Milk epidemic of scarlet fever and angina, originating from a milkmaid with scarlatinal otitis media

Abstract

A report is given of a milk epidemic of scarlatinal angina, comprising 118 cases of scarlet fever and about fifty cases of sore throat.The infection was spread through contamination of the milk from a milkmaid with purulent otitis media after non-recognized scarlet fever.On cultivation,Streptococcus pyrogenes, group A (Lancefield), type 3 (Griffith) was isolated from 108 of these patients and from pus from the ear of the milkmaid. The cows, on the other hand, and their milk were found to be normal (two examinations at an interval of 6 days).Inquiry into the conditions under which the milk was transported from the producer via the dairy to the consumers and information concerning the distribution and consumption of the milk confirmed in all details the assumption as to the causal connexion between the otitis media in the milkmaid and the outbreak of the epidemic.This epidemic furnishes an example of transmission of the infection from man directly through the milk to a fairly large number of consumers without any intermediate infection (mastitis) in the cows.Clinically the cases in this epidemic may be said, on the whole, to be mild; still, one of the patients died of complicating bronchopneumonia.