View report page

9
but it is not recorded that the sufferers had milk from farm X at any time. They had milk from
the implicated depot, and may have had " pasteurised" milk. In these instances, moreover, the
customers were well-to-do, and infection by cream is also a possibility, in view of the fact that at the
time of the outbreak the strawberry season was at its height.
As regards the main discrepancies referred to under this heading (2), they are obviously of a sort
likely to be met with in view of the facts that the destination of only some portions of the milk
from farm X was entered in the manager's records, and that no precise statement can be given as to
the destination of such portions of the cream, separated milk and pasteurised milk as were derived
from farm X and supplied from the depot. Some of the milk from farm X was undoubtedly sent
out to persons whose names do not appear in the records, and apparently F, A, N and P were among
those who received it without definite entries of the fact.
It is not possible to say exactly when the milk derived from farm X ceased to be infective.
The supply was discontinued after June 18th ; certain precautions—wholesale pasteurising, etc.—had
already been taken a day or two before this. An abrupt cessation of the prevalences in the several
districts involved followed upon the discontinuance of the infected supply. The milk presumably
remained infective for some time after this, for it is interesting to note that illness was developed
three or four weeks later, in the family of the milker at farmstead Xs, the reported symptoms of which
suggested scarlet fever. The nature of the illness was still in doubt when Mr. Dunbar visited the farm
on July 26th. If this illness was caused by drinking milk, the milk must have remained infective for
five or six weeks, dating from June 7th. The fact may be here recalled that in the Hendon outbreak,
which commenced at the end of November, 1885, cases were traced to milk supplied as late as the
beginning of the following January.
Original cause of the outbreak.
The question whether the outbreak was human or bovine in origin must now be discussed.
Inquiry at the farms, at the milkers' cottages, and at the school revealed only two possible sources
of human contagion. These demand careful examination; they are as follows
1. The milker who suffered from "influenza" two or three weeks before Easter. As regards
this man, it must be observed that it is most probable that his illness was influenza. It was so
diagnosed by the medical man who saw him at the time when he was indisposed, and influenza was
then prevalent in the village. Moreover, between the time of occurrence of this illness and the
outbreak of milk scarlet fever there was an interval of over two months.
2. The milker whose family sickened June 11th to 15th. The history of dates of onset was
carefully investigated in these cases by us at the time, and we questioned and requestioned all those
concerned. It seems clear that the milk possessed infective property at least four days before the
appearance of symptoms of illness in any member of the milker's family. The dates are as follows :—
June 7th, 8th, 9th and 10th.—Milk causing infection in Surrey districts.
June 11th.—First case developed in milker's family (his daughter).
June 13th, and for four or five days after.—Milk causing infection in Loudon and
Surrey.
The milker himself was attacked and stopped work on June 14th.
It would appear, therefore, that the cases iu this milker's family were caused by drinking
infected milk from farm X, in fact that the milk infected the milker and not the milker the milk.
Inspection of the cows at farm X was made by us while they were in the fields on June 20th,
and by Mr. Dunbar when they were in the sheds on the 21st and 23rd June. Mr. Dunbar reports
as follows:—
" Inspected 21.6.09.
23.6.09.
" Report on the cows at the two farms described as farm ' X.'"
" The nearer farm, X1—Is/ shed.—10 cows. No. 1, scars on several teats. No. 2, ' Ileddy,'
calved end of February or first week in March, has a cough and is feverish, has one scar on right
hind teat, and a serpiginous scar on right fore teat; on one teat there are 3 pustules. This cow
was brought into the farm early in March when newly calved. She presents the most marked
scabbing and scarring of teats and under parts of udder of any of the cows at the nearer or further
farms. No. 5, a bleb on one teat containing sero-pus.
" 2nd shed.— 6 cows. No. 2, scabs on right hand teat; this cow is now almost dry. No. 3,
calved 18 months ago but is still milking. A scab on left hind teat and several small scabs on right
hind teat. On left fore tear, a vesicle. No. 4, ' Daisy,' one teat shows a place where a scab has been
removed. No. 5, 'Profit,' 3 scabs on one teat and evidence of scabs lately removed.
" 3rd shed.—-11 cows and a bull. The third and fourth cows from the bull, ' May' and
' Gallant,' each have scabs on their right fore teats.
" The further farm—X2, 1st shed.—7 cows. No. 1 on right, a red cow, has several small
scabs. No. 2 calved a fortnight ago. No. 3, a white heifer, calved some weeks ago; several
excoriations on left hind teat and a small scab on inner side of one teat. No. 4, a red heifer, calved
some weeks ago, similar conditions ; a pustule on right hind teat. The sixth from the end, a red
cow, similar conditions ; there are two large scabs. Fifth from right end, one pustule the size of a
pea and four smaller ones on one teat. Seventh animal at end of shed, a roan heifer, calved
recently, has a few blebs on the teats.
" Single stall.—The cow in this stall calved on the 19th.
" 3rd shed.—6 cows. First cow, similar blebs to those already noted. Third cow, similar
blebs. Practically every one of the milch cows at the further farm has some evidence of vesicular
or scabby conditions. Fourth cow apparently has arthritis of left hip joint. Fifth cow, several