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of the existence of some common cause connected with the occurrence of these cases.
Although the possibility of other causes was not overlooked, there were two which
suggested themselves as being most likely, one was school influence and the other
milk infection. Enquiry into the circumstances connected with the cases was made
during the afternoon of the same day ; no reason was found for suspecting any school
of giving rise to the outbreak, the fact was however, elicited that six of the seven
patients lived in houses in which milk was received from M. a milk vendor, whose
shop is situate in the Hackney road, in Bethnal Green, about opposite the middle of
the eastern boundary of Shoreditch. The other patient lived in a house where the
milk was received from a vendor P whose shop is in the Kingsland Road. Enquiry
was made of the Public Health Department of Bethnal Green, and it was ascertained
that there had been that day an unusual number of cases of scarlet fever in that
borough and that the houses invaded were supplied with milk by M. This milk
vendor was then informed that there were grounds for suspecting the milk which
was being distributed by him of conveying the infection of scarlet fever. Enquiry
was then made as to whether any cases of scarlet fever had been recently certified
on his premises, and also as to the existence of any cases of throat illness amongst
the persons living on his premises or engaged in his business. The result was
negative.
It was ascertained from M. that the milk he sold came from two contractors,
namely X., and another who may be alluded to as Y. From X. about four churns
were obtained, and from Y. one churn daily. According to the information given by
M. respecting his milk rounds and the houses supplied by him, there appeared at first
some grounds for suspecting that Y's. was the milk implicated, and M. at once undertook
to cease supplying this milk. He was informed, however, that it might be
necessary to stop the milk he was receiving from the other contractor X., and he was
warned to make his arrangements accordingly.
On the following day, May 1st, the cases were rapidly being notified, and it was
evident that a serious outbreak had to be contended with. I had a conference with Dr.
Bate, the medical officer of health for Bethnal Green, and we were agreed that there
were very strong grounds for believing that the milk supplied to M. by one or other of
the two milk contractors above referred to was infected and disseminating the disease.
As the result of our conference, Dr. Bate undertook to interview the milk contractors
on the subject, whilst I proceeded to interview the medical officer of health to the
London County Council, and acquaint him with the facts up-to-date, as it appeared not
improbable that some of the infected milk, in consequence of steps taken to stop its sale
locally, might be diverted elsewhere into other sanitary districts in the Metropolis.
This actually happened though fortunately only to a comparatively small extent. It is
hardly necessary to state that measures were at once taken by the medical officer of the
County Council to ascertain the source of the infected supply. Meanwhile, it had been
observed that several of the cases certified were in houses supplied with milk by the