82 MILK AND THE PUBLIC HEALTH chap. 



typhoid fever, the onset of his attack being December 1. 

 The cases amongst his customers were all in March, and 

 followed his return to work at the dairy. It is interesting to 

 note that this milkman supplied 154 households, that it was 

 found that in most instances the milk was scalded before 

 delivery, but that 22 householders preferred to obtain the 

 milk fresh. All the cases outside the dairy occurred among 

 persons belonging to these households. The dairyman infected 

 the milk fully three months after the beginning of his illness. 



The Brentry outbreak, carefully worked out by Dr. Davies ^ 

 (M.O.H., Bristol), is another illustration of a carrier- spread 

 epidemic. The Brentry Inebriate Eeformatory, Bristol, con- 

 tained 240 inmates and 24 resident officers. Typhoid fever 

 first appeared in 1906. The water supply was good, and 

 there were no drainage defects. No cases of typhoid fever 

 existed in the neighbourhood. In September 1906 a kitchen 

 helper developed typhoid fever, and in November 3 further 

 cases occurred. All 3 cases received an allowance of milk, 

 thus suggesting carriage by milk. Fresh cases occurred in May 

 1907, continuing through July, August, September, October, 

 and November in small groups and at varying intervals. In 

 November 1906 a milk steriliser had been installed, but the 

 1907 evidence was still stronger against the milk as the 

 cause. There were evidently present opportunities of con- 

 tamination after sterilisation. 



Inquiry in November 1907 showed that an inmate em- 

 ployed as cook and dairymaid (Mrs. H.) had suffered in 

 January 1901 from a severe attack of typhoid fever, from 

 which she had apparently recovered. She was admitted to 

 Brentry, April 1906, and was employed in kitchen work up to 

 October 13, 1906, when she was also entrusted with the 

 dairy work, which she continued to do up to November 1907. 



The milk, after sterilisation, was stored in the dairy, whence 

 it was measured out for the various " villages " by means of a 

 hand dipper. All the milk passed through her hands. 



Mrs. H. was absolutely excluded on November 13 from all 

 kitchen and dairy work, and the last case occurred on Nov- 

 ember 25, twelve days after her isolation commenced. The 

 institution remained free from typhoid fever subsequently. 



1 Royal Society of Medicine Proceedings, Epidemiological Section, April 1908. 



