This section is from the book "Smith's Family Physician", by William Henry Smith. See also: Natural Physician's Healing Therapies: Proven Remedies that Medical Doctors Don't Know.
That it occurred in the house of the milk-vendor, where the business was carried on; he died; and seven other persons, members of his family, or boys employed and living on the premises, had Typhoid, and one of the latter died.
That it occurred in the family of a person who dwelt in a small cottage in the cow-yard, distant about 100 yards from the last-mentioned house and dairy, three persons having fever here. The first case here was in a girl, who, a fortnight before she actually fell ill, had left a situation at a public house supplied with milk from this dairy, and since then had been residing at home. This family, the mother of the girl told me, rarely took milk, except on Sundays, being poor: but when the girl was ill, milk was given to them from the dairy. The mother herself, and subsequently a little boy, had Typhoid when the girl was convalescent.
That, in addition to the two boys who had lived in the house for a longer or shorter time, two men engaged in the business, who did not live in the house, had Typhoid. One of these was the cowman, engaged after the master was taken ill: the other was a young man who worked in the cow-yard, and carried out milk, and who took all his meals at a coffee shop supplied from the dairy, and where two families, also supplied from the dairy, had fever. That a fifth man, employed at the cow-yard, and residing at home, had fever. He also occasionally had his meals at the above-mentioned coffee shop, and his tea at his mother's, who was supplied from the dairy. His family being poor, he bought no milk for them anywhere, and he was the only member of it attacked.
That another single man, residing within the radius in a wholesale house, and engaged as a coachman outside the radius, who habitually took his meals at this same coffee house, had an attack of Typhoid.
That (omitting the girl who came ill from the country), out of sixty-two other families within the district which are known to have suffered from Typhoid, fifty-four, or fully 87 per cent., were constantly supplied from the dairy with the milk they required, two were occasional customers, and five only stated that they did not deal there at all. I am not quite sure that complete reliance can be placed on this last statement: certainly I doubt it in one case out of the five. All five resided close to the dairy, and it is most probable obtained there, as the most convenient place, any extra milk their families required. In another instance, a girl was attacked in a family not supplied by the dairy, but it appeared that, on two consecutive days in the beginning of July, she had taken tea with a schoolfellow, who, with her mother, had Typhoid a few days later, this family being supplied from the dairy. No one else in this girl's family had fever.
Confining myself now to the fatal cases happening in families within the quarter mile radius, (some of which individuals, however, were taken ill or died in the country), but excluding the girl who came ill from the country, and died within the radius, I find that the total of such cases was twenty-five. Every one of the families in which these deaths occurred dealt for milk with the dairy in question-I include here the deaths in his own household;-only one of them was an occasional customer.
Outside the radius, in the rest of the parish, I said I had fourteen fatal cases to account for. Five of these fourteen occurred in families supplied by this dairy, that is, more than a third of them. With such facts as these before me, I had a strong prima facie case against the milk; but, strong as it was, it did not absolutely exclude the idea of coincidence. I did not know how far the dairyman's connection extended. I learned, however, that customers of his outside the radius, some at the distance of a mile or more, had been attacked with Typhoid, and that several of them had died. What I had now to do, therefore, was to ascertain what families he actually did supply; with this information I should be able to determine the question decisively. Accordingly I communicated to the father of the deceased dairyman the rumour which was freely canvassed both in the profession and in the neighbourhood, and suggested that it would assist in settling the question, if he would consent to furnish me with a list of his son's customers. It redounds greatly to his honour that he at once complied with my request, and expressed his desire to do everything in his power to assist in unravelling the mystery of the outbreak. I may say here, as the proper place for saying it, that he fully carried out his promise, and in doing so has earned not only my personal respect, but the sympathy and respect of every right-minded person.
The result of my inquiry in this direction is that the members of 142 families were supplied with milk from the dairy in question. The district within the quarter mile radius alone must contain over 2000 families. So, after all, no very considerable proportion got their supply from this source. Out of these 142 families (which includes the dairyman's household), I have ascertained that 70 were invaded with Typhoid within the ten weeks during which the outbreak extended,-that is to say, half of them were invaded. This includes all the families which had deaths from Typhoid. I did not go from house to house to inquire among all the customers, so that it is quite possible that other non-fatal cases may have occurred in other families whose medical attendants have not communicated with me. But this is enough for us. Inquiring as to the source of milk-supply in all the other instances of Typhoid in the parish, during the same period, that came to my knowledge, I scarcely ever heard the name of any one milkman mentioned twice.
In these 70 families there happened altogether 175 cases, of which 30 were fatal.
Again, taking the list of customers, I have gone through my mortuary records with it house by house, and I find that, besides the thirty deaths from Typhoid which I knew of, there were altogether but three other deaths in these families; one was of an infant born prematurely (from what cause I could not ascertain), one was a person who died suddenly with fatty degeneration of the heart, and the third was an old lady, whose death is attributed on the certificate to "Choleraic diarrhoea."