86 CITY MILK SUPPLY 



that was discovered by Boldman and Noble will suffice. In August, 

 1909, there was an outbreak of typhoid fever in that part of New York 

 City that lies north of 40th Street. There were 380 cases above the 

 normal for the district and a certain milk supply that was common to all 

 was shut off. The infected milk was found to come from Camden, N. J., 

 where it was found there had been a case of typhoid fever on a farm that 

 was not a patron of the creamery that shipped the milk under suspicion. 

 Inquiry developed the fact that every year there were in town 14 or 15 

 cases of " Camden fever" which was in reality typhoid fever. This is 

 at the rate of 50 or 60 cases per 10,000 of population; an excellent illus- 

 tration of the well-known fact that a few cases in a small town may be 

 the equivalent of many in a metropolitan center. At the dairy where 

 the typhoid fever was, it was found that the owner had the disease in 

 1864, and that in his family since that time there had been four cases of 

 typhoid fever and three of "slow fever" resembling typhoid. On examina- 

 tion of the stools of the entire family it was found that those of the dairy- 

 man himself who had the disease 46 years before yielded typhoid bacilli 

 in practically pure cultures on the medium in which platings were made. 

 Connection of this man with the New York epidemic was established when 

 it was found out that he ran one of the three local milk routes in Camden 

 and was in the habit of turning over his surplus milk to his son-in-law 

 who added it to his own and delivered it to the creamery of which he was 

 a patron. "Thus the prevalence of 'Camden fever' in Camden and 

 typhoid fever in New York were both explained." With the shutting off 

 of the infected milk typhoid fever in New York City returned to normal. 



The infection of milk by temporary bacillus carriers is perhaps most 

 often accomplished by those harboring diphtheria germs. It is estimated 

 that 1 per cent, of the urban population carries diphtheria-like organisms. 

 The nurses of diptheria patients are particularly prone to become tem- 

 porary carriers. The men in Montclair whose throats probably became 

 infected with diphtheria germs while they were sterilizing the bottles 

 afford a good example of a temporary carrier infecting a milk supply. 

 There are also acute carriers those who having had contagious disease 

 continue to carry the germs for a brief period. Such persons may also 

 infect the milk supply. 



Characteristics of Milk-borne Epidemics. Milk-borne epidemics 

 possess certain characteristics which should be remembered whenever 

 it is sought to determine the source of an outbreak of contagion of un- 

 known origin. There are two sorts of milk-engendered epidemics; those 

 which burst on a community with explosive violence, and those which 

 smolder on without exciting comment. Of the former type the 

 epidemic of typhoid fever at Stamford, Conn., in 1895, is an example. 

 There were 386 cases and 22 deaths in the period from April 15 to May 

 28. No less than 176 persons were stricken in the first week. Such 



