DIPHTHERIA. 53 



throat and nose of all persons about the establishment. The 

 results will very likely bring to light facts which may not have 

 been recognized, or which had been suppressed. 



The precautions to be observed upon the detection of diph- 

 theria in a dairy are obvious. Sale of the milk, raw, should 

 be interdicted as long as a single person about the place har- 

 bors diphtheria bacilli. Certainty on this point should be 

 established by two or three negative cultures at intervals of a 

 few days, each set being taken simultaneously from the nose 

 and throat of all individuals concerned. The quickest way to 

 resume the sale of milk would be to exclude patients and germ 

 cases from the premises. 



Milk-borne diphtheria in Orovil/e, Cal. The writer has used 

 cultures to confirm suspicion of a dairy as the cause of an epi- 

 demic, when no history of clinical diphtheria could be elicited 

 (34, 35). 



Diphtheria was apparently introduced into the town b>- a 

 visitor who had recently recovered from the disease elsewhere. 

 One case was reported on November 14th, shortly after the 

 arrival of the \-isitor in the family. No more cases were re- 

 ])orted for six weeks. 



F'rom December 25, 1907, until January 25, 1908, cases were 

 reported in 15 families. Six of these families consumed milk 



from the R dairy. One of these 6 families was reported 



on December 25th, and the other 5 were reported during the 

 5 days, January 15th to 20th. Two other families gave a history 

 of probable spread from the families on the milk route in ques- 

 tion. Se\-en infected families in town gave no history of con- 

 nection with the milk route. 



The suspicions of the health officer were directed to the dairy 

 l)y the number of infected families who were among its patrons 

 and by the fact that few families consuming the milk escaped. 

 A considerable portion of the milk was used by two cheap res- 

 taurants, and if any cases were contracted from the milk in 

 these establishments, it was not possible to trace them. 



The only people handling the milk were a man, his wife 

 and daughter. Cultures were made from the nose and throat 

 of each one. The mother and daughter gave positive cultures 



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