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whose customers had been attacked, had also been supplied with Mr. X.'s milk, and probably with
N.'s milk.
Meantime careful watch was kept upon the notifications of scarlet fever in other parts
of London, and on May 11th Dr. Harris, medical officer of health of Islington, was able to
associate the occurrence of some six or eight cases, in a portion of his district
abutting upon the boundary of St. Pancras, with the distribution of the milk of a particular
vendor. This vendor was also found by Dr. Sykes, medical officer of health of St. Pancras, to
have supplied with milk four households in which cases of scarlet fever developed coincidently
with the occurrence of the cases supplied by the vendor in Islington. The vendor referred
to was, it was ascertained by Dr. Harris, obtaining milk from Mr. X., but no information was
forthcoming as to the particular farm from which this milk had been supplied. There were
thus in all *5 districts invaded (Bethnal-green, Shoreditch, Finsbury, St. Pancras and Islington),
in each of which milk supplied by Mr. X. had been consumed by the sufferers. The five
districts, it may be noted, were on three different " van-rounds," the number of persons who were
consumers of Mr. X.'s milk and who were attacked was in Shoreditch and Bethnal-green considerable,
in Finsbury and in St. Pancras and Islington it was much less.
The evidence implicating a particular farm.
While the evidence implicating Mr. X.'s milk was of a conclusive character almost from
the outset, great difficulty was experienced in determining which of the particular farms supplying
him was at fault. The evidence implicating a particular farm, the milk supply from
which was stopped on May 4th, is of a threefold character.
(a) There is the evidence afforded by consideration of the manner of distribution
among local vendors in Shoreditch, Bethnal-green and Finsbury, of churns sent
up from the different farms.
(b) There is the fact that scarlet fever occurred in the family of the farmer,
coincidently with the outbreak of the disease among consumers of the milk supplied
by him in London.
(c) There are the facts relative to the cessation of the occurrence of new cases, in
correspondence, allowing for period of incubation, with the stoppage of the implicated
supply. These facts again are of two-fold character, and include—
(i). The broad fact that, if the entire area involved in Shoreditch and
Bethnal-green be considered, the correspondence in question was marked.
(ii.) The fact that information furnished by Mr. X., concerning the source
of the milk distributed by particular vendors on May 2nd, 3rd and 4th, the three
days on which milk from the suspected farm was last distributed, corroborates, so
far as it goes, the conclusion that this farm was at fault. This question will be
referred to later.
The evidence under the head (c) completes the proof, but this evidence was not, of course,
available until after the cessation of the outbreak. The action taken had, therefore, to be based
upon the evidence under the other two heads, and as regards (b) it should be noted that the
nature of the illness which affected the farmer's family was not established beyond all question
until the occurrence of desquamation in one of the cases, and this phenomenon was not observed
until May 11th.
Need for record, of sources of milk supply.
The need for record of the sources of milk supply was strongly manifested during the
inquiry. As illustration of this need may be cited the nature of the evidence upon which it
was necessary to proceed in determining the source of the infected milk.
This evidence consisted—
(i) Of information given by Mr. X. This information related to the origin of
the milk sent on the Shoreditch and Bethnal-green rounds, but Mr. X. admittedly knew
little or nothing of the way in which the vanman disposed of his milk, this matter
resting almost entirely in the said vanman's own hands.
(ii) Of information given by local vendors. This information was doubtless reliable
so far as it went, but the local vendors, in some instances, knew nothing as to the
ultimate source from which their supply was derived, in other instances, even if they
took some interest in the matter, they were content with being assured that one or more
churns delivered to them came from a particular farmer, and did not attempt to learn
where the rest of the milk supplied to them came from.
(iii) Of information given by the vanman. This man alone had had opportunity
for acquiring anything approaching precise knowledge as to the distribution of the milk.
According to his statements he had adopted a rough scheme of distribution of the churns
of milk, and, inasmuch as certain broad outlines of this scheme were understood both
by his employer and by the vendors whom he supplied, to be adhered to by him, it would
appear that to some extent he felt under obligation to follow the prescribed routine in
its main outlines, but he deviated considerably on occasion from what he regarded as
his ordinary practice, and he was either unable or unwilling to give a detailed account
of the variations which had occurred. Under any circumstance it is doubtful
whether he could have supplied, having regard to his plan of procedure, very precise
information; but it needs to be stated as a matter of fact, that some of his statements
were found quite inconsistent with information given by Mr. X. and by the local
vendors.
* A case or two occurring in that part of Hackney which adjoins the Shoreditch boundary was subsequently
traced to the implicated milk.