62 
TYPHOID FEVER IX DISTRICT OF COLHMBIA. 
It is probable that contaminated milk was also responsible for 
scattering cases, although of this we are unable to present conclu- 
sive proof. A study of chart Xo. 3, leaving out the condensation of 
dots along the lines of milk dealers Nos. 4, 13, and 85, which rep- 
resent the three milk outbreaks, shows the rema inin g dots roughlv 
scattered along the routes of the milk dealers more or less uniformlv. 
The ratio of the number of cases of typhoid fever occurring among 
the customers of each milk dealer to the number of persons using 
that milk is instructive. This ratio is determined from the number 
of cases per 100,000 gallons of milk sold by each dealer. 
The number of gallons of milk sold by each dealer was obtained 
only for the months of July, August, September, and October, and 
the ratio is based upon the number of cases of typhoid fever and the 
number of gallons of milk sold during the same period. 
MILX AND TYPHOID FEVER. 
The importance of clean and good milk from a public-health stand- 
point is well recognized by sanitarians, but the danger that lurks in 
contaminated milk does not seem to be generally understood. This 
ignorance seems glaring among the dairymen and others who handle 
the milk supplies for the District of Columbia. 
Dr. George M. Kober, in his admirable monograph, “Milk in Rela- 
tion to Public Health,’’® has collected 195 epidemics of t}’phoid fever 
occurring in various parts of the world, due wholly to milk. In this 
same paper will also be found a compilation of 95 epidemics of scarlet 
fever and 35 epidemics of diphtheria due to milk. 
Doctor Kober sav^s; 
It is a remarkable fact that every attempt to improve the purity of this invaluable 
article of food, especially for infants, children, and invalids, the sick and convalescent, 
should be promptly opposed by the milk industry, which constitutes a strong spoke in 
the commercial wheel, and evidently considers it meddlesome interference with their 
trade. 
These men evidently do not know and can not know, that such hydra-headed diseases 
as cholera infantum, scarlet fever, and diphtheria have been disseminated in the milk 
supply; that typhoid-fever epidemics have been thus caused, and that milk may be 
the vehicle of the germs of tuberculosis and other infectious diseases and morbific 
agents. 
Pure natural milk can only be secured at dairies with sanitary buildings, a pure water 
supply, healthy, well-fed and well-cared-for cows, a well-equipped and well-kept milk 
room, provisions for thorough cleanliness, intelligent people in charge, and clean 
methods throughout. There are a number of persons, thanks to the training received at 
the dairy schools, who make an honest effort to place on the market milk obtained under 
such conditions, but by far the majority are indifferent to hygienic requirements, and 
therefore matters of this kind should not be left to the individual, but the principles 
which ought to be carried out should be embodied in effective laws and accepted and 
enforced in a practical sense. 
a Senate Doc. No. 441, 57th Cong., 1st sess., Washington, 1902. 
