View report page

30
Tlie eastern group of districts had the highest scarlet fever death rate during the year
1901, viz., 0-11 per 1,000 living, and the western group of districts the lowest (0-09^. Among
the several metropolitan boroughs Bethnal Green and Bermondsey had the highest death rate
(0 34) and Woolwich the lowest (0'04). The scarlet fever death rates in London in the four
quarters of the year 1901 were as follows: first quarter, 0*08 ; second quarter, 014; third
quarter, 015, and fourth quarter, 014 per 1,000 living.
Of special outbreaks of scarlet fever in Loudon during the year the most notable was one
commencing in April and extending into May, and in which some 300 persons were attacked.
The cause was an infective milk supply, the milk being received originally from a farm in
Staffordshire. This milk was distributed by a wholesale milk vendor along with other milk to
numerous retail vendors, for the most part in Shoreditch, Bethnal-green and Finsbury, in which
districts the majority of the persons affected resided, a few cases occurring also in St. Pancras,
Isbngton, and Hackney. Information was first brought to the knowledge of the County Council's
Public Health department by Dr. Bryett, the medical officer of health of Shoreditch, who had
observed that the persons in his district who were attacked had been mostly supplied with milk
by two retail vendors, one in Shoreditch, the other in Bethnal-green, and he further stated that
the Shoreditch vendor derived his supply from two middlemen, and that he haid ascertained
from Dr. Bate, the medical officer of health of Bethnal-green, that there had been a similar
occurrence of scarlet fever in his district among the customers of the local vendor in that district,
who also derived his supply from one of the middlemen mentioned.
The locatiou of the farm from which the infective milk was supplied was at once investigated
by the County Council's officers, who received continuously information from the medical
officers of the districts concerned. The inquiry was rendered much more difficult by the fact
that the middleman whose milk was under suspicion derived his supplies from nearly forty
farms, and by the absence of records as to the localities in which the several milk supplies
had been distributed. As a result of continuous inquiry by all the officers concerned the
farm from which the infective milk supply was received was, in less than three days
from the time when Dr. Bryett first reported the outbreak, sufficiently identified for the
middleman to be advised to stop the supply of milk from this source. Upon this farm cases of
srarlet fever were found in the farmer's family.
The details of this outbreak will be found in a report presented to the Public Health Committee,
which is appended (see appendix II.), and the matter was also the subject of the following
report of the committee to the Council on the 21st May, 1901, in which the insufficiency of the
law for limiting the distribution of an infective milk supply in London is discussed.
The medical officer has brought under our notice the position of the law in London in relation
to the subject of limiting the spread of dangerous infectious disease by milk. Medical officers of
health in London possess powers for this purpose under section 71 of the Public Health (London) Act.
On finding evidence that any person in his district is suffering from dangerous infectious disease
attributable to milk supplied from any dairy situated either within or without his district, or that the
consumption of milk from such dairy is likely to cause such infectious disease, the medical officer
of health, if authorised by an order of a justice having jurisdiction in the place where the dairy
is situated, may inspect the dairy, and if accompanied by a veterinary surgeon may inspect the
animals therein. If, on such inspection, he is of opinion that any such infectious disease is caused
by the consumption of the milk supplied from such dairy, he is required to report thereon to his
authority, and his report must be accompanied by any report furnished to him by the veterinary
surgeon. The sanitary authority is then empowered to serve on the dairyman notice to appear before
them within not less than 24 hours, and, if he fails to show cause why an order should not be made,
they may make an order requiring him not to supply any milk from the dairy within their district.
" This procedure, if strictly followed, involves considerable delay. In the outbreak which has
recently been investigated, a considerable number of persons were daily infected during the period
in which the infective milk was being supplied, and, had the supply of this milk been continued
pending the carrying out of the procedure above indicated, numerous cases which ought to and might
have been prevented would have occurred.
Moreover, when milk from a particular source has been found to be producing disease in one
district, and even when it transpires that cases traceable to the same supply of milk are occurring in
other districts, it would be necessary for the medical officer of each .of these other districts separately
to inspect the particular dairy from which the milk was supplied, and comply with the other requirements
of the section before the implicated milk could be excluded from his district. It seems
obvious that when disease has been traced to a particular milk supply the sale of such milk should be
altogether stopped, and not merely that it should be excluded from the district in which the outbreak
has occurred. The County Council has no power to exclude from London even a particular milk
known to be the cause of disease. Moreover, when a sanitary authority in London excludes fiom its
district the milk from a particular farm, notice is required to be given to the council of the county
in which the farm is situated, but we know of no power of the County Council to stop the sale of the
milkIn the recent outbreak the milk supplied in the districts affected was procured through a middleman
who obtained the milk from a number of farms in various parts of the country and distributed
it to'the local vendors direct from the railway stations to which it was sent by the farmers It does not
appear to be a general practice in the milk trade to keep such a record as would enable the origin of
the milk supplied to particular local vendors to be readily traced. We think such a record should
be kept, and that a medical officer of health should be able to procure information as to the sources
of supply of milk distributed in his district. _ , . .
We may point out that authorities in Scotland have much wider powers and duties in this connection
than those of authorities in London. Thus, under section 60 (2) of the Public Health
("Scotland) Act, 1897, if the medical officer of any district has evidence that any person in the district
is suffering from an infectious disease attributable to milk from any dairy without the district or
that the milk from any such dairy is likely to cause any such disease to any person residinq; in the
district such medical officer shall forthwith intimate the-same to the local authority of the district in
which such dairy is situate, and such other local authority shall be bound, forthwith, by its medical
officer to examine the dairy and the persons aforesaid, and by a veterinary surgeon to examine
the animals therein, previous notice of the time of such examination having been given to the local