33 
SUMMARY OF EPIDEMICS. 
Of the 51 scarlet fever epidemics reported as spread by milk, com- 
piled by the writer, 25 occurred in the United States and 26 in Great 
Britain ; all cases enumerated in the outbreak were reported as living 
in houses supplied with the suspected milk in 27 of the epidemics; a 
case suffering from the disease at such a time as to have been the pos- 
sible source of infection was found at the producing farm, the dis- 
tributing dairy, or milk shop in 35 cases ; the outbreak was supposed 
to have been due to bottles returned from infected households and 
refilled without previous sterilization in 3 cases; the diseased person 
or persons were mentioned as handling the milk or milk utensils in 3 ; 
the sick milked the cows in 12; the same person nursed the sick and 
handled the milk in 1 ; same person nursed sick and milked cows in 
1; the outbreak was supposed to be due to disease of the cow in 2; 
it was reported that measures taken upon the presumption that milk 
was the cause of the epidemic were followed by abatement of the out- 
break in 22 cases. 
The following outbreak is one of many interesting illustrations: 
SCARLET FEVER IN NORWALK, CONN.® 
In November, 1897, an unusual number of cases of scarlet fever 
occurred in Norwalk. Population of Norwalk, South Norwalk and 
East Norwalk, 22,000. Previous to October 25 scarlet fever had 
been reported as follows: August, no cases; September, 5 cases; Oc- 
tober 10, one case. The source of infection in most of these cases 
had been traced. Between October 25 and November 9, 29 cases 
developed. The 29 cases were distributed in 25 families and 24 
houses. School infection was eliminated. Many cases did not at- 
tend school, and some were in families where they had no school 
children. The cases were widely separated ; 17 of the infected 
houses were in South Norwalk, 3 in Norwalk, and 4 in East Nor- 
walk. The families were of different social positions and contact- 
infection seemed improbable. The only factor in common to prac- 
tically all of the cases was the milk supply. Twenty-seven out of 
the 29 obtained milk from one dealer, H. The other two were in 
one family in East Norwalk; they were a girl of 12 and boy of 9 
years, and were taken ill on November 7 and 9, respectively. They 
had no connection with the milk route, nor could their infection be 
traced to any source. 
a Smith, (Herbert E.) ; Report Connecticut State Board of Health, 1897, p. 259. 
1414— Bull. 56—09 3 
