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milk supply. She was placed in a large well-ventilated room,
the husband occupied a separate one, and nursed by the
District Visiting Nurse, and an untrained nurse who remained
in the house. The latter prepared the husband's food ; but she
was given strict directions about rendering her hands aseptic.
Nevertheless, the husband fell ill about a week after the wife
got up. No other source of infection besides his wife could be
tfaced.
39. Remarks.—The facts given above are, I consider, conclusive
proof that this epidemic was caused by a particular
milk supply.
A. Source of Infection.—A considerable number of milk
epidemics of Enteric Fever have been reported in recent years.
Some of these have been clearly traced to the use (for washing
the milk cans or diluting the milk) of water contaminated with
the excreta of a previous case of the disease. But in other
cases—as in the present epidemic—there appeared no probability
of contamination by a previous ease. It has been
suggested that, as is probably the case with Scarlet Fever,
Enteric Fever may be communicated to man by the milk of
diseased cattle. A third explanation is the contamination of
the milk by sewer gas.
Pre-existent Case of Enteric.—In the present case, it seems
unlikely that anyone with Enteric Fever had had any connection
with the dairy. I enquired carefully from their medical
attendants as to the recent ailments of all connected with the
dairy, and could find nothing suspicious about them. May,
too, is the month when Enteric Fever is least prevalent. If
there had been any case of the disease among the dairy people,
the dirty and intemperate habits of these, and the existence of
the tank of water, offered a likely means of the contamination
Y 2