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not until the last clay of the year; so that, allowing a short period
for incubation if this milk had been in fault, fresh cases of illness
might have been expected, even so late as three weeks after the recognition
of the last case. Bat none such occurred. The inference
fairly deduceable from this immunity was borne out by two
facts that subsequently came to my knowledge, viz., (1) that the
two supplies of country milk were mixed for the evening delivery,
so that practically the Faringdon milk, mixed with a large quantity
of the Wantage milk, was supplied daily during the month to all
the customers (about 500), and yet typhoid fever appeared in only
thirteen families; and (2) that not only was the Faringdon milk
sent out pure to many of the customers in the morning (this being
the sole morning supply of country milk, and the "shed" milk
never being mixed), but two local retail dairymen in a small way
of business were supplied from the farm-churns night and morning,
and yet no case of illness occurred among their customers,
who are mostly poor people, served across the counter.
Raving thus shown the want of evidence to connect the outbreak
with milk, it may not be out of place to enquire whether it had
the characteristics of "milk typhoid"—whether the facts tally
with those of unquestionable endemics of this kind, which have
been investigated by competent medical and sanitary authorities—
e.g., the one at Islington, reported by Dr. Ballard, then (1870)
the Medical Officer of Health for that parish, but now of the Local
Government Board; and the other at Marylebone (1873), reported
by Mr. J. Netten Radcliffe and Mr. Power, of the Local
Government Board, and Dr. Whitmore, the Medical Officer of
Health for the parish of Marylebone ? These endemics, agreeing
in most particulars, presented one point of difference which rather
increases their value for the present purpose, viz., that while the
latter was proved due to the specific pollution by typhoid excreta,
of the water used for dairy purposes, the pollution of water in the
former appeared not to be of a specific character; but to depend on
the absorption of sewer gas, under circumstances which I need not
particularise.
The first point to be noticed is the number of persons attacked
in the several outbreaks? At Islington in ten weeks there were
175 cases in 70 families out of 142 which had milk from the
offending dairy. At Marylebone 244 "unmistakeable" cases
occurred within a period of four weeks and in 132 families, 118 of
which had received the infected milk; 218 of the cases being found
in these 118 families. In 77 out of 88 streets where the disease
was met with, this milk had been supplied. The infective agency
—the specific contagium of typhoid, was ultimately proved to have
been in the milk from one farm, and this milk was sold as
"nursery milk." So far as the general milk supply of the towndairy
was contaminated, it was shown to have been due to the