384 INVESTIGATION, ETC., OF MILK-BORNE EPIDEMICS 



Methods of prevention in milk-borne epidemics. — Preventive 

 methods in milk-borne outbreaks will be much the same as for 

 epidemics spread in other ways. Nevertheless it is desirable that a 

 few words should be added on this subject, (i) As the first step in 

 the investigation of outbreaks proved to be a system of notification 

 common to infectious diseases, by which exact data could be 

 acquired, so in any attempt at prevention the usual first line of 

 defence, namely, isolation of the patient and disinfection of the 

 premises, must be considered as essential. The problem of isola- 

 tion, is not in every way a simple one, and its methods and results 

 in certain directions remain for the present sub judice. But this 

 does not affect the elementary principle at the back of the method. 

 To isolate an infectious person from amongst a susceptible 

 community, whether large or small, is an obvious step in the 

 direction of limiting the opportunities afforded for the spread of 

 the disease. (2) In the second place, thorough and efficient disin- 

 fection of the patient's belongings and the premises he has 

 occupied, equally stands to reason, when infectious disease is 

 considered in the light either of the old doctrine of materies niorbi 

 or the new doctrines of modern bacteriology. (3) To these two 

 methods of delimiting the spread of infectious illnesses may be 

 added the third matter for consideration in all such outbreaks, 

 r\dLvae\y , general sanitation. In diseases such as cholera, plague, or 

 yellow fever, the question of sanitary environment, is the immediate 

 necessity. So great a part do insanitary conditions and uncleanli- 

 ness play in these diseases, that they have been termed " filth 

 diseases. No attempt at prevention could afford to neglect in' 

 such cases the immediate remedy of sanitary defects. In the; 

 diseases which we have taken as typically milk-borne, namely,] 

 scarlet fever, diphtheria, and enteric fever, the same remarks apply' 

 only in a less degree. Diphtheria and typhoid fever have a some- 

 what intimate relationship to insanitation in relation to milk,] 

 which therefore demands immediate and adequate consideration 

 in any preventive methods which may be attempted. 



These three cardinal principles of prevention which are applied 

 in all epidemic outbreaks will not be forgotten or set aside, simply; 

 because an outbreak happens to have had its origin in infected j 

 milk supply. True, the one thing required is the control of the\ 

 milk supply, hnt this should not be accepted as an indication that 

 isolation, disinfection, and remedial sanitation are not required as, 

 much as under any other circumstances. They have their place,] 

 and although in the mind of the responsible sanitary official the 



