52 THE MILK SITUATION IN THE DISTRICT OF COLUMBIA. 



SYMPOSIUM ON CAUSES OF TYPHOID FEVER IN DISTRICT. 



In a symposium on the causes of typhoid fever in the District 

 under the auspices of the District Medical Society on February 19 

 and 26, 1908, in which Dr. H. W. Wiley, Dr. H. M. Bolton, and Mr. 

 C. B. Lane, of the Department of Agriculture, Dr. M. J. Rosenau, 

 Dr. L. L. Lumsden, and Mr. J. H. Kastle, of the Bureau of Public 

 Health and Marine-Hospital Service, Dr. G. Lloyd Magruder, and 

 others participated, and which was followed by a discussion in which 

 Gen. George M. Steinberg, Dr. George M. Kober, Dr. William C. 

 Woodward, Dr. E. C. Schroeder, Dr. Henry G. Beyer, and others 

 took part, the attitude of the committee of the District Medical 

 Society with regard to the importance of the improvement of the 

 local milk supply as a potential factor in the elimination of typhoid 

 fever and other germ diseases from the District of Columbia was in 

 a large measure confirmed. 



MILK EPIDEMICS. 



The committee invites attention in this connection to a most inter- 

 esting and valuable article by Passed Asst. Surg. John W. Trask, of 

 the Public Health and Marine-Hospital Service, on " Milk as a cause 

 of epidemics of typhoid fever, scarlet fever, and diphtheria.'' * in 

 which the following suggestions are offered for the detection, pre- 

 vention, and reporting of milk epidemics : 2 



When in a city an unusual number of cases of scarlet fever, diphtheria, or 

 typhoid fever occurs among the customers of any one dairy it may be con- 

 sidered a sufficient reason for ca-using a careful inquiry to be made and a 

 search for some source of milk infection. The mere finding of cases on one milk 

 route is not by any means conclusive that milk is the carrier of the infection, 

 but it is sufficient to cast suspicion and at times, undoubtedly, also to warrant 

 regulation, even if no source of contamination is found, for it is often exceed- 

 ingly difficult to find the infective focus. 



xiie Health oruceis of many cities have for some time been charging each case 

 of typhoid fever, scarlet fever, and diphtheria to the dairyman supplying the 

 milk to the invaded household. In this way it is apparent when an unusual 

 number occurs on one route, and measures can be taken to ascertain whether 

 the incidence of the disease has an etiologic relationship to the milk. Cases 

 which otherwise would show no relationship to each other are revealed as as- 

 sociated, and the milkman makes neighbors of families separated by consider- 

 able distances. In the complicated life of cities this gives the health officer a 

 valuable aid in the control of certain of the common infectious diseases. 



Inspection and regulation of the production, handling, and sale of milk will 

 lessen the number of milk epidemics. In cities the proper charging of each case 

 of scarlet fever, diphtheria, and typhoid fever to the dairy on whose route it oc- 

 curs will often reveal milk outbreaks which can then be suppressed before reach- 

 ing too great proportions. The most rigid inspection and regulation practicable 

 at the present time, however, are impotent to prevent chronic bacillus carriers 

 from being employed on milk farms ad at dairies. They are also unable to 

 keep mild ambulant cases of infectious diseases from being so engaged, for the 

 reason that such cases often can not be diagnosed until after other cases have 

 developed. Soper's cases 8 of "Typhoid Mary" was a constant danger in her 

 capacity as family cook to the members of the family in which she happened to 

 be employed and to visitors eating of the salads and food prepared by her, but 

 what might have happened had she been employed in the handling of milk dis- 

 tributed over a large city route can only be surmised. 



1 Bulletin No. 56, Hygienic Laboratory. Public Health and Marine-Hospital Service, pp. 

 23-115; March, 1909. 



2 Op. cit., pp. 47-49. 



8 Soper, George A., Jour. Am. Med. Assn., June 15, 1907, p. 2019. 



