124 THE MILK QUESTION 



terized by all the serious complications which are associ- 

 ated with streptococci, such as erysipelas, rheumatism, 

 and peritonitis. Relapses are common, the glands of the 

 neck become very large and tender, and sometimes sup- 

 purate. 



The outbreak of septic sore throat in Boston. In May, 

 1911, an extensive and serious outbreak of "tonsillitis" 

 occurred in Boston and in the neighboring town of Brook- 

 line and city of Cambridge. There were, all told, over two 

 thousand cases, with about forty-eight deaths. The infec- 

 tion was believed to be conveyed in the milk from the 

 Deerfoot Farms at Southboro. This was not only the most 

 widespread and serious but the first epidemic of this kind 

 traced to milk in this country. It corresponds in all essential 

 particulars to the outbreaks of septic sore throat which 

 have frequently been reported as occurring in England. 

 The Boston-Cambridge-Brookline epidemic presents in- 

 teresting details, some of which are here given. 



Tonsillitis not being a reportable disease, accurate vital 

 statistics of the epidemic are not at hand. The facts as 

 here given are taken from the epidemiological studies of 

 Winslow, and also from the special studies and records of 

 the health offices of the three affected towns. 



Two forms of sore throat occurred at the time. The 

 clinical and epidemiological features of these two forms of 

 sore throat give the picture of two separate and distinct 

 diseases; the one ordinarily diagnosed tonsillitis was be- 

 nign, directly contagious, and presented no unusual features 

 from the usual sore throat more or less prevalent in almost 

 all large communities; the other disease, which we will call 

 septic sore throat, was mahgnant, not readily communicable 

 from person to person, and presented special cUnical feat- 

 ures. The inflammation and swelling of the lymph struc- 

 tures of the throat and of the mucous membranes were more 

 severe than ordinarily. Edema was a feature, and many 

 of the cases presented pseudomembranous formation and 



