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allowing for the period of incubation, by a marked drop in the number of cases of
scarlet fever daily occurring, and there is little doubt that when it was stopped it was
still in a highly infectious condition, and thus many cases which might have occurred
were prevented.
The number of cases which occurred in Shoreditch during the period the infectious
milk was being distributed was 170, and of those 129 were amongst persons who had
been supplied with the milk It is probable also, although no evidence was obtained as
to the fact, that in several other cases the milk supplied was from the same infected
source. It was noticed during the period of the scarlatina outbreak that the number of
cases certified as diphtheria was markedly increased. From inquiries made it was found
that in half of these cases the milk supplied was from the same infected source, and
there are reasons for believing that a large percentage of these cases were really cases
of scarlet fever, and that there was no real increase in the amount of diphtheria
prevalent during this period It is hardly necessary to state that cases secondary to
the original milk infected cases swelled the number of cases of scarlatina in Shoreditch
for several weeks after the infected milk had been stopped. Had it not been for this
milk outbreak, cases of scarlatina in Shoreditch would in all probability have been
much below the average of previous years.
During the time the infected milk was operative it was observed that the
proportion of attacks amongst adults was larger than is usual with the ordinary run of
scarlet fever cases, a fact in all probability to be accounted for by the manner in which
the infection was distributed. Judging from the fatality of the cases, there is no reason
for believing that the type of the disease was severer than usual. Nearly the whole
of the cases occurring during the outbreak were removed to hospital for treatment.
The disinfection of the premises infected was carried out with as little loss of
time as possible after the removal of the cases. Efforts were made in all cases to
deal with infected premises the same day as they were notified as ready for disinfection.
During the early days of the outbreak when the work of disinfection was extremely
pressing, assistance was rendered by the disinfecting officers of the Borough of
Finsbury. Afterwards by dint of employing extra assistance and working from 6 a.m.
to 1 or 2 o'clock the following morning each day's work was satisfactorily carried out.
In a few cases only had disinfection to stand over until the next day. The outbreak
involved a very large additional amount of work not only with respect to disinfection
but in regard to the various inquiries which had to be made in each case, and for about
a fortnight the ordinary course of the sanitary work was considerably retarded more
especially in the sanitary districts of inspectors Firth, Jordan and Quelch, which were
chiefly affected.
The facts connected with this outbreak emphasize the need that exists for
legislation making it a statutory obligation upon all milk vendors, whether wholesale or
retail, to be in a position to give forthwith when required to do so by a medical officer of
health reliable information both as to the farm or farms from which any particular day's
supply of milk has been received and the customers to whom it has been delivered.