118 THE MILK QUESTION 



The characteristics of milk-borne typhoid outbreaks. The 

 characteristics of a typhoid outbreak due to milk have 

 been summed up by George Newman as follows : 



(a) There is a special incidence of disease upon the track of 

 the implicated milk supply. It is localized to such area. 

 (6) Better-class houses and persons generally suffer most. 



(c) Milk drinkers are chiefly affected, and they suffer most 

 who are large consumers of raw milk. 



(d) Women and children suffer most, and frequently adults 

 suffer proportionately more than children. 



(e) Incubation periods are shortened. 



(/) There is a sudden onset and rapid decline. 

 (</) Multiple cases hi one house occur simultaneously. 

 (A) Clinically the attacks of the disease are often mild. Contact 

 infectivity is reduced and the mortality rate is lower than usual. 



My experience with the epidemiology of typhoid fever 

 has taught me that it is comparatively easy to detect a 

 milk-borne outbreak in its early stages. A very suggestive 

 sign is the occurrence of several cases at the same time in 

 a family, especially among the women and children. Thus 

 I have in mind a family of six children in which four of 

 them, with the mother, came down with typhoid fever 

 within a period of five days. In a city having a clean and 

 satisfactory water supply such an incident throws sus- 

 picion upon the milk, for there is hardly any other single 

 food that will cause an outbreak of this character. If 

 health officers keep a card index system of each case of 

 typhoid fever in relation to the milk dealers, it is easy to 

 detect whether or not a particular milk dealer is having an 

 undue proportion of cases among his customers. This is 

 another way by which a typhoid outbreak may be detected 

 during its early stages. 



Scarlet fever 



We do not know the cause of scarlet fever, but are quite 

 convinced that it is a germ disease transmitted from person 



