46 EPIDEMIC DISEASES TRANSMITTED BY MILK. 



not protect against the dangers of water. Poor scalding is a 

 serious matter in connection with bottles that may have been 

 in the sick room. Water may get directly into the milk from 

 leaks in milk coolers, or by intentional adulteration. The 

 distributing stations in the city and various places w r here milk 

 is sold, furnish their quota of opportunities for the infection 

 of milk. 



Detection of milk-borne typhoid fever epidemics. Milk-borne 

 epidemics are most quickly detected through a system of ascer- 

 taining early the facts regarding the possible sources of infec- 

 tion among the reported cases. The health officer should keep 

 a card for each dairyman, and post up the cases occurring 

 among his present patrons, or those that took the milk at any 

 time within a month previous to attack. An unusual number 

 will direct attention to the necessity for an investigation (39). 

 A large proportion of children among those infected would 

 place the milk supply under particular suspicion. 



Bacteriological examinations are not available for antici- 

 pating milk-borne trouble, nor usually for demonstrating the 

 presence of the organisms in the milk. The technical diffi- 

 culties are too great to take up the search for the typhoid 

 organism in the hope of obtaining decisive useful results. The 

 same holds true of the examination of water, in connection 

 with a typhoid epidemic. In the case of both milk and water, 

 one difficulty lies in the fact that the organisms may not be 

 present at the time suspicion is aroused. The facts must be 

 determined by epidemiological evidence. The writer has found 

 very useful a 3 by 5-inch card printed for the reception of 

 information on the following points, slightly changed from one 

 used in working up the Palo Alto epidemic (8). 



STATE HYGIENIC LABORATORY. 

 UNIVERSITY OF CALIFORNIA, BERKELEY. 



Patient's name Address 



( of first symptoms 19 



Date \ of taking to bed ... 19 



^of physician's first visit 19 



Age sex color nationality 



