London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1894
[Report of the Medical Officer of Health for London County Council]
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It is desirable to study more particularly the dates of occurrence of cases in the sub-districts of
Greenwich and Lee which were specially attacked, and for those sub-districts, viz., Kidbrooke sub-district
and Greenwich sub-district, the dates of commencement of illness have been ascertained, as being more
important for the purpose of defining the limits of the outbreak than the dates of notification. I give
particulars which have been derived from information furnished by Mr. Hartt, Mr. Burton and other
gentlemen, whom I have to tbank for the trouble they have taken in the matter.
The cases given in the table have been classified according to their milk supply, so as to snow whether they received their milk from Mr. A, Mr. B, or from other milk vendors, and in the case of Mr. B's customers whether their milk was distributed on one or other of three different rounds.†
| Greenwich. | Kidbrooke. | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Date of commencement of illness. | Mr. A.'s customers. | Mr. B.'s customers. | Other vendors. | Mr. A.'s customers. | Mr. B.'s customers. | Other vendors. | ||||
| Son's round. | Man's round. | Walking round. | Son's round. | Man's round. | Walking round. | |||||
| March 19 | — | — | — | — | — | 3 | _ | |||
| „ 20 | — | — | — | — | 1 | 4 | — | — | — | — |
| „ 21 | 6 | — | — | — | — | 8 | 3 | — | — | — |
| „ 22 | 4 | 1 | 2 | — | — | 10 | 1* | — | — | — |
| „ 23 | 8 | — | 1 | 1 | — | 3 | 4* | — | — | — |
| „ 24 | 3 | — | 2 | 3 | _ | 2 | — | — | — | — |
| „ 25 | — | — | — | 1 | 2 | 1 | — | — | — | — |
| „ 26 | — | — | — | — | 1 | _ | — | — | — | |
| „ 27 | — | — | — | — | 1 | 1 | — | — | — | — |
| „ 28 | — | — | — | 1 | 2 | — | 1* | — | — | — |
| April 1 | — | — | — | 3 | 5 | — | — | — | — | — |
* These cases are properly speaking on B.'s son's round, but they may have been served with milk by B.'s man.
The incidence of the disease on the drinkers of Mr. A.'s milk was so marked that from the
outset there was no doubt that a milk supply was involved. Mr. Hartt has however supplied me with the
results of enquiry in an area selected for the purpose of showing the relative incidence of disease on
the suspected and other supplies.
This area is bounded by Shooter's-hill road on the south side, on the east by a line drawn from
the east end of Shooter's-hill road through the Rectory field cricket-ground to Charlton-road, on the
north by a line drawn along the Charlton-road taking in the north side, and the south side of Westcombepark
road as far as Vanbrugh-park road. On the west side it is bounded by Vanbrugh-park road and
Vanbrugh-terrace. Inquiry in this area gave the following results—
Total number of houses in area 368
Number of houses supplied by Mr. A 27
Number of houses supplied by Mr. B. 97
Number of houses supplied by other vendors 244
The cases of scarlet fever were limited to houses supplied by Mr. A. and Mr. B. and were
equally distributed between them.
II.—As to the possibility that contamination of the milk was caused by the conveyance of infection from
some person suffering from scarlet fever who was employed at the farm.
This question has been the subject of careful inquiry, and it may be well to enumerate the facts
which have been ascertained in reference to the matter.
Three men were employed in milking the cows at the farm. These men said they had not
recently suffered from any illness, and when examined by me on March 31st they presented no evidence
of having suffered from scarlet fever, and, save that one of the men had recently cut his finger, their
hands showed no sores and they stated that they " had never had cowpox."
The milk was taken round by a carrier who was assisted by a boy.
This carrier, J. D., was the man who was in the first instance suspected of having communicated
to the milk the power of conveying infection. He gave the following account of his illness. He did not
feel well on the 18th, and recollected that he overslept himself on that morning. This indisposition
passed off, however, until on the 20th he again felt unwell, and on the evening of the 21st his throat
became sore. On the 22nd his case was pronounced to be one of scarlet fever.
J. D. took out the milk until the morning of the 22nd, when the supply was stopped. His
illness appears, however, to have corresponded in time of development with the early cases forming part
of the general outbreak, and there can be little doubt that he was infected by the milk just as the rest
of the early sufferers were. The boy who assisted J. D., Mr. A.'s wife and daughter, a milk clerk, and
a woman living in a cottage on the farm, were also attacked by scarlet fever, but in none of them did the
first symptoms date back so far as in the case of J. D., and the possibility of their having originally
infected the milk is therefore out of the question. These attacks of illness then did not precede in time
of development the early cases occurring among consumers of milk.
There were, however, certain cases of illness in children of farm employes, occurring prior to the
general milk outbreak, which demand attention.
1. The cases in N.'s family. N. is a foreman who works on the farm, and is never brought in
contact with the milk. His cottage is situated within a few hundred yards of the cowshed. His son
T. N. worked at a linendraper's in Lee. In February some of the apprentices in the shop were
† It will be seen later that Mr. B. personally distributed the milk of another farmer in a fourth round. No
cases of scarlet fever occurred in this round.