70 CITY MILK SUPPLY 



largement of the cervical glands, particularly in the case of children and a 

 course much longer and attended with many more complications than the 

 usual types of tonsillitis. The joints often are affected and the heart 

 and kidneys seriously damaged; middle ear disease and erysipelas may 

 appear, pneumonia and peritonitis sometimes develop and terminate 

 fatally. In the principal epidemics that have been studied in this country 

 the incidence of the disease has been greater among females than males. 

 In the Cortland-Homer epidemic 57 per cent, of the cases were of females; 

 in Concord 58 per cent.; in Baltimore 58 per cent., and in Rockville Center 

 59 per cent. In the Baltimore epidemic the fauces appeared to be the 

 portal of entry but in some cases there was some question whether en- 

 trance to the body was not obtained in some other way. The disease 

 is now recognized to be caused by a hemolytic streptococcus of the Smith 

 type. The incubation period is about 3 days; the length of illness varies 

 with the severity of the attack and the complications that develop. 



Savage's list of outbreaks of septic sore throat shows that extensive 

 epidemics occurred at Guilford and Colchester, England, and at Christi- 

 ania, Norway, before the disease was recognized in the United States. 

 Here, septic sore throat was first known as such and studied by modern 

 methods in the epidemic that occurred in Boston, Mass., in 1911. Wins- 

 low who made a study of the epidemic pointed out that before the Boston 

 outbreak occurred the disease prevailed in prosodemic form in the 

 region where the infected milk was produced and he has described an 

 epidemic that occurred in Westchester County, New York, which was 

 also prosodemic but on which a milk-borne outbreak was superposed, and 

 Frost in the Baltimore epidemic attributed some cases to this mode of 

 dissemination. So the disease is not necessarily caused by infected 

 milk; it may be spread by contact infection. This accords with what is 

 now known of the bacteriological aspect of the disease for the Smith 

 streptococcus is primarily a human infection ; it causes carrier cases and it 

 infects milk chiefly by being transferred through the teat canal and wounds 

 to the udder of the cow where it proliferates and causes massive infection 

 of the milk which gives rise to the widespread epidemics that have f ocussed 

 attention on the disease. In one instance a bottle infection has been de- 

 scribed and it has been held that milk has been infected by an infected 

 person who handled it. Much patient investigation has been required to 

 reach this correct understanding of the disease for at first, owing to the 

 fact that the causative organism was a streptococcus and that mastitis 

 was known to be often caused by streptococci, suspicion was directed 

 to the cow and all garget cases were regarded as potentially dangerous, 

 although herdsmen and others who were familiar with cows thought it 

 improbable that mastitis which is so common could more than very 

 exceptionally be the cause of contagion. Mistrust of the udder-sick cow 

 was deepened by the discovery of cases of mammitis in some of the herds 



