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mixture with surplus nursery milk. At Kensington there were
16 cases only, in four weeks, and in thirteen families. These
families were spread over nine streets, comprised in six milk
deliveries: in these nine streets the dairy counted 116
customers. In all these outbreaks women and children furnished
the larger number of victims, probably either because women
and children drink more freely of milk than men, or because,
spending more of their time within doors, they are more exposed
to the danger of breathing contaminated air. In the Islington
outbreak, 44 men, 97 females above ten years of age, and 32 children,
were attacked; in Marylebone, only 29 men, 119 women,
and 96 children: in Kensington, two men, 8 women, and 6 children.
The sufferers belonged to the better or well-to-do classes. At
Marylebone and Kensington the proportion of sick female domestic
servants was large—absolutely and relatively, and about equal,
viz., Marylebone, 92 out of 244 cases (—37 per cent.) Kensington,
6 out of 16 (also 37 per cent.)
So far the agreements. But when we inquire into the distribution
of cases in families, we discover material differences. Thus,
in Islington there were but 22 solitary attacks—out of 175: the
cases mostly occurred in groups of from two to eight in a family,
the average being a little over three. So in Marylebone groups of
cases, ranging from three to six in a family, were observed, and in
one house, out of 30 children, 18 were stricken: but in Kensington
ten of the sixteen cases were solitary—there were only three
groups of two cases in each, viz., in one family two young childdren;
in another, a married couple; and in a third, a child and a
nurse—the second cases occurring not simultaneously but after
many days, so that for the purposes of the enquiry, qua
origin of the outbreak, they may be entirely disregarded.
In one house containing 28 persons, of whom 20 were children,
and where 16 pints of milk were consumed daily, there was but
one case—a servant.
At the time of the Islington and Marylebone outbreaks,
Typhoid fever was comparatively in abeyance in those portions of
the parishes where the infected milk had not been distributed,
and, I believe, in the Metropolis generally; but the Kensington
cases occurred at a time when the disease is known to have been
more than usually prevalent.
In respect of the fatality the several outbreaks presented marked
differences. Thus, in Islington about the ordinary percentage of
cases (17) pioved fatal, a rather remarkable and suggestive fact
qua origin, seeing that "milk typhoid" is usually a mild form of
the malady: in Marylebone the mortality was only 10.6 per cent.;
but in Kensington 8 out of 16 persons attacked died, equal to a
rate of 50 per cent. This rate, however, would be considerably
reduced if the whole of the cases were taken into account, for of