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4
handed over to him. In this way, so the head milkman C. stated, it came about that Mr. A.
would have the milk of the two Eltham cows in the morning, and that Mr. B. would have it in
the afternoon. On questioning the carriers they agreed generally with this statement, but seemed to
think it was rather too absolute as far as the morning was concerned. They could not positively assert,
however, that with respect to any particular morning from the 18th to the 22nd C.'s statement did not
hold good.
With regard now to the cowshed and to the cows therein, the following observations were
made—
There was one large shed constructed in the form of the letter L, and at the end of one arm
of the L a portion was partitioned off to be used for the purpose of isolating cows newly arrived at the
farm.
On the occasion of my first visit, March 24th, I found, as already mentioned, that two cows
presented an ulcerated condition of the teats (a roan cow newly arrived from Eltham, and a white
cow). Mr. A., on my pointing this out to him, at once gave directions for the isolation of these two
cows, and of a third (the other cow which arrived from Eltham at the same time as the roan cow affected).
These three cows were placed in the portion of the shed separated off. The roan cow from Eltham
had lost patches of hair, but its companion cow did not present any abnormal appearance. On the
occasion of a subsequent visit on March 30th, the sores on the roan cow were almost healed, and
those on the white cow were in process of scabbing over. Two fresh cows were found to be affected
with ulcerated teats, the Alderney cow and another. This last cow, the two Eltham cows, and the
white cow, were all milked by the milker C. The Alderney cow was, however, milked by another milker.
An attempt was made to follow up the previous history of the two cows bought from the Eltham
dealer. It was understood from this dealer's foreman that the cows came to Eltham on March 15th,
and were taken to Mr. A.'s farm at Kidbrooke on the 17th. It was maintained that it was impossible
to state where they had come from. As regards their milk during their stay at Eltham, it was said
it might have gone to a neighbouring village, but on inquiring there the farmer who would have
received it denied having done so, and no scarlatina had recently occurred in the locality.
The chief facts ascertained with reference to the outbreak may be summarised as follows—
Three cases of illness among milk consumers commenced on the 19th March and four on the
20th, the number attacked then increased considerably, on the 21st 17 persons fell ill, on the 22nd
19, on the 23rd 19. The cases then rapidly diminished in numbers, and the special incidence of the
disease upon persons consuming the particular vendor's milk may be said to have ceased after the 24th.
This date of the cessation of fresh attacks accords with the stoppage of the milk supply on the 22nd,
allowing for period of incubation.
Throughout the outbreak Mr. A.'s customers suffered to a greater extent than Mr. B.'s ; again
Mr. A.'s customers were attacked earlier than Mr. B.'s.
The arrival of the Eltham cows on the 17th, some two days before the outbreak commenced,
caused suspicion to fall upon them; this suspicion was in some degree strengthened
by the statement made that the larger morning yield from these cows had gone to Mr. A.'s customers,
while the smaller afternoon yield had gone to Mr. B.'s; a statement in correspondence with the larger
proportion of Mr. A.'s customers attacked. On following up the matter, however, and examining the
proportionate incidence and time of incidence of disease on Mr. B.'s separate rounds in relation to the
distribution of the milk of the Eltham cows, it was found that the evidence was conflicting, and it
proved impossible to arrive at any certain conclusion.
The chief feature of the outbreak which remains insufficiently explained on the assumption that
the milk of the two Eltham cows was infective, is the prior incidence of the disease on Mr. A.'s
customers and the early implication of Mr. A.'s own family.
Assuming C. not to have been mistaken, Mr. A.'s own family would not have been supplied with
milk from the Eltham cows on their first arrival, and Mr. B.'s customers would have been the first to
receive milk from those cows. Assuming C. to have been mistaken as to the distribution of the milk
on the afternoon of the 17th (the day when the cows arrived), there would still be difficulty in reconciling
a hypothesis that the milk of the Eltham cows was infective, with the recollections of Mr. B. and his
carriers as to the particular customers supplied by them with Mr. A.'s milk.
Shirley F. Murphy,
Medical Officer of Health.