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no other milk was received into the dairy or distributed by the dairyman. The cow last purchased was
introduced into the shed on the 1st March, the day after she had calved, and before this she had been
kept on the Plumstead marshes where the only water available was from ditches supplied by a stream
contaminated by cesspool overflows and from other polluted sources. In the absence of any evidence
of exposure of the milk to infection by human agency or of any local condition that would suffice to
explain the outbreak, water from these ditches, milk from this cow, and subsequently the cow herself
were sent to Dr. Klein. Dr. Klein, however, failed to find typhoid bacilli in the water or in the cow's
milk, and later, when the cow was killed, he found her to be in all respects a healthy animal.
The beginning of the outbreak had been early observed by Dr. Sidney Davies, the medical
officer of health, its cause ascertained, and the dairyman ordered by the sanitary authority to cease to
supply milk from the dairy. This order having been disobeyed, he was prosecuted and a penalty
followed. A detailed special report on the outbreak was presented by Dr. Davies, extracts from which
appear in his annual report.
The medical officer of Camberwell, commenting on the number of cases notified in that district
between the 3rd August and the 26th October, states that " a certain number of the cases were contracted
outside Camberwell, usually at the seaside or in the country, where those attacked had gone for a
change of air." The report relating to Wandsworth also points to the fact that" in this, as in previous
years, there have been a number of cases of enteric fever that have been developed outside the district,
the sufferers coming back ill from other places."
Articles of food as a cause of enteric fever are referred to in the reports relating to Wandsworth,
the Strand, and Eltham. Thus it is stated that in Wandsworth " many of the cases were due
to eating of food contaminated with the germ of the disease, bnt in others no definite history of
infection could be ascertained." The medical officer of health of the Strand writes that " in three
cases the disease was attributed to eating shellfish, and the medical officer of health of Eltham states
that one patient " was supposed to have contracted the disease by eating oysters."
Diarrhœa.
The deaths in the administrative county of London attributed to diarrhoea and dysentery in
the year 1895 numbered 3,581, compared with 1,774 in 1894.
The death rates per 1,000 living in 1895 and preceding periods were as follows—
1851-60 1.03
1861-70 1.04
1871-80 0.95
1881-90 0.75
1891 0.572
1892 0.602
1893 0.802
1894 0.412
1895 0.822
The death rate in 1895 was therefore double that in 1894, a result no doubt due to the higher
temperature of the summer quarter of 1895.
The diarrhœal death rate of each year since 1840 in relation to the mean death rate of the
period 1841-95 is shown in diagram XVI. The mean temperature of the summer quarter of each year
in relation to the mean of the period 1841-95 is also shown.
The age distribution of the deaths from this disease in the registration county of London in
1895 was as follows—
Under 1
year.
1-5.
5-20.
20-40.
40-60.
60-80.
80 and
upwards.
2,772
539
20
17
43
154
55
If the London death rate from diarrhcea be compared with the death rates of other large towns
it will be found to be lower than any except the death rate of Bristol both in the period 1885-94, and
the year 1895.
Diarrhœa—Death rates per 1,000 living.
Ten years,
1885-94.
1895.
Ten years,
1885-94.
1895.
London
•68
•831
Bristol
•47
•75
Manchester
1.02
1.56
Nottingham
•96
1.58
Liverpool
1.04
1.63
Bradford
•78
1.58
Birmingham
1.06
1.24
Hull
1.04
2.46
Leeds
1.05
1.57
Salford
1.38
2.10
Sheffield
1.06
1.88
West Ham
•78
•85
Both in 1885-94 and 1895 the eastern group of districts suffered most heavily, and the
northern least heavily, from diarrhœa. In 1895 the district of St. Luke had the highest rate (1.59),
and of St. James the lowest (.26).
1 See footnote (1), page 10.
1 See footnote (2), pnge 10.
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