40 
town water supply, and 14 private wells. The total number of cases 
was 39. On this day B stopped selling milk and in three weeks the 
epidemic subsided. The final summary of the outbreak was: In- 
vaded houses, 39 ; all used B’s milk, 21 used public water supply, and 
18 used private wells. B claimed to supply regularly 80 houses with 
milk. One hundred and eighty people lived in the 39 invaded house- 
holds. 
There were several occurrences during this outbreak of special 
interest. Miss M, living in Xew Jersey, visited Elkton for two days, 
October 5 and 6, returning home on the 7th. While in Elkton she 
was at a house supplied with milk from B’s farm. Xo typhoid had 
occurred at this house up to that time. On October 14 Miss M fell 
ill with typhoid. In one family a negro servant, whose chief food 
consisted of oatmeal and milk, left Elkton the middle of October and 
went to Glasgow, Del., where she became ill of typhoid and died. In 
another family was a married daughter who left Elkton the last of 
October to visit friends. In about ten days she fell ill with typhoid. 
At the jail where there were from 15 to 20 prisoners who received no 
milk whatever, 3 members of the jailer’s family, and 2 men assisting 
about the place, all of whom used B’s milk in one form or another, 
fell ill with typhoid, while the prisoners were not attacked. 
In cities where large dairies are the rule, receiving milk from per- 
haps hundreds of farms some of which are situated miles away, it is 
necessarily very difficult at times to find the infecting focus. Cases of 
the disease may occur on two or three milk routes, and search will show 
that they all receive part of their milk from the same farm or else that 
one dairyman at times sells surplus milk to the others, but the milk 
consumed will all be directly or indirectly traced to some common 
source of contact of disease with the milk. In tracing the relationship 
between milk and the disease, ice cream and other forms of milk prep- 
arations such as whipped cream are to be borne in mind. A confec- 
tioner’s shop or bakery may be the focus producing an epidemic. 
(c) Special incidence in milk drinkers. — In addition to the fact that 
as a rule cases occur only in houses using the infectious milk, many 
times interesting incidents occur where in a family the only person 
attacked will be one drinking raw milk, or where the only person 
exempt will be the sole one not using it. Usually cases are found 
mainly among the milk drinkers. 
(d) The better houses suffer greater invasion. — The so-called better 
class of houses are often attacked in greater proportion than others. 
This is explained by the fact that families with larger incomes are sup- 
posed to drink more milk, whereas those with lesser resources use it 
mainly in tea or coffee or cooked in food preparations and for children. 
