TYPHOID FEVER MILK-BORNE OUTBREAKS 



335 



the disease directly through the milk, 

 6 by secondary personal infection, and 

 4 indirectly. The premises were old 

 and insanitar)', and were probably in- 

 fected from previous cases which had 

 occurred long before. But the month 

 before the dair>Tnan's wife became 

 ill, the cess-pit which had been closed 

 was cleared out, and the contents were 

 put in the dustbin, and left until June 

 when the outbreak occurred. 



Probable exciting cause. — Human 

 infection of milk. 



Reference. — Public Health, 1901-02, 

 p. 403. 



•WaUasey, ChesMre, 1901 {\){July). 



Total number of cases . . 26 

 Number of cases amongst 



drinkers of suspected milk . 24 



Number of polluted milk sources i 



Number of milkmen ... 2 



Circumstances i7nplicating the milk 

 supply. — Grave sanitary defects found 

 at farm whence the milk supply 

 came, including bad water supply. 

 Slop water and cess-pool contents 

 could gain access to water supply. 

 B. colt was found in the milk. 



Wallasey, ChesMre, 1901 (2) 



{^Septembery, 



Total number of cases . . 90 

 Total number of cases amongst 



drinkers of suspected milk . 50 



Percentage on total cases . • 55-5 



Grave sanitary defects at farm 

 supplying milk, and water contained 

 many B. coli. Stoppage of the milk 

 supply checked the outbreak. 



[The medical officer issued the 

 following circular to all the milk 

 dealers in the district : — 



"With a view to preventing the 

 spread of infectious disease, especially 

 typhoid fever, by means of contami- 

 nated milk, it is most desirable that all 

 milk purveyors should ascertain for 

 themselves the sanitary condition of 



the farms from which their milk is 

 procured, both in the interests of the 

 public and to protect themselves. In 

 deciding upon a milk supply, the 

 pur^'eyors should consider not only the 

 cleanliness of the farmer^s premises 

 generally, and the care taken to keep 

 all milk vessels pure, but above all he 

 should ask about the water supply. 

 It is best that this should be from a 

 public supply, laid on in pipes direct 

 to the farm with a tap in the dairj^, 

 and communicating also with the 

 refrigerator. The purveyor ought to 

 look with suspicion on all wells, 

 whether open or connected by pumps, 

 especially if the wells are close to the 

 house or farmyard, so as to be open to 

 contamination by soakage into the 

 well. It is also most desirable to find 

 out what care is taken by the milkers 

 to keep their hands clean, and to wash 

 the udders of the cows, othertvise the 

 milk is sure to be more or less con- 

 taminated."] 



Probable exciting cause. — Contami- 

 nated water. 



Reporter and reference. — Dr A. 

 Craigmile. Annual Report of Medical 

 Officer of Wallasey, 1901. 



Melboame, 1901. 



Total number of cases , . 22 



Niunber of cases amongst 



drinkers of suspected milk . 22 

 Percentage on total cases . .100 

 Number of families supplied by 



milkman . . . . -154 

 Number of such families invaded 22 



Percentage 14^ 



Number of polluted milk sources i 

 Number of milkmen . . . i 



Circumstances implicating the milk 

 supply. — The keeper of the dairy was 

 removed to hospital on 6th December 



1900, suffering from enteric. He 

 remained in hospital till 15th January 



1901. He went home from the hospital^ 

 and declared that he did not work 



