MILTON J. ROSENAU 4^3 



more or less contact with the milk from over 40,000 dairy farms. It is estimated that 

 there are 1,300 typhoid carriers in Massachusetts, 60 of whom are known (1927). 

 Typhoid fever has also been traced to cream, ice-cream, and other milk products. 

 Milk-borne outbreaks of parat3^hoid fever have been described by Levine and 

 Eberson,' Williams,^ and others. 



Scarlet fever. — Milk-borne outbreaks of scarlet fever are sometimes extensive and 

 serious. The milk is practically always infected from human sources. So far as known 

 cows do not have scarlet fever. There is a suspicion, however, that some streptococcal 

 infections of the cow may reproduce a disease resembling scarlet fever in man. 



Two outbreaks of scarlet fever due to ice-cream have been reported. One took 

 place in South Kensington, England, in 1875, following a large dinner where the des- 

 sert was frozen pudding.'^ A clear-cut outbreak due to ice-cream occurred in Flint 

 (Mich.), in July and August, 1924, involving forty-one cases extending over seven 

 days. The ice-cream was infected by the maker, who had a mild case of scarlet fever.^ 

 Cold does not destroy, but rather preserves, this and other viruses. 



Diphtheria. — Diphtheria bacilli in milk practically always come from human 

 sources, either cases or carriers. In a few rare instances ulcers upon the teat of the 

 cow have become infected with diphtheria, and the bacilli are thus transferred to 

 the milk. Such an occurrence, however, is unusual. Even in such instances the ul- 

 cers are infected from human sources. As a rule, diphtheria outbreaks caused by 

 infected milk are more limited both as to numbers and area than milk-borne out- 

 breaks of typhoid or scarlet fever. 



Septic sore throat. — The first milk-borne outbreak of ''septic sore throat" recog- 

 nized in this country occurred in and about Boston in May, 191 1. Since then simi- 

 lar outbreaks have occurred in Baltimore, in Concord in New Hampshire, in Chicago, 

 and elsewhere. The disease has spread, and our country is now seeded with this in- 

 fection. Septic sore throat due to infected milk has been well known in Great Britain 

 for thirty years. Swithinbank and Newman state that a year never goes by in which 

 there are not outbreaks of sore throat or tonsillitis due to milk or cream. The infec- 

 tion usually gets into the milk from human sources, although it is suspected that 

 some streptococci associated with diseases of the udder may be pathogenic for man. 



Smith and Brown^ have shown that the responsible organism is Streptococcus 

 epidemicus,^ and furthermore disclose a difference between human (epidemicus) and 

 bovine (/3 type) streptococci. Both are hemolytic. The bovine streptococci produce 

 garget in cows but do not cause tonsillitis in man; on the other hand, the human 

 streptococci produce sore throat in man but have slight pathogenicity for cows. 



Smith and Brown studied the streptococci from five milk-borne epidemics at first 

 hand, together with cultures from the big epidemics of Chicago, Baltimore, and Bos- 



' Levine, M., and Eberson, F.: J. Infect. Dis., 18, 143. 1916. 

 ^Williams, H: J. A.M. A., 84, 251. 1925. 

 3 Buchanan, G. S.: Rep. Loc. Gov. Bd. Suppl. 72. 1875. 

 t Ramsey, G. H.: Am. J. Hyg., 5, 669. 1925. 



5 Smith, T., and Brown, J. H.: /. Med. Research, 31, 455. 1915; also Smillie, W. G.: /. Infect. 

 Dis., 21, 45. 1917. 



^ Brown, J. H., Frost, W. D., and Shaw, M.: 7. Infect. Dis., 38, 381. 1926. 



