99 
demies.) The 90 epidemics compiled by Car0e have not been included 
because of lack of time and space, Xo attempt has been made to note 
every outbreak reported as spread by milk ; many cases where the evi- 
dence did not seem entirely convincing have been omitted. Xecessarily 
much of the evidence upon which it is determined whether or not 
an epidemic is conveyed by milk is circumstantial; the same may be 
said of water-borne disease, and indeed of many of the things in daily 
life which we firmly believe. In an explosive outbreak of an in- 
fectious disease, to find that all persons attacked had used one milk 
supply, that they had apparently nothing else in common, that no 
cases occurred except among users of this milk, and then to isolate 
from the milk the specific organism of the disease in a virulent state, 
is believed to be good evidence in the absence of other explanation. It 
is not to be inferred that this has been taken as an absolute standard 
up to which all epidemics must come before being considered as spread 
by milk, for to do this the outbreak would have to occur in a locality 
previously entirely free from the disease and the development of 
secondary contact cases, which is necessarily a common occurrence, 
would wrongly exclude such epidemics. Then, too, the difficulty of 
isolating the Eberth bacillus when in small amount and accompanied 
by large numbers of other organisms and our lack of absolute knowl- 
edge as to its specificity, and the fact that no organism has as yet been 
isolated which is commonly accepted as the causal agent of scarlet 
fever, would lead to erroneous conclusions if the isolation of a specific 
organism were insisted upon. 
TYPHOID FEVER. 
Schiider ff collected from the literature 650 typhoid epidemics the 
supposed cause of which had been reported. Four hundred and sixty- 
two were reported as spread by water, 110 by milk, and 78 by all other 
means. This places milk second only to water as a carrier of typhoid 
infection. But the ratio of 462 to 110 probably by no means shows 
the true relation of water and milk as producers of such outbreaks. 
Schiider’s epidemics were collected mainly from continental Europe 
where milk epidemics are apparently not as common as in England 
and America, due possibly to the more or less customary practice in 
Europe of u&ing pasteurized or cooked milk. The result of such a 
compilation as the above may also have been affected by the fact, 
that until comparatively recently water has received much more atten- 
tion in typhoid epidemiological work than has milk. It would seem 
that Schiider did not include in his list the approximately 90 typhoid 
a Schiider, Zeitschrift f. Hyg. und Infection skrankheiten, 1901, XXXVIII, p. 
343. 
