November 13, 1914] 



SCIENCE 



717 



SPECIAL ABTICLES 



MILK EPIDEMICS OF SEPTIC SORE THROAT IN THE 



UNITED STATES AND THEIR RELATION 



TO STREPTOCOCCI 



In England epidemics of sore throat, bear- 

 ing some relation to the milk supply, were 

 recognized as early as 1880 (Rugby). Since 

 then a number of such epidemics have occurred 

 and in those in which the etiology was investi- 

 gated, streptococci were uniformly found as 

 the infectious agent. In some of these epi- 

 demics there were reasons to believe that 

 udder or teat infections were the source of the 

 organisms; in others the evidence seemed to 

 point to a milker or handler as the source. 



In the United States the first epidemic of 

 sore throat recognized as having a definite re- 

 lation to the milk supply appeared in Boston 

 in 1911 and was carefully investigated by 

 Winslow.^ There is no doubt, I think, that 

 many such epidemics have occurred in the 

 past in this country, as well as in other coun- 

 tries, but on account of the almost universal 

 prevalence of ordinary colds and sore throats 

 their epidemic character and origin was not 

 recognized. Indeed, in the medical literature 

 ■there are references here and there to outbreaks 

 of severe colds and other similar infections 

 associated with serious and fatal complica- 

 tions, such as peritonitis. It is not unlikely 

 that such epidemics originated from a con- 

 taminated milk supply since we know that 

 these milk epidemics are, as a rule, serious in- 

 fections followed often by severe complica- 

 tions. In the case of milk epidemics of scar- 

 let fever, diphtheria and typhoid fever, it may 

 be pointed out that formerly their possible re- 

 lation to the milk supply was not recognized 

 or was denied, and only recently, when more 

 intensive studies of such epidemics were made, 

 was their true relation to milk supply estab- 

 lished. 



Since the Boston epidemic of 1911, similar 

 outbreaks have been reported from Chicago, 

 Baltimore, Boston (1912), Concord, IST. H., 

 Cortland and Homer (N. T.), Wakefield and 



ij. Inf. Dis., 1912, X., 73. 



Stoneham (New York) and Jacksonville, HI. 

 The number of persons stricken in these various 

 epidemics has been estimated as follows: Bos- 

 ton, 1,400, Chicago 10,000, Baltimore 1,000, 

 Boston (1912) 227, Concord 1,000, Wakefield 

 and Stoneham 1,000, Cortland and Homer 669, 

 Jacksonville 348 ; making a total of nearly 16,- 

 000. Probably many more than this number 

 were affected since the above are all conserva- 

 tive estimates. This number is sufScient to at 

 least give one some idea of the magnitude and 

 importance of this type of infection. 



In all, the onset, the character of the symp- 

 toms, and the later complications are strik- 

 ingly alike and, it may be said, they agree in 

 this respect with the epidemics in England. 

 Furthermore, the relation to the milk supply 

 appears to be unquestionable in all. The in- 

 teresting fact stands out that there is a cer- 

 tain uniformity in the reports in that the con- 

 taminated milk, though used perhaps by a 

 small proportion of the people, still furnished 

 a very high proportion (70, 80 or 90 per cent.) 

 of the reported cases. The remainder of the 

 cases probably resulted from personal contact 

 or from some other means. 



Streptococci were unquestionably the cause 

 of the disease in all the epidemics, being 

 found abundantly in the throats or in the se- 

 cretions of the sick persons in all the cases 

 investigated. This fact is of great impor- 

 tance because it establishes definitely the etiol- 

 ogy, and since the clinical symptoms in all 

 the epidemics are so strikingly uniform, we 

 may consider these infections as a definite 

 clinical entity. They should, I think, take 

 their place and be considered in text-books in 

 medicine along with other infectious diseases, 

 such as scarlet fever, measles, typhoid fever 

 and the like. 



As regards the nature of the streptococci, 

 there is a fair degree of uniformity so far as 

 the reports of the various investigators per- 

 mit one to judge. They are all virulent, 

 usually highly so, for animals. In general, 

 they correspond, with only slight variations, 

 in their morphology, in their cultural charac- 

 teristics, and in their biological properties. 

 In certain respects there seem to be some 



