DIAGRAM I. SHOWING RELATION OF MILK ROUTES TO TYPHOID FEVER CASES DURING THE EPIDEMIC AT STAMFORD, CONN., 1895. SUMMARY OF EPIDEMICS. Of the 51 scarlet fever epidemics reported as spread by milk, compiled by the writer, 25 occurred in the United States and 26 in Great Britain; all cases enumerated in the outbreak were reported as living in houses supplied with the suspected milk in 27 of the epidemics; a case suffering from the disease at such a time as to have been the possible source of infection was found at the producing farm, the distributing dairy, or milk shop in 35 cases; the outbreak was supposed to have been due to bottles returned from infected households and refilled without previous sterilization in 3 cases; the diseased person or persons were mentioned as handling the milk or milk utensils in 3; the sick milked the cows in 12; the same person nursed the sick and handled the milk in 1; same person nursed sick and milked cows in 1; the outbreak was supposed to be due to disease of the cow in 2; it was reported that measures taken upon the presumption that milk was the cause of the epidemic were followed by abatement of the outbreak in 22 cases. The following outbreak is one of many interesting illustrations: SCARLET FEVER IN NORWALK, CONN." In November, 1897, an unusual number of cases of scarlet fever occurred in Norwalk. Population of Norwalk, South Norwalk and East Norwalk, 22,000. Previous to October 25 scarlet fever had been reported as follows: August, no cases; September, 5 cases; October 10, one case. The source of infection in most of these cases had been traced. Between October 25 and November 9, 29 cases developed. The 29 cases were distributed in 25 families and 24 houses. School infection was eliminated. Many cases did not attend school, and some were in families where they had no school children. The cases were widely separated; 17 of the infected houses were in South Norwalk, 3 in Norwalk, and 4 in East Norwalk. The families were of different social positions and contactinfection seemed improbable. The only factor in common to practically all of the cases was the milk supply. Twenty-seven out of the 29 obtained milk from one dealer, H. The other two were in one family in East Norwalk; they were a girl of 12 and boy of 9 years, and were taken ill on November 7 and 9, respectively. They had no connection with the milk route, nor could their infection be traced to any source. Smith, (Herbert E.); Report Connecticut State Board of Health, 1897, p. 259, EXPLANATION OF DIAGRAM II. A., B., and K. are dairy farms selling their product to retail milk dealer H. K. is the farm on which a case of scarlet fever occurred antedating the outbreak in Norwalk. The large square T. O. W. N. represents the city of Norwalk. H. is the retail milk dealer among whose customers all cases but two occurred. The dash-lines represent H.'s milk route, and each dot is a case of scarlet fever. C., D., E., F., G., I., and J. are other dairymen having routes in Norwalk. The lines extending from them into the city represent their milk routes and are introduced to show their freedom from the disease. (30) |