from this
vendor "coincident with the isolation of the cows which had abnormal temperatures."