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MEASURES TO PREVENT THE DISSEMINATION OF THE INFEC- 
TION OF TYPHOID FEVER IN MILK. 
(a) The prevention of the introduction of infection into milk . — 
This at once suggests itself as the proper measure ; but the difficulty 
of carrying it out practically becomes evident when we consider the 
number of farms from which the milk supply of the average Amer- 
ican city is obtained, the liability of cases of typhoid fever occurring 
on these farms, and the numerous ways in which the infection may be 
conveyed from the patient to the milk. New York City’s milk sup- 
ply, according to Darlington, is derived from 35,000 farms, and 
shipped from TOO creameries, located in 6 States. It is easy to ap- 
preciate how difficult and expensive it would be to keep up a suffi- 
ciently thorough supervision of the multiple sources of that city’s 
milk supply. It is practicable to accomplish much toward the pre- 
vention of the infection getting into the milk after the milk is de- 
livered to the city. The following requirements are suggested : 
1. Location of the dairies in good surroundings. 
2. The prevention of the handling of the milk by persons who are 
in contact with typhoid fever patients or who themselves are liable 
to be discharging typhoid bacilli in their excreta. It does not 
seem unreasonable to require the owner of a store in which milk is 
sold and in which there is a patient with typhoid fever to either 
remove the patient to a hospital or some other house or to close up 
the business until the danger from that patient is passed. 
3. Exclusion of flies and other insects so far as possible, by screen- 
ing, etc. 
4. Sterilization of bottles and cans returned from houses before 
being again filled with milk, or the use of paper bottles which would 
not need to be returned. 
5. The sealing of the bottles or cans of milk so that they may not 
be infected in the course of delivery. 
(h) The destruction of infection in milk. — This at the present time 
seems to be the cheapest and the most practicable method to prevent 
the spread of typhoid infection in the milk supply of cities. In 
exceptional instances when a dairy receives its supply of milk from 
only one or two farms over which a thorough supervision may be 
exercised, efforts to prevent the infection reaching the milk may be 
attempted. But for the general supply of cities officially supervised 
pasteurization of the milk is the best measure. Supplement this with 
an intelligent supervision over the depots and stores where milk is 
sold and milk as a causative factor of typhoid fever in cities would be 
removed. 
In other words, pasteurization appears at the present time to be 
the only practical solution of the milk problem. All objections to 
the proper pasteurization of milk seem to be entirely theoretical or 
such as may be readily overcome. 
