PROPAGATION OF TYPHOID FEVER AT ISLINGTON BY MILK.

New Zealand Mail, Issue 13, 22 April 1871, Page 4

PROPAGATION OF TYPHOID FEVER AT ISLINGTON BY MILK.

On Saturday evening Dr Ballard read a paper before the Association of Medical Officers of Health, remarkable for the novelty and gravity of the. facts it disclosed, for the wonderful acuteness and patience used in tracking them out, and for the precision and clearness with which the various links in the chain of evidence were connected. No wonder it was listened to with breathless attention, and received the enthusiastic applause of the members present. The President compared it to the gradual unfolding of some harrowing mystery in a tragic drama, and Dr George Buchanan averred that he had never met with a closer and more ably constructed piece of medical logic. The paper was by acclamation ordered to be printed, and circulated pro bono publico. Meanwhile, as we have been able to present it entire to our readers, we will venture on a short summary of its contents. That typhoid fever should be propagated through the medium of contaminated milk is a horrible idea. It implies unsuspected dangers to the helpless part of the population in the commonest and most innocent article of food ; and what adds to the horror is the fact that many physicians are in the habit of ordering milk largely as the diet of typhoid patients, wno might thus be imbibing fresh doses of poison in the guise of this blandest. and simplest of food. The facts which Dr Ballard made out are shortly these. Typhoid is, as is now agreed, propagated by sewer poison. Now, there was on the premises of a certain respectable milk-dealer at Islington an underground wooden tank, supplied from the mains of the New River Company. This has not been opened or inspected for years. When opened at Dr Ballard's desire, some inches of one side were found decayed or destroyed by rats. This allowed the water to flow over into a hole in the ground, evidently scooped out by' rats, and leading to certain underground ratburrows, by which, when the tank was filling, the water flowed into some old brick drains and Water-closet drains close by. Through these underground channels there was free communication between the tank and the sewers; not only could water run away into the drains but foul gasses from the drains were sure to pass back into the tank; and in June last an alteration was made in the drains, during which they were obstructed, so that there would be a reflux of the overflow water from these drains and rat-burrows back into the tank. It is a significant proof that this did happen, that.atleast two families shortly afterwards complained that the milk " had a bad taste," and that the milk when kept became "not merely sour, but stinking." It is certain, the milk-cans were washed out with water from this tank, and a shrewd suspicion may exist that some of it was mixed with the milk; but, if so, it must have been done without the master's knowledge; because if ever water wa,s used for this purpose it was taken from another cistern, which also supplied the house, and the tank water was intended only for washing and stable use. Giving, then, milk poisoned with a small dose of swerage, we find that the milkman, his family and servants and customers were very soon affected with a peculiarly fatal typhoid fever ; and the connection between the milk as cause, and the fever as effect, is shown by the fact that the fever was confined virtually to those who drank his milk. The mecal" practitioners of the neighborhood soon became aware of the existence of an extensive and fatal epidemic in a limited district in the healthiest part of Islington. Of course, all the obvious and usual causes were first suggested, inquired into, and dismissed as untenable. The exposure of new ground in widening the railway, the nuisance of huge dung-shoot, and the existence of foul drains in houses, were all accused turn ; but it was the milk distribuiion alone which was proved to be co-exten-sive with the fever. Dr Ballard ascertained that 142 families, including the milkman's own, formed the " milk wall" or clientelle of tins dairy. Of these one hundred and forty two, it is known that 70 families were invaded by typhoid in the ten weeks during which time the outbreak lasted. In these 70 families

were 175 patients, of whom.3o died—a mortality of more than 17 per cent. It was remarkable to see how trie typhoid picked out the families supplied from this one dairy, and avoided all the rest. Wherever it appeared, it did'not attack one, but several members of the household. In certain families, where particular members took no milk; they escaped, whilst others suffered. ' The women and children who took most milk, suffered in greatest proportion. A lady who had a tumbler of this milk daily, whilst the house was supplied from another source, was the only victim in the house. The dairyman himself, and his workmen, who, of course, took the milk freely, were amongst,the first Victims—for this, like other outbreaks, became milder as time went on, and ceased when the business wa9 given up and the cows, sold, some time after the death of the proprietor. Meanwhile, the disease was mainly confined to a circle within a quarter of a mile radius from the dairy, whilst the rest of the extensive parish of Islington was virtually free. We have just given the list of the facts set forth in Dr Ballard's very able and closely-argued paper, to which .we must refer for a fuller narrative. Meanwhile, the notion of " death in the milk pail'' is as disagreeable as it is unexpected.— "Medical Times and Gazette," Nov. 26.