The subjoined table shows the death-rate in the parish for 13 periods of four weeks corresponding to my monthly reports, the deaths of non-parishioners in the Brompton Hospital being excluded:—
| Date of Report. Four weeks ended | Rate of Mortality per 1,000 living. | Mean temperature of the air. |
| January 31 | 19.8 | 41.6 |
| February 28 | 23.2 | 38.7 |
| March 28 | 22.0 | 43.0 |
| April 25 | 16.8 | 49.5 |
| May 23 | 16.8 | 48.2 |
| June 20 | 14.1 | 58.4 |
| July 18 | 17.5 | 62.8 |
| August 15 | 19.9 | 61.1 |
| September 12 | 14.7 | 59.4 |
| October 10 | 13.7 | 55.3 |
| November 7 | 15.3 | 51.6 |
| December 5 | 21.4 | 39.1 |
| January 2 (1875) | 24.7 | 32.7 |
| Average | 18.4 |
Before concluding these general and prefatory remarks, I think it right to say a few words on the subject of certain outbreaks of disease due, it is not unreasonably believed, to a contaminated condition of that important article of diet, milk. It is true that the facts to which I am about to advert belong rather to the sanitary history of the current year than to 1874; I feel, however, that it would not be right to defer the publication of them, and the subject can be referred to again, if necessary. With reference first, then, to scarlet fever, a remarkable outbreak occurred in the month of June (1875) in South Kensington. Within sixty hours after a dinner party of sixteen in one of the most splendid streets in the metropolis, and in a house which had no sanitary defect and no infected inmates, six of the party were prostrate with scarlet fever. There was a large assemblage at the “at home” after the dinner, and four or five of the guests were stricken either with primary scarlatina or with characteristic sore throat. Some of the servants and others, likewise, were similarly affected. A vigorous enquiry excluded all suspicion of personal contagion as the cause of the outbreak. The one fact clearly proved was that all the sufferers had partaken of cream in some form or other, cream being of course more largely consumed at the dinner than at the “at home.” Many persons, doubtless, who partook of cream escaped, and their immunity may be accounted for in a variety of ways; but it is certain that every one who was attacked had partaken of cream. There were several curious not to say crucial cases, pointing to the cream as the nidus of infection. But how the contagium found its way into the milk-pot, if there, is a question that has hitherto baffled enquiry. The dairy—in town, but not in Kensington—whence the offending fluid was obtained was carefully scrutinised as to the state of health of the cows and of the employés, but no fact was elicited to explain the occurrence. [11]
As bearing on this subject, I may remark that it is not very long ago that a number of cases of sore throat, occurring in families supplied from a certain dairy, were brought under my notice; and I ascertained that illness of a similar character had prevailed in the house of the dairyman.
Referring to this subject, Professor Parkes, in his “Practical Hygiene,” states that scarlet fever has appeared to get into milk from the cuticle or throat discharges of persons affected with scarlet fever who were employed in the dairy while ill or convalescent. Remarkable cases of this kind have already been reported, and the fact that another zymotic disease—viz., enteric or typhoid fever—has been spread widely through the medium of milk, only serves to increase the importance of the subject in a sanitary point of view. It is well ascertained, however, that enteric fever has been conveyed in the foul water used in diluting milk—a double evil being thus inflicted on unwary purchasers.
At about the same time as the scarlatina outbreak my attention was again directed to milk as a probable source of disease by a leading practitioner, who gave me the particulars of a very interesting series of cases of dysentery, attributed on apparently sufficient grounds to the use of milk from diseased cows; and of a further series of cases of diarrhæa, attributed to some change in the character of milk supposed to depend on the food on which the cows were being fed. The information came too late to admit of an investigation of the subject, but the facts deserve to be put on record for future guidance.
In the first set of cases, seven in number, the symptoms were generally of a severe character. Three of the patients were young children, and the other four adults. The child first attacked, aged 2½ years, died after seventeen days’ illness. The dysenteric symptoms were sharp and constant, and marked on the first evening by a strong convulsion. The little patient sank, worn out by incessant tenesmus and exhausted brain-power. The body temperature was high throughout. This was the only fatal case. The second case was that of the child’s nurse. She was sent home showing signs of fever, and was ill a long time. In the third case the child, aged six years, had dysenteric straining of almost pure blood. There was little constitutional disturbance, and the attack soon yielded to treatment. The fourth case was that of a middle-aged gentleman attacked with diarrhæa, which assumed a dysenteric character, as many as twenty-five motions being passed in a day. The attack, which left marked debility; lasted ten days. The next case was that of an old nurse, who, ridiculing the idea of the milk being the cause of illness, drank all that was left after tea one day, and was rewarded with a violent diarrhæa that lasted a whole week. Another case was that of a child (who, however, was teething, and) who, after partaking of milk from the same source, suffered during six or seven days under a severe dysenteric attack. The seventh case was that of a lady, who after some days of bowel irritation, was prostrated with acute dysentery which was long in yielding and left great debility.
Upon enquiry being made of the dairyman who supplied the affected families with milk, he acknowledged that two, if not three, of his cows were “wrong in their quarters”—i.e., they had diseased udders; but he hoped that the small amount of bad milk they yielded would not be felt with the large quantity of good milk with which it was mixed! In each case the supply of milk from that particular dairy was cut short, and as regards the families interested, a limit was thus set to the endemic. But what mischief, if any, was done in other directions does not appear, and it is too late to enquire.
The other cases referred to were eleven of diarrhæa, which occurred at about the same period of time. The milk supply was derived in part from a dairy and in part from cows kept for private use, the one point in common between the two sheds being that “distillers’ wash” formed part of the food of the cows. There is no history of any illness or disturbance of the secretion of the cows themselves.
I regret that I had not an opportunity of investigating these cases—and especially the first series—at the time of their occurrence, as they might have thrown some light on an obscure but very important, an increasingly important subject—viz., that of disease in animals as a factor of disease in man. Professor Parkes states, inter alia, that milk contaminated with pus from an inflamed udder will give rise to stomatitis (inflammation of the mouth) in children and to apthæ (thrush) on the mucus membrane of the lips and gums. But there is no mention of these symptoms in the cases under review. Parkes also refers to the power of milk which contains large quantities of the fungus Oidium lactis, or Pennicillium, to produce dyspeptic symptoms, and even cholera-like attacks. Gastric irritation and febrile gastritis are also enumerated among the effects following the ingestion of impure milk.