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31
As the form of sore-throat was infectious, some of the
later cases that cropped up might have been due to infection
from primary cases; for this reason I continued to search for
the cause of the outbreak among the facts and circumstances
relating to the actual commencement of the outbreak in Church
End. Although at the beginning there was no evidence
sufficient to even lead one to suspect that the epidemic might
have had its origin in milk-infection, I collected evidence
under this head from the very first, and, as the cases multiplied,
bv the fourth day there were good grounds for suspicion. Owing
to the fact that the milk-supply of London and its suburbs
is getting more and more into the hands of a few large
companies and firms with large and irregular areas of
distribution, it is getting more difficult year by year to trace
the origin of any outbreak to milk-infection. There was of
course far less difficulty when small dairymen supplied small
and localised areas. The reasons that impelled me to attribute
the outbreak to milk-infection were the following: —
I.—It was to my mind easy to exclude all other conditions
to which an epidemic of such throat-illness has ever been
ascribed.
II.—The Disease cropped up with scarcely an exception in
good class property—where of course most milk is consumed.
III.—On inspecting all the cows which furnished milk to
the area, I discovered 3 which were evidently out of health, and J
in each case the teats were slightly ulcerated and one of the
cows had a small chronic abscess in the udder. I also carefully
examined the throats of those who milked the cows but found
them, without exception, healthy.
IV.—I then ascertained that the supply to which these cows
contributed was distributed to 17 per cent. of the total houses
in the District, but of the number of houses infected it supplied
94 per cent.*
V.—The unfavourable climatic conditions had prevailed for
at least a fortnight prior to the appearance of these throat-cases
which undoubtedly cropped up in far less than a week after
* This important evidence was not available until the lapse of several days.