A report on the influence of milk in spreading zymotic disease : with a tabular analysis of forty-eight outbreaks / by Ernest Hart.

  • Hart, Ernest, 1835-1898.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: A report on the influence of milk in spreading zymotic disease : with a tabular analysis of forty-eight outbreaks / by Ernest Hart. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    subject of the outbreak. Thus of 19 medical practitioners personally urged by the Ealing Saniiary Authority to give information, and furnished with forms for facilitating its record and transmission, not more than ii supplied facts of the sort asked for; other 8 either sending no reply at all or refusing the names and addresses of their patients. Some few, too, of private residents in the place believed to have suffered throat illness in their families disregarded the appli- cation made to them by Mr. Power by circular letter; among them being a gentleman, a customer of the suspected dairy, who had lost a child by diphtheria. Special Incidences op Milkborne Disease. In some outbreaks traced to milk the incidences on special sections of the community have been excessively heavy or singular. These sections have sometimes been whole villages, at other times they have been merely the residents in some very restricted local area, or even a single dwelling. In the case of an outbreak of concurrent scarlatina, diphtheria, and throat illness at Upton, in February, 1889 (No. S. 18), as many as 77 per cent, of the households using tbe implicated milk were invaded, and 37 per cent, of the contained members were attacked. In the case of an outbreak of scarlatina at Glasgow in August, 1892 (No. S. 24), out of 193 families sup- plied with a particular milk service in one round, there were 57 families invaded and 91 individuals attacked ; whilst of 166 families on another round there were 37 families invaded and 59 individuals attacked. Moreover, in one street 21 families, being more than half those supplied with the milk, were invaded, and yielded 29 cases. Concurrent Diseases. Another feature of milk outbreaks not altogether infre- quently met with is the concurrence at the same place, and, indeed, in some instances in the same individual, of multiple diseases. In the case just before mentioned—that of Upton— which, together with the adjacent town of Macclesfield, was visited by a milkborne epidemic, the three diseases of scarlatina, diphtheria, and allied throat maladies, were con- current in the invading localities. The outburst was of scarlatina, quite suddenly, after long absence of the disease; in addition, much throat mischief was prevalent, and there were two undoubted cases of diphtheria. Other instances of special incidence are deserving of brief notice. As Bush Hill Park (No. S. 21) all the cases of scarlatina were in drinkers of the particular milk, and 33 cases arose in 22 households; and in the dairyman’s own family the infant fed on “ nursery ” milk escaped, and another child taking the implicated milk was attacked. At Hastings, in 1893 (No. S. 27), of 20 boys in a school, the only patients were 2 who partook of the suspected milk separately each morning. In Ganterbury, in 1886 (No. D. 6), of 196 houses supplied either wholly or inpart by the milk, 115 were invaded by diphtheria in a period of eight days. In a family taking other milk at home, the only case was of a member who took the suspected milk in his tea at a friend’s house. At Glapham, in 1882 (No. T. F. 3), in a family of 15 persons, only I was attacked, and he the only drinker of the milk in a raw state. At f?t. Albans, in 1884 (No. T. F. 15), i visitor to tbe farm in question as causing typhoid fever by its milk supply, and who drank one glass of milk, was attacked. In Edinburgh, in 1890 (No. T. F. 27) in a household of 9 mem- bers the only one attacked was a young adult who nightly partook of a large quantity of milk on coming home from a hard day’s woik. In tbe case of typhoid fever caused by the ingestion of ices in Greenw’icb and Rotherhithe in 1892 (No. T. F. 43), 2 boys living in different streets, but eating ice ci’eams from the same street vendor were the only members attacked in their respective households; and a servant girl, who visited the invaded district on Sundays, and who partook of ices therein, was the only one of her mistress’s household attacked. Help from Unpromising Facts. The special significance of some apparently unpromising facts in the couise of the elucidation of problems surrounding milk outbreaks has been noticed in some cases, and this par- ticularly in the instance of the renowned scarlatina epidemic at Hendon and in North London, in 1885 (No. S. 10), where Mr. Power was bothered by the exceptional absence of scarla- tina from one locality taking milk from the farm which seemed to be spreading the disease in the other quarters using the milk. But he was able to demonstrate that the locality in question did not at the time of its clean bill of health receive milk from certain cowsheds at the farm ; when at a later date it also began to suffer from the malady in the person of the milk drinkers, it was found that the cows which in this case were the media of infection had been transferred from infected sheds to the sheds whence the locality was supplied. Hence the facts were after all found to have sig- nificance tending further to inculpate the implicated milk. And when the milk was prohibited in London, it was found to be causing scarlatina among persons at Hendon to whom it had, on its rejection by London, been clandestinely given. Housing of Milch Cows. Some amount of attention is, as will be readily agreed, necessary to the conditions of housing of milch cows. In the case of Hastings, in 1893 (No. S. 27), the cowsheds outside the district were badly drained and ill-paved, and deficient in ventilation; and Dr. Scarlyn Wilson, the health officer,is of opinion that the febrile condition of the cows noticed was doubtless due to the insanitary character of their housing. The milk in question at St. Helens, in connection with an outbreak of typhoid fever in 1895 (No. T. F. 46) came from a shippon which was in a filthy state, and in which cows and pigs were both housed, tbe floor being rubble-paved, a gully being in the shippon, and inches of animal manure littering the place. These are conditions for which there can be adduced no reasonable excuse, cleanliness being one of the prime essentials of all dairying businesses. Farmers as Scavengers. Dr. Brown, of Bacup, has drawn attention to the case of a dairy farmer who combined the occupation of dairy farming with that of scavenger, having in the latter capacity to see to the removal of night soil. Dr. Brown very properly animad- verts on this strange and dangerous multiplication of offices, pointing out how easy it is to surmise the entry of hurtful matter into any milk with which the farmer had to do (No. T.F. 41). Concealment of Infectious Disease. The concealment of infectious disease on dairy farm pre- mises and the like has played its part in the causation of dis- ease through the agency of milk. At Sunderland in 1882, in connection with an outbreak of scarlatina (No. S. 5), the ill- ness at the dairy in question was only accidentally discovered, it not having been reported. At a milk shop in Hull (No. S. 7) a child was ill of scarlatina three weeks before knowledge of the case came to the health authorities, and no steps had in the interval been taken to guard the milk from chance of in- fection. And these are but instances taken from the list of epidemics summarised. Unnotified Infectious Disease. Near akin to concealment of disease is the subject of non- notification. Typhoid fever of a fatal character in the person of a farmer, and of a non-fatal sort in the person of his son, was not reported at a farm implicated in the outbreak of that disease in Mid-Warwickshire in 1883, reported on by Dr. Wilson (No. T.F. 13). At Plymouth, when an outbreak of typhoid fever occurred there in 1892 (No. T.F. 29), the Infectious Disease (Notification) Act of 1889 was not in force. And it is this all-impojtant matter of non-notification which has in the past had much to do with the uninterrupted pro- gress of many milk caused epidemics, the health body having been kept in ignorance of the fact of disease being in their midst unchecked until their attention has been drawn to the circumstance by the data afforded by death registers and other tardily received information. Undetected Infectious Disease. Closely allied to the matters just treated of is the discovery of illness in the families of dairymen, farmers, and the like, when milk has been traced to be the medium of dissemina- tion. Thus we see in the instance of an outbreak of scarla- tina at Greenock in 1881 (No. S. 2), that there had been cases of that disease recently before in the farmer’s family. At Glasgow in 1888 (No. S. 17) theie was found to have been ill-