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London County Council.
Public Health Department,
Spring Gardens, S.W.
31st May, 1894.
Report of the Medical Officer of Health on a recent outbreak of Scarlet Fever
at Blackheath.
(Ordered by the Public Health, &c., Committee to be printed, 11th June, 1894.)
On Saturday, March 24th, I learnt from Mr. C. H. Hartt, Medical Officer of Health of
Greenwich, that a number of cases of scarlet fever had been notified in his district and in the adjoining
district of Kidbrooke among persons who were obtaining their milk from a particular farm in the latter
district.
I at once proceeded to Kidbrooke and saw the medical officer of health, Mr. H. C. Burton. I learnt
that 15 or 20 cases had been notified within the past few days in Kidbrooke, among persons who were
consuming milk from the farm in question. It was then stated that about half the milk obtained from
the cows at this farm was distributed by the farmer himself (Mr. A.), partly in Kidbrooke and partly
in Greenwich, the remaining half was sold by Mr. A. to a retail vendor, Mr. B., whose dairy premises
were situated in the Greenwich district, but within half a mile of Mr. A.'s farm.
Mr. Burton had, at an early period, ascertained that Mr. A.'s milk carrier was himself suffering
from sore throat, and inasmuch as at that time it was not known to him that Mr. B.'s customers were
involved in the outbreak, the circumstances gave rise to the impression that infectious property might
have been communicated to the milk after it left the farm, in such a way that Mr. A.'s customers were
attacked while Mr. B.'s escaped.
I now visited Mr. A.'s farm, and then called upon Mr. B., and elicited facts which altered the
aspect of affairs. Mr. B.'s customers were it appeared distinctly involved in the outbreak, and although
cases of scarlet fever had occurred in Mr. A.'s own house and among his employes and their families,
the dates of attack of these cases did not, so far as I could ascertain, accord with the hypothesis that any
one of them was responsible for the contamination of the milk. On visiting Mr. A.'s cowshed, moreover,
my attention was directed to a roan cow which bad lost patches of hair and which presented on the teats
a number of excoriations and scabs. This cow, I was informed, was one of a pair of newly calved cows
which had recently been purchased from a cattle dealer at Eltham. On making further investigations,
I found a white cow standing in the shed was also affected with abrasions and scabs on the teats. This
cow was milked by the man who milked the two Eltham cows.
The farmer who had from the outset accepted the evidence incriminating his milk, and who
showed every desire to prevent the spread of the mischief, whatever the loss inflicted upon himself
might be, had already discontinued the supply of milk on March 22nd. He was now informed by
Mr. Burton that this discontinuance of the supply should be maintained, and to this he consented.
Messrs Burton and Hartt now instituted a detailed investigation into the phenomena of the outbreak,
and the result of the inquiries made by them and of further inquiry made by myself I now propose to
give.
I.—The distribution of the disease in locality and time and its relation to milk supply.
The special incidence of scarlet fever upon the districts affected commenced about March 20th;
the area attacked lay, for the most part, on the eastern side of Blackheath. The Shooters-hill road
after passing along the northern boundary of the open space approaches Kidbrooke parish at the northeastern
corner of the heath, and then for a distance of about half a mile pursues an easterly direction
to join the Old Dover road, having Kidbrooke on its south side and Greenwich to the north. The
roads running north and south out of this portion of Shooters-hill road were those specially attacked.
As part of the heath lies in Lewisham, a few outlying cases occurred in houses situated in that district.
The milk of Messrs A. and B. was thus distributed mainly in the following districts—
Kidbrooke parish situated within the jurisdiction of the Lee Board of Works.
Greenwich sub-district situated within the jurisdiction of the Greenwich Board of Works,
but it may have been in small part distributed in
The north-eastern portion of Lewisham.
And in parts of the Lee and Charlton sub-districts within the jurisdiction of the Lee
Board of Works.

These figures sufficiently indicate the existence of an increased incidence of scarlet fever
commencing in the week ending March 24th so far as Lee and Greenwich are concerned.
Sold by Edward Stanford, 26 and 27, cockspur-street, Chariying-cross, S. W.
No. 189—Price 1d. [1320—m. 94a