ACUTE INFECTIOUS DISEASES 81 



the consumers of a particular milk supply. The eldest son 

 of the farmer contracted typhoid fever from an unknown 

 source. He was ill between two and three weeks before the 

 condition was correctly diagnosed. Evidence was not forth- 

 coming as to precisely how the milk became infected, but the 

 milk was brought into the farmhouse before distribution. 



2. Example of Infection of the, Milk after leaving the Farm 

 from an unrecognised Case of Typhoid Fever. Harrington 1 

 reported an extensive outbreak in Jamaica Plain, Massa- 

 chusetts, U.S.A., 410 cases of typhoid fever being notified 

 during a period of about six weeks. Of these cases 348 

 primary and 23 secondary proved to be in families supplied by 

 two milkmen (purveyors not farmers), F. and Q. The cases 

 were nearly equally divided between the two milkmen. There 

 were only 29 cases in which a history of the use of their milk 

 could not be obtained, and 7 in which there was a possibility 

 that the victims had on some one or another day drunk it, 

 The investigations undertaken showed that the source of con- 

 tamination of the F. milk was the milkman F. himself. F. 

 died of typhoid fever on April 10, and the autopsy showed 

 that he must have suffered from typhoid fever as early as 

 March 20. On or about that date he consulted his doctor, 

 who concluded that F. was merely tired and overworked. From 

 that time until April 2, although feeling ill, he attended to his 

 daily work, which included the general handling of his milk. 

 On April 2 a diagnosis of typhoid fever was made, and he 

 took to his bed. The first case amongst his customers was 

 notified March 31, 1908, and cases continued to be reported 

 until May 15. 



The infection of Q. is not so clear, but both F. and Q. 

 obtained their milk from the same dairy, and it is certain that 

 there was the greatest possibility of an interchange of cans 

 between F. and Q., for it was the custom of each to return 

 the empty cans washed but not sterilised. 



3. Examples of Outbreaks spread ly Typhoid Carriers. 

 One of the earliest outbreaks spread in this way which has 

 been recorded is that described by Jamieson 2 in Melbourne, 

 and dealing with a little outbreak of 6 cases. The dairy- 

 keeper was in hospital for an ordinary severe attack of 



1 Public Health, 1908, xxii. p. 19. 2 Ibid., 1902, xiv. p. 655. 



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