SOURCES OF THE CONTAMINATION OF MILK. 49 



Other precautions 

 Remarks 



Summary 



Signature 



In tracing back the milk from the patient to the source, it 

 will be found that many milk routes may derive their supply 

 in part or whole from the dairy under suspicion. Record of 

 the facts is facilitated by making a diagram with lines indicat- 

 ing the course of the various milk sui)plies from the producer 

 to the distributing station and on to the milk routes. At the 

 dairy under suspicion, the inquiries and observations that 

 might be made, and corrective measures to be re(|uired, are 

 obvious. A dairy can by no means be freed from susi)icion 

 even if no typhoid patients or convalescents are found there. 

 Widal tests might bring to light a convalescent from a mild 

 unrecognized attack. There is ahva\'s the jjossibility that the 

 infection of the milk has resulted from a bacilli carrier and to 

 detect such a person requires a bacteriological examination of 

 the feces and urine. A -case of infection of milk from a 

 typhoid bacilli carrier has recently occurred in Washington, 

 D. C. 



Berkeley, Cal., outbreak. A small milk-ljorne epidemic that 

 has been brought to the attention of the writer illustrates well 

 the bad conditions that may prevail (35). 



During the last half of October, 1906, there were 20 cases 

 of typhoid fever reported to the health officer. A study of 

 the cases with reference to water supply had eliminated that 

 source of infection from consideration, and information was 

 secured that many of these cases had ver\- likely been con- 

 tracted in a nearby cit>- where typhoid was prevalent. Ten 

 of the cases, reported from October 15th to 29th, were all sup- 

 plied with milk from the same dealer. The last case of typhoid 

 on this milk route was a son of the dairyman, who, but a few 

 da.\s before, had been delivering milk. 



A visit to the home where he lay sick revealed dangerous 

 conditions. No professional nurse was employed. The privy. 



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