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14
the disease shows a distinct decline. The outbreak caused a
good deal of anxiety and work to your officials.
At one time as it was not clear that school influence was
the sole cause at work, and as we could not trace the infection
to the milk of any particular vendor, a systematic enquiry
was made as to the sources from which the vendors
obtained their wholesale supplies. Each vendor as a rule
gets his milk from three or four sources, and as it is not
always mixed 'before distribution, it became necessary to go
further back and obtain information with regard to these.
A list was compiled to ascertain whether there was any overlapping,
but it was found that there was none, and we came
to the conclusion that the disease was not being spread by
milk.
Later on evidence was obtained showing that many of the
children throughout the district were suffering from slight
sore throat, and I have no doubt that the infection beginning
in the school was afterwards sown broadcast in the district
by these children whose brothers and sisters often attended
other schools.
It is well recognized that both diphtheria and scarlet fever
are often propagated in this manner, and that when diphtheria
is in a school, the specific organism of the disease
may be demonstrated to exist even in the throats of children
who are apparently in good health.
School influence, direct or indirect, would not account for
some of the cases, but experience shows that we have still a
good deal to learn as to the occurrence of this sporadic form
of the disease.