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30
local Medical Officers of Health with the names of the purveyors to
whom they send supplies.
If this had been done in the case I am discussing it would
have been useless for the farmer to juggle with his contract note,
as, immediately that the presence of typhoid at the farm had been
known, the local Medical Officer of Health would have communicated
with Dr. Caldwell Smith and myself.
Another point is that it is doubtful if statutory powers exist to
prevent cheese being made from infected milk.
Immediately that the supply of milk to London from his farm
was rejected, the farmer began to make cheese from it.
What happened to the cheese I know not: but Medical Officers
of Health should certainly have the power at once, on discovery, to
suspend the sale of such stuff.
Three cases of typhoid that occurred during 1909 had no
relation to this outbreak.
In one instance the history pointed to ice cream, purchased at
Hammersmith, as the vehicle: in another the lad had drunk water
from Beverley Brook, and in the third there was a history of personal
contact with a convalescent patient outside the district.
Three fatal cases of Puerperal Fever occurred during 1909.
All three were delivered by medical men.
In one case peritonitis followed difficult instrumental
delivery : in both the other cases the patients were, at the time of
parturition, suffering from phthisis, and it was difficult to decide
how far the deaths were due to septicaemia, and how far to miliary
tuberculosis.
As stated in my previous reports, since the coming into force of
the Midwives' Act the actual inspection of the work of registered