INFLUENCE OF DISEASE UPON MILK 123 



ities all cases of typhoid fever and other infectious dis- 

 eases occurring in their own families and among their 

 employees or in the families of the latter. 



PARATYPHOID FEVER 



Paratyphoid fever is also transmitted by milk, but 

 less frequently than typhoid fever. The milk may be 

 infected directly with the paratyphus bacilli by contact 

 with persons affected with the disease or indirectly by 

 polluted water being used to wash the milk vessels, uten- 

 sils, and bottles. Water may be contaminated by fecal 

 matter from infected persons. 



DIPHTHERIA 



A number of milk-borne epidemics of diphtheria are 

 on record, although this disease has been less frequently 

 disseminated by milk than typhoid fever. The diph- 

 theria bacilli are present in the oral cavity and on the 

 nasal mucous membrane of persons affected with the 

 disease and may persist in these locations for months 

 after the patient has apparently recovered. Persons 

 who have attended diphtheria patients may also carry 

 the bacilli. Infected persons may infect the milk directly 

 or indirectly. In the beginning of some cases of diph- 

 theria, the throat is apparently normal or only slightly 

 affected. These cases and cases of chronic nasal diph- 

 theria are most difficult to diagnose from clinical symp- 

 toms. Because of the occurrence of cases of this type 

 and the continuance of the bacilli in some individuals 

 after the subsidence of clinical symptoms, it is not possible 

 to guard entirely against the occasional infection of milk 

 by the diphtheria bacillus. But the danger will be greatly 

 reduced if prompt attention is given to all cases of sore 



