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London County Council
SCARLET FEVER.
Report by the Medical Officer of Health submitting a report by Dr. W. H. Hamer
and Dr. T. Henry Jones on an outbreak of scarlet fever in London and Surrey,
and a bacteriological report by Dr. Mervyn Gordon.
In June last upwards of 400 persons living in districts in London and Surrey, and who consumed
milk obtained from a particular milk company, were attacked by scarlet fever. From the outset there
was strong reason for believing that a milk supply derived from a particular company was the source
of infection, and in view of the fact that the occurrences of scarlet fever apparently due to this cause
were widely distributed over the counties of London and Surrey, it was necessary that the health
administration of both counties should be concerned in the inquiry. Hence inquiry into the circumstances
of the outbreak was jointly undertaken by Dr. W. H. Hamer and Dr. T. Henry Jones, who was
acting in place of Dr. Seaton, County Medical Officer of Surrey. These officers were assisted by the
several medical officers of health of the affected districts as well as of the county and districts in
which the company's depot and some of the farms supplying the depot were situated. They also had
the advantage of assistance from Mr. Dunbar, veterinary inspector in the Public Health Department
of the London County Council, and the services of Dr. Mervyn Gordon, assistant pathologist of St.
Bartholomew's Hospital were retained by the London County Council. In their inquiries Drs. Hamer
and Jones also had the active co-operation of the manager, the secretary and medical adviser of the
company, who rendered all possible assistance in the work of investigation.
From a perusal of the joint report, which I present, it will be seen that no reasonable doubt
can be entertained^that the milk of a particular farm was responsible for the occurrences of scarlet fever
in the districts of the two counties, and interest centres in the question how the milk of this farm
acquired the ability to infect those who consumed it with this disease.
In the past, two hypotheses of milk infection have been discussed, the one that the milk
acquired its infective property from a human source, that it was in fact infected by the milker or by some
other person suffering from scarlet fever ; the other, that the milk was infected by some condition of
a cow or cows.
It has on former occasions been observed that inquiry has failed to demonstrate that human
agency had been responsible for the infective condition of the milk ; such inquiry has often shown
that even when one or more of the persons engaged on the farm have suffered from scarlet fever the
dates of their infection have been subsequent to the dates of infection of other persons living at a
distance and who undoubtedly owed their attacks to consumption of the milk in question; in fact,
that the persons engaged upon the farm had suffered as other persons from consumption of the
milk. So in the outbreak investigated by Drs. Hamer and Jones it was found that scarlet fever
did occur in the family of a milker, but that the evidence in connection with this occurrence
could not be regarded as affording explanation of the infection of the milk by human agency,
while it distinctly suggests that the milk was infective before leaving the farm. Careful inquiry,
indeed, in the neighbourhood of the farm failed to yield any evidence of the existence of a human
source of infection of the milk.
The question of infection of the milk being of bovine origin needs to be considered. Under
similar circumstances Sir William Power, in 1882, when investigating an outbreak of scarlet fever in
certain London districts, made the suggestion that inasmuch as " there is one sort of relation between
scarlatina and accidents of the puerperal state, another sort of relation becomes comparatively easy
of belief," in fact, that " if scarlatina in man have other animal source than human source, it may be
that one such source is the cow that has recently calved, a cow either not at all ill (except for her parturition)
or not so obviously ill as to prevent her milk being used for human consumption." The suggestion
thus tentatively made, in 1882, at once assumed large importance upon the demonstration
by Sir William Power, in 1885, of the bovine origin of scarlet fever occurring in persons consuming
milk from a Hendon farm the cows at which were affected with an eruption of the teats and udder.
A similar development of scarlet fever in man, associated with the consumption of the milk of similarly
affected newly-calved cows, or cows infected from such newly-calved cows, has been observed in a
number of instances since that date.
In London in 1892 and again in 1894 and in 1902, considerable prevalences of scarlet fever due
to infected milk were strongly suspected to have been originally of bovine origin. In the present
instance a like possibility was necessarily entertained, and it has been found possible by study of the
farm operations, in minute detail, to show that just at the time when the milk first began to show
infectious property, there was added to it the milk of three recently-calved cows, the calf of one of
which had died after being suckled by the cow for four or five days. These circumstances, together
with the fact that the three cows mentioned, and other cows at the farm, showed at the time of the
inquiry appearances upon their teats and udders suggestive of Hendon disease, renders it probable
that a morbid condition of the cow was responsible for the subsequent human illness.
Dr. Mervyn Gordon has investigated the outbreak from the bacteriological side, and his
report is appended. He isolated from all six specimens examined by him a particular streptococcus
which he regards as being either the streptococcus anginosus (Andrewes and Horder) or the streptococcus
mastitidis (Savage). Dr. Gordon draws attention in his report to a recent observation made by
21479 S.S./11144