84 CITY MILK SUPPLY 



small dairy was delivered by a boy who had a "sore throat" but who was 

 not under a physician's care. Thirty-six cases of diphtheria appeared 

 on the route. Many incidents of epidemiological significance pointed 

 to the milk and the boy as the source of infection. In Vermont, in 1902, 

 six cases of diphtheria appeared on the route of a dairy whose milk was 

 delivered by dipping from a large can by a boy who had "sore throat" 

 but from which diphtheria bacilli were later isolated. Cases developed 

 in houses where he left the milk but in others on the same street where 

 he did not, there were none. In Chester, Mass., nine cases of typhoid 

 fever appeared on the route of a dairy of which the wagon driver had 

 just recovered from the disease, the epidemic stopped on his dismissal. 



Infection of Milk after Delivery. Milk may also be infected in shops 

 where it is kept for sale; this is especially likely to occur if it is dispensed 

 from cans or diptanks. At Hamar, Norway, in 1900, there were 42 

 cases of typhoid fever among the customers of a shop where the pro- 

 prietor and his wife had the disease; the latter tended store while still ill. 

 Savage records an outbreak of scarlet fever reported by Robertson in 

 1901. Forty cases were traced to a milk shop that communicated by a 

 short passage with a house wherein was a woman suffering from an un- 

 recognized case of scarlet fever. On the removal of the woman to a 

 hospital the epidemic waned. 



Milk is sometimes infected after delivery in homes, restaurants and 

 hotels. In private homes the infection is most likely to occur when there 

 is contagion in the household but at other times it may be brought 

 about by servants and others, who are carriers. In any event the cases 

 are usually restricted to the members of the family and to friends. From 

 milk infection in restaurants and hotels widespread infection may result. 

 The sudden appearance in Boston, Mass., of 37 cases of typhoid fever 

 about Sept. 21, 1909, led to the inquiry into conditions at a hotel in 

 Jefferson, Mass., because all of the patients told of having spent Labor 

 Day, Sept. 6, there. After some investigation interest centered on a 

 waitress who in a very tired condition, left the hotel Sept. 9, and who 

 called a physician on the 15th. She gave a positive Widal reaction on 

 the 22nd, which showed that her case antedated the cases among the 

 guests by 1 or 2 weeks. The bulk of the milk used at the hotel arrived 

 at 8 a.m. part being used at once and part being kept over night and 

 served the next morning. When the hotel was crowded the capacity 

 of the ice chest was overtaxed and consequently the milk was insufficiently 

 refrigerated. The milk was ladled out of the cans into pitchers by maids, 

 who filled the glasses from them; often the dippers dropped back into the 

 cans. The waitress who was ill was fond of milk and often made her 

 supper of milk and cakes, helping herself from the cans. It is believed 

 that on Labor Day eve she infected the milk and as it was not properly 

 iced at that time there was an abundant growth of typhoid germs in the 



