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by the company in two counties. It was therefore definitely arranged that no milk from this
suspected depot should be sent either into London or into Surrey, and accordingly none was supplied
from the depot [after that day. The secretary of the dairy company stated that the Medical Officer
of Health of a district in which some of the farms supplying the suspected depot were situated
had already been commissioned by the company to examine and report on all the 31 farms,
the company's attention having been directed as early as June 16th to the fact that milk from
this depot was credited with having caused scarlet fever in Surrey. It was suggested that
as farm after farm was given a " clean bill," by this medical officer of health, the supply might be
brought into use again. To this, however, the obvious objection was raised that until the implicated
farm should be discovered the entire supply of the depot must be regarded as suspect. Finally, it
was arranged that Dr. Hamer and Dr. Jones should proceed to the head office of the dairy company
in the country on the following day (Sunday) to examine the records of distribution, and afterwards,
if necessary, to proceed to the inspection of the 31 suspected farms.
Summary of investigations as to source of infection.
On Sunday, June 20th, we accordingly went to the headquarters of the company in the country
and were met by the manager and secretary, who had arranged for all records to be in readiness at the
implicated depot eighteen miles away. We travelled therefore to this depot, where we were met by
the medical officer of health of the district and by the medical officer of health of an adjoining
district—previously referred to as having been commissioned by the dairy company to inspect the
farms supplying the depot. The latter gentleman had already visited twelve of the farms and had heard
of no cases of scarlet fever at any of them, but reported that at the cottage of a man employed on
one of the farms—X—there were said to be some cases of German measles, and at two other farms
—Y and Z—some cases of measles ; he had had no opportunity of examining the cases at X and Y.
Upon investigating the records at the depot we found it possible to trace with a fair degree
of accuracy the distribution of milk from individual farms to individual retailers in the affected
districts in London and in Surrey. We therefore proceeded in the first instance to make a careful
analysis of these daily supplies. At that time we had knowledge of nine or ten London and Surrey
retailers whose customers had been attacked by scarlet fever. We arranged the names of these
retailers at the heads of a series of columns (see Chart I.), and entered for the morning and afternoon
of each day from June 6th to June 19th (when all milk from the depot was stopped) the names of
the farmers supplying these vendors, so far as they could be ascertained. A preliminary analysis of
these entries then caused some suspicion to fall in the first instance upon the milk supplied from
farms X, Y and Z, and not upon any other supply. It was clear, however, that, if the records could
be trusted, farm Z could even at this stage be for practical purposes excluded, for this farm had
not supplied at least three of the implicated vendors at the time when the milk sold by them began to
carry infection. From farm Y, milk had been sent to most of thejimplicated vendors, at one time or
another, but never to one particular vendor whose customers had suffered conspicuously. From farm
X it was recorded that milk had gone to all the implicated vendors at the time when their supplies
became infective. It so happened that farms X, Y and Z were near each other.
In view of these facts we decided to go at once to farm X, and the medical officer of health of
the district in which the depot was situated kindly drove us thither in his motor car. Upon enquiring
at the farm we were directed to the cottage of the farm carter, in whose family cases of German
measles were said to have occurred. At this cottage, about half a mile from the farm, we found the
carter, G. L., his wife, and three children—R. L. (aged 8), I. L. (aged 5) and A. L. (aged 2). The
man, in the course of his daily work, habitually took the milk from the farm (X) to the depot; he
also lent a hand in milking the cows whenever his help was wanted. He and his family had an
allowance of one pint of milk daily from the farm, and this milk was, we were told, the only milk
derived from the farm which was consumed locally. The milk was generally taken with tea, but
occasionally drunk raw by the children. The history of illness in the family was as follows :—
June 11th.—I. L. (5) sickened and was found to have a sore throat; later she developed
a rash.
June 13th.—A. L. (2) developed a sore throat.
June 14th.—G. L. (the father) had a headache and was out of sorts.
June 15th.—G. L., his wife, and R. L. (8) developed sore throats. G. L. stopped work on this
date; he had milked two cows on the preceding evening.
We were told that the family never left the village and had had no visitors since Christmas.
R.L. and I.L., who generally slept together, attended school in a neighbouring village.
On examination, I.L. was found still to have a sore throat, also some roughness of skin on the
soles of both feet. A.L. was very poorly and had a sore throat but no peeling. R.L. was acutely ill;
her throat was much congested, with exudation on both tonsils, the glands of her neck were swollen,
and she had a typical scarlatinal rash (dusk}', punctate, erythematous) on her chest, back and limbs,
but not on her face. None of the children had had coryza or lachrvmation. G.L. was still feeble ;
he had had a sore throat and his tonsils were enlarged. His wife had had a sore throat, but it was
almost normal again ; she looked and said she felt poorly.
The farm (X) at which G.L. was employed consisted of two farmsteads—X1 and X2—with two
separate herds of cows and cowhouses ; G.L. was carter for both and acted as auxiliary milker at both
when necessary. He generally went first to get the milk from X2, milked two cows there morning
and evening, helped to lift the churns into the cart, and then proceeded to X1, where he also
occasionally milked a cow before helping to lift the churns into the cart, after which he took all the
churns to the depot. He had nothing to do at either X1 or X2 with measuring the milk or filling the
churns.