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"de novo" origin of typhoid fever at times. This water supply
might have become fouled by simple pollution, but the probability
of specific infection was negatived.
Of the 11 primary cases which occurred in Barnes, all recovered.
Two secondary cases occurred and also recovered. I believe that
the cases in Wandsworth also did well. Clinically the outbreak
was interesting on account of the number of quite young children
infected. I had one case, as already narrated, aged but 18 months.
Quite a number of the cases began with symptoms, and
some with physical signs of acute lobar pneumonia, and
most had a heavy crop of spots. There are several other points of
interest, notably the enormous importance of the correct diagnosis
made, under difficult circumstances, by Dr. Hovenden.
This diagnosis was arrived at on clinical grounds, though
disputed for weeks by the pathologists of a first-rate London
Hospital.
Although of course most of the cases were notified after the
probable medium of infection was recognised definitely on February
14th, all of them were infected before the sterilization of the
milk commenced on February 15th, and as nearly 20,000 persons
were being supplied daily by the one purveyor, the possibilities for
mischief were very great.
Dr. Caldwell Smith was most kind and helpful in his co-operation
with me, and we both received all possible assistance from
the purveyor, who did everything to help us in elucidating
the facts.
One or two practical recommendations may perhaps be made.
Valuable as it is for Medical Officers of Health in towns to be
supplied, by purveyors of milk, with lists of their sources of supply,
it would be infinitely better were dairy farmers compelled to furnish