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Had the vanman been able and willing to give an intelligent account of his distribution
of the milk at the outset, there can be no question that the implicated supply could have been
stopped at least forty-eight hours earlier than it actually was. In the absence of this muchneeded
information it was impossible to indicate with certainty the particular farm involved.
The local vendors were urged by the medical officers of health of Shoreditch and Bethnalgreen
to discontinue to supply Mr. X.'s milk. Mr. X., however, did continue to supply a number,
and any change in the detail of supply which may have been made did not suffice to exclude the
infected milk supply from distribution, as he did not himself know which farm was at fault.
In the interest, noi only of milk consumers, but also of local vendors and of contractors,
it is obviously desirable that at a time of emergency complete records should be forthcoming.
Considerably more than half the milk distributed in Shoreditch and Bethnal-green by Mr.
X.'s vanman was delivered to the various local vendors in the form of "whole churns," and
it would have been a simple matter for record of the origin and mode of distribution to have
been kept by Mr. X. The local vendors, while in some instances stipulating that they should
be supplied with churns from particular farms, appear to have implicitly relied upon the
vanman in regard to the matter, and made no serious attempt to check his deliveries, or to
keep any record of the source of the milk which they received.
The source of infection of the milk.
The illness affecting the farmer and members of his family was practically contemporaneous
in its development with the outbreak in London. The latter may be said to have commenced on
April 25th, when six cases of illness developed among persons drinking Mr. X.'s milk. Two
previous cases were noted as beginning, one on the 22nd and one on the 24th, but marked
incidence of disease on consumers of the milk first occurred on the 25th, and the incidence
notably increased during the days immediately following this date. The wife of the farmer at the
Staffordshire farm was sick and complained of sore throat on the evening of the 27th, and she
noticed a rash on May 1st. The farmer himself and his daughter developed sore throats on April
28th; his son was sick and complained of sore throat on April 29th. The illness was mild in
three of the cases, but the farmer's wife had a more severe attack. She presented definite
evidence of desquamation when seen on the 11th May by several medical men.
Inquiry was made as to illness among other persons resident 011 the farm and in the
neighbourhood, but on case could be heard of, and the other residents themselves—a son, two
milkers, a man and a boy, and a domestic servant —presented no evidence of illness, and there
was 110 history of their having been exposed to infection.
Inquiry was also made as to the cows on the farm. They were housed in four sheds, and
numbered 29 in all, with two bulls. No cows had newly arrived at the farm for several months.
A cow had calved about the beginning of April, and another calved 011 April 18th; neither of
these cows presented any notable abnormality. Samples of milk were taken from three cows by
Dr. Hamer on the 4th May, on which date the only indication of ulceration of the teats was a
crust on the teat of one cow, while the milk of two cows was abnormal in appearance. The milk
was examined bacteriologically by Dr. Gordon, and on May 11th, Drs. Klein and Gordon
inspected the cows, and a further sample of milk was taken for examination from one of the
cows having abnormal milk. Dr. Reid, the medical officer of health of Staffordshire, Dr. Freer,
the medical officer of health of the district, and Dr. Hamer being present at the time.
Bates of attack of customers of particular vendors.
The falling off in the special incidence of scarlet fever 011 the 7th, 8th, 9th and 10th May,
upon persons and upon houses supplied with Mr. X.'s milk is shown in diagram I. On
reference to the black columns showing the number of houses invaded on successive days it will be
seen that the number underwent marked diminution on the 6th, 7th and 8th, and after the 10th
the incidence on houses supplied with Mr. X.'s milk ceased to be greater than might have been
expected, having regard to the many centres of infection then established. Diagram II. shows
for successive days the number of houses newly invaded, the occupants of which obtained milk
from individual local vendors deriving their supply from X. Particular attention may be called
to the fact that the incidence of disease in point of time varies in the case of the different vendors.
A.'s, B.'s, and C.'s customers were early involved. There can be no question that these vendors
received milk from the implicated farm during the period immediately preceding the outbreak.
D.'s customers were attacked a few days later than A.'s, B.'s, and C.'s, and F.'s (the Islington
and St. Pancras cases) were involved at about the same time, or if anything a little later than
D.'s. No record had been kept as to the origin of the milk supplied by Mr. X. to 1).
and F., and the question as to which farms it came from could not be cleared up. The
vendor E.'s customers, the Finsbury cases (G.) and the cases (H.), to be later referred to, were
the last to suffer. It was ascertained that milk from the implicated farm was distributed in
Finsbury on either May 2nd or May 3rd, probably on May 3rd, and E. received the last consignment
of infected milk—that distributed on the morning of May 4th. The vendor B. received,
according to Mr. X., the bulk of the infected milk both on May 2nd and May 3rd. Only a few
fresh cases developed among his customers during the week succeeding the latter date, but it may
be noticed that this vendor's customers had already suffered to a marked extent during the week
beginning 28th April, and it may be that the majority of those who were susceptible were
infected prior to 2nd May.
An interesting point in the history of the outbreak is the occurrence of cases on the four
days subsequent to the stoppage of the milk in houses supplied by twenty other vendors obtaining
X.'s milk. These cases are grouped together in the diagram and shown opposite the letter
H. There is no reason for suggesting other explanation of their occurrence than the milk, and