POINTS OF INTEREST IN REPORTING MILK EPIDEMICS. In reporting milk epidemics some of the points of special interest are the following: 1. The number of cases of the disease existing in the involved territory during the time covered by the epidemic. 2. The number of houses invaded by the disease. 3. The number of invaded houses supplied in whole or in part, directly or indirectly, by the suspected milk. 4. The number of cases occurring in invaded houses so supplied. 5. The number of houses supplied with the suspected milk. 6. The relative proportion of houses so supplied to those supplied by other dairies. 7. The time covered by the epidemic. 8. The location of the case or cases from which the milk became contaminated. 9. The relation of the original case to the milk. 10. The time relation of the original case to the epidemic. 11. The special incidence of the disease among milk drinkers. 12. The elimination of other common carriers of infection. 13. The effect upon the epidemic of closing the dairy or taking such measures as will eliminate possibility of milk contamination from the suspected focus. 14. The finding of the specific organism in the milk. BUSEY AND KOBER'S SUMMARY OF EPIDEMICS. Busey and Kober summarized the epidemics compiled by them as follows: TYPHOID-FEVER EPIDEMICS. Mr. E. Hart tabulated 50 epidemics of typhoid fever and we have collected 88, making a total of 138 epidemics traceable to a specific pollution of the milk, the main facts of which are presented in a subjoined table. In 109 instances there is evidence of the disease having prevailed at the farm or dairy. In 54 epidemics the poison reached the milk by soakage of the germs into the well water with which the utensils were washed and in 13 of these instances (Nos. 5, 24, 39, 45, 70, 89, 90, 98, 99, 103, 111, 116, 124), the intentional dilution with polluted water is admitted. In 6 instances (Nos. 10, 74, 104, 107, 112, 121) the infection is attributed to the cows drinking or wading in sewage-polluted water. In three instances (Nos. 118, 123, 131) the infection was spread in ice cream prepared in infected premises. In 21 instances the dairy employees also acted as nurses (Nos. 1, 6, 12, 16, 17, 24, 30, 37, 38, 41, 46, 52. 65, 68, 82, 110, 111, 115, 126, 127, 133). In 6 instances (Nos. 101, 102, 113, 117, 132, 134) the patients while suffering from a mild attack of enteric fever, or during the first week or ten days of their illness continued at work, and those of us who are familiar with the personal habits of the average dairy boy will have no difficulty in surmising the manner of direct digital infection. In one instance (No. 24) the milk tins were washed with the same dishcloth used among the fever patients. In one instance (No. 87) the disease was attributed to an abscess of the udder, in another (No. 92) to a teat eruption, and in No. 81 to a febrile disorder in the cows. Nos. 85, 103, 120, and 127 were creamery In No. 96 the milk had been kept in the sick room. cases. SCARLET-FEVER EPIDEMICS. Mr. Hart collected 15 epidemics of milk scarlatina, and we have tabulated 59, making a total of 74 epidemics spread through the medium of the milk supply, the details of which will be found in Table No. II. In 41 instances the disease prevailed either at the milk farm or dairy. In 6 instances persons connected with the dairy either lodged in or had visited infected houses. (See Nos. 8, 9, 10, 11, 15, 40.) In No. 12 the milkman had taken his can into an infected house. In 20 instances the infection was attributed to disease among the milch cows; in 4 of these (Nos. 17, 18, 19, 35) the puerperal condition of the animal is blamed. In 9 instances disease of the udder or teats was found. (See Nos. 30, 31, 34, 39, 41, 59, 61, 62, 66.) In one instance (No. 54) the veterinarian diagnosed a case of bovine tuberculosis. In 6 instances there was loss of hair and casting of the skin in the animal. (See Nos. 17, 18, 19, 38, 40, 41.) In No. 68 the cattle were found to be suffering more or less from febrile disturbance. In 10 instances the infection was doubtless conveyed by persons connected with the milk business, while suffering or recovering from an attack of the disease (see Nos. 2, 22, 26, 29, 42, 57, 58, 60, 69, 71), and in at least 8 cases by persons who also acted as nurses. (Nos. 1, 2, 7, 9, 13, 14, 25, 63.) In three instances (Nos. 1, 73, 74) the milk had been kept in the cottage close to the sick room. In No. 15 the cows were milked into an open tin can which was carried across an open yard past an infected house, and in No. 53 the milkman had wiped his cans with white flannel cloths (presumably infected) which had been left in his barn by a peddler. Nos. 21 and 44 appear to have been instances of mixed infection of scarlet fever and diphtheria. DIPHTHERIA EPIDEMICS. Mr. Hart collected 7 epidemics of milk diphtheria and we have added 21 more. (See Table III.) In 10 of these 28 instances diphtheria existed at the farm or dairy, and in 10 instances the disease is attributed directly to the cows having garget, chapped and ulcerative affections of the teats and udder, while in No. 13 the cows were apparently healthy but the calves had diarrhea. (See Nos. 2, 5, 14, 18, 19, 20, 21, 22, 24, 25.) In No. 23 one of the dairymaids suffered from a sore throat of an erysipelatous character, and in No. 27 the patient continued to milk while suffering from diphtheria. In No. 28 one of the drivers of the dairy wagons was suffering from a sore throat. pected milk and these had 42 (?) Sudden outbreak among pa- At dairy. 63 Only 19 cases of typhoid fever Probably by polluted spring water. Sudden outbreak limited to patrons of 1 dairy. Lived over milk Possibly by in- Probably been a case Outbreak on 1 milk route. A At dairy. fected cans re- milk depot to main dairy. Most likely by Sudden explosive Outbreak limited Dr. J. T. Shepherd, |