47 
of the invaded houses showed that cases of typhoid existed only in 
those houses receiving milk in pint bottles. There were no cases 
among the quart-bottle customers. Cases continued to be reported 
on this route and the sale of milk from the dairy was therefore 
stopped. After two weeks new cases ceased to develop. It was then 
found that a man from New York City had come to Montclair ill 
with typhoid fever and had remained for a few days at a house sup- 
plied with milk from this dairy until he could be removed to a hos- 
pital. This house had during the patient’s stay been supplied daily 
with three pint bottles of milk. The empty bottles were removed 
daily and, without sterilization, refilled and delivered to other 
houses. It seemed that this was the means of spreading the disease. 
Eighteen cases occurred in Montclair and 10 in Bloomfield, all in 
houses supplied with milk in pint bottles from this dairy. 
Pathogenic organisms may possibly reach the milk through dust 
while in the care of the vendor, but most likely the vendor himself is 
the more important and that, while organisms floating in the air can 
undoubtedly settle into milk, yet the chief danger is from contact 
with diseased persons or those having an intimate relation with the 
sick. 
DETECTIOlSr OF MILK EPIDEMICS. 
lYlien in a city an unusual number of cases of scarlet fever, diph- 
theria, or typhoid fever occurs among the customers of any one dairy, 
it may be considered a sufficient reason for causing a careful inquiry 
to be made and a search for some source of milk infection. The mere 
finding of cases on one milk route is not by any means conclusive 
that milk is the carrier of the infection, but it is sufficient to cast 
suspicion and at times, undoubtedly, also to warrant regulation, even 
if no source of contamination is found, for it is often exceedingly 
difficult to find the infective focus. 
The health officers of many cities have for some time been charging 
each case of typhoid fevor, scarlet fever, and diphtheria to the dairy- 
man supplying the milk to the invaded household. In this way it 
is apparent when an unusual number occurs on one route, and meas- 
ures can be taken to ascertain whether the incidence of the disease 
has an etiologic relationship to the milk. Cases which otherwise 
would show no relationship to each other are revealed as associated, 
and the milkman makes neighbors of families separated by consider- 
able distance. In the complicated life of cities this gives the health 
officer a valuable aid in the control of certain of the common in- 
fectious diseases. 
