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"We then visited farmstead X1, where lived the farmer, his wife and her sister, and the foreman
milker, all adults. So far as we could learn, none of these persons had been ill save the foreman,
who hiid suffered from influenza and sore throat two or three weeks before Easter, i.e., nearly three
months previously ; he averred that he never drank milk. This man's illness was said to have
begun with headache, followed by sore throat and swollen neck ; he had had neither rash nor peeling.
He had been off work for a fortnight, of which he spent a week in bed, owing to feebleness. His
doctor, whom we saw later, declared that the attack had unquestionably been one of influenza,
which had been very prevalent in the district at the time. We inspected the 27 cows in the fields,
where it was difficult to examine them carefully ; we noticed that one had a cough and seemed in
rather poor condition.
On farmstead X2 lived a milker, his wife and her mother and six children, among whom, it
was stated, no recent illness of any kind had occurred. Subsequent enquiry, however, elicited the
fact that one of the boys, aged 10, had suffered from digestive disturbance about three weeks
previously, after eating green gooseberries, and had been away from school on that account for one
afternoon ; he had had no sore throat or rash. At this farmstead there were 32 cows, all of which
we inspected in the fields. Several of these cows had recently calved, and the condition of three of
them excited our suspicion and suggested the necessity for veterinary examination. We arranged,
therefore, to return to the farm on the following day (Monday), after obtaining the assistance of
Mr. Dunbar, Veterinary Inspector of the London County Council.
It now seemed desirable, before making further inquiry as to farm X, to make sure that there
was no human source of scarlet fever infection at farms Y and Z already referred to. If there had
remained any chance that the recently reported cases of measles at these two farms were really cases
of scarlet fever, it was obvious that some suspicion would still attach to the milk derived from them.
The diagnosis of measles at farm Z, however, had been vouched for by the Medical Officer of
Health who had begun systematic inspection of the 31 farms; we therefore proceeded to farm Y
There we found V.G. (9), the farmer's daughter, suffering from genuine measles ; the rash, now
almost faded, had first appeared on June 16th and the child had had running eyes and a bad cold on
the 11th ; she had been isolated since the 13th. We found her throat normal; she had no enlarged
cervical glands and no sign of peeling. Three other younger children showed no signs of illness. V. G.
had travelled in a pony cart and by train daily up to the 11th June to and from a school in a small
town a few miles away with the children from the adjoining farm Z. Two of these children from farm
Z had suffered from measles, one sickening on June 3rd and the other on June 10th. There had been
other cases of measles in the school from May onwards, on account of which the boys' department
had been closed ; but the girls' department, with six cases in all, had been kept open throughout. The
illnesses at farms Y and Z were thus clearly ascertained to be genuine measles, and this fact tended
to discredit an hypothesis that the milk at farms Y and Z was at fault.
On the other hand, the suspicion entertained in the first instance that the milk from farm X
was infective had been materially strengthened by the discovery of genuine scarlet fever in the carter's
family, and our investigations were now especially directed to this particular farm.
In order to complete the narrative of our investigations in the neighbourhood of the depot and
farms, we may here state that on the morning of June 21st (Monday), while awaiting the arrival of the
London County Council veterinary inspector, Mr. Dunbar, we further investigated the method of distribution
of the milk at the depot (a matter to be referred to later); we also visited the village school
and made enquiry as to various children reported to have been absent therefrom. All the information
we obtained tended to show that there had been no scarlet fever in the district for several months and
no outbreak in the school since the winter of 1906-7. On the afternoon of the same day
(June 21st) we were joined by the Medical Officer of Health of the County, Dr. Tubb-Thomas (who
kindly took us to the farms in his motor-car), and by Mr. Dunbar, and we all proceeded to make
examination of the cows at the farmsteads X1 and X2. In view of the evidence against those farmsteads
which now became available, the Medical Officer of the County thereafter undertook administrative
control of the infected supply. On the 23rd June Dr. Mervyn Gordon visited the farmsteads
X1 and X2, on behalf of the London County Council, having been commissioned to make
bacteriological examination of material from cows presenting suspicious appearances. (See his
report, appended.)
Distribution of milk from the Depot.
We now proceed to consider the chief questions of {etiological interest arising in connection
with this outbreak, and first it is desirable to examine in detail the evidence incriminating the milk
of farm X, derived from study of the distribution of the milk of the 31 farms.
We had thought it unlikely, in view of the information available in the first instance, that
the milk from particular farms could be definitely traced to particular vendors in London and
in Surrey. Observation of the methods followed at the depot showed, however, that for practical
purposes this could generally be done. The milk was always cooled before being sent away from the
depot. During the summer months some of the milk, but not all, was pasteurised before being
cooled. These two processes may be described here.
Cooling.—On arrival at the depot the milk from each farm was tipped into a receiver capable
of holding from 30 to 40 gallons ; from this it was pumped into a reservoir, thence delivered over a
cooler, and run into churns, in which it was dispatched to its destination. During this process,
some 8 quarts of each consignment of milk ran bacjv into the receiver when the jlumping was discontinued
; to make up for this loss it was the practice just wheu farmer A's milk was nearly exhausted
to pour in 8 quarts of farmer B's milk, so that, theoretically, all A's milk should go to one consignee,
while the 8 quarts last pumped, which ran back into the receiver, were assumed to consist of B's
milk only, to which the rest of B's consignment was added for the next pumping, and so on. As a
matter of fact, after the cooling process, the milk described as A's milk would contain a trace of B's;
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