TYPHOID FEVER. 43 



The careful study of the cases of typhoid fever in the Dis- 

 trict of Columbia with reference to the source of the milk, has 

 made it possible to compile figures showing the amount of that 

 disease traceable to each dealer. The results appearing in the 

 reports (28, 29) on the work are rearranged in the appended 

 table. 



In 1906 definite outbreaks of typhoid fever were attributed 

 to dairies No. 4 and No. 13. Note the difference in the rate 

 of typhoid attributed to these dairies in 1907, when no out- 

 breaks occurred among their customers. In 1907, dairy No. 

 163 was the source of an outbreak. 



Dairy No. 10 makes a very fine showing during both seasons, 

 attributed to the fact that efficient methods for sterilizing the 

 bottles and for pasteurizing the milk were used. The good 

 showing of dairy No. 17, in 1908, may be attributed to the 

 fact that an efficient method of sterilizing bottles was used and 

 to the fact that a portion of the milk was derived from a special 

 dairy. Suspected outbreaks were attributed to dairies Nos. 8, 

 44 and 46 in 1907. 



The work on typhoid fever in the District of Columbia led 

 Rosenau, Lumsden and Kastle to the conclusion that infected 

 milk is one of the important known factors in the spread of the 

 disease there. This view concerning the relation of milk to 

 the spread of the disease has been expressed by others. 

 ' Importance of milk as a carrier. Whipple writes, on page 

 132 of his book (38): 



" In a general sort of way it may be said that in the cities of the United 

 States, at the present time, about 40 per cent, of tlie typhoid fever is due 

 to water, 25 per cent, to milk, 30 per cent, to ordinary contagion (includ- 

 ing fly transmission), and only about 5 per cent, to all other causes." 



Neufeld (22) considers that milk is next in importance to 

 water as a means for transmitting typhoid fever. Trask (32) 

 has collected data concerning 317 milk-borne typhoid fever 

 epidemics. Harrington (13) states that during two years the 

 Massachusetts State Board of Health investigated 18 local epi- 

 demics of typhoid fever. Of these, 14 were milk-borne, 3 due 

 to water, and 1 unexplained. The importance of milk in con- 

 nection with typhoid has till lately been underestimated. 



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