drawn without any spilling of the intestinal contents, with consequent bacterial invasion of the abdominal cavity; and poultry so drawn would undoubtedly withstand decomposition and deterioration much longer than that which is undrawn.

6. The practice of depositing poultry in cold-storage when in the beginning or advanced stages of decomposition, in order to save it, is dangerous to the health of the consumer, since when it is again withdrawn for sale its condition is unaltered.

7. Proper and adequate inspection of poultry as it enters cold-storage is desirable, and storage of material already in process of decomposition should be prohibited.

8. The practice of placing cold-storage poultry in cold water for a number of hours for the purpose of thawing causes heavy bacterial infection, and consequent more rapid decomposition than occurs when thawing is allowed to proceed slowly at room temperature. Such treatment causes also a material increase in weight, by reason of absorption by the tissues of water, to the detriment of the purse of the purchaser, and hence is fraudulent.

Several questions in connection with the subject of cold storage of poultry are still in process of investigation, the results of which will be submitted in the final report.

By order of the Board,

CHARLES HARRINGTON,

Secretary.

AN EPIDEMIC OF SCARLET FEVER IN BOSTON, CAMBRIDGE, SOMERVILLE AND EVERETT.

During the first twenty days of January, 1907, 717 cases of scarlet fever occurred in Boston, Cambridge, Somerville and Everett. Of these cases, 367 were in Boston, a number which overtaxed the accommodations for scarlet fever patients at the City Hospital for the first time since its erection; 152 cases occurred in Cambridge, 155 in Somerville and 43 in Everett. Of these cases, 485, or 67 per cent. of the total number, occurred within a period of six days, that is, January 7 to 12, inclusive.

The suddenness of the onset of the epidemic, the fact that the cases were not grouped together in any one locality nor in any one school, and the fact that several cases were reported, such as a mother and her newborn child, a family of children confined with measles, etc., in which ordinary exposure to other scarlet fever cases was impossible, or at least most improbable, immediately suggested a common source of infection. An investigation of the milk supply of the cases showed that one large

milk concern supplied families in all four of these cities. A further investigation showed that this dealer supplied in Boston 80 per cent., in Cambridge 85 per cent., in Somerville 86 per cent. and in Everett 83 per

cent. of the cases investigated,

an average of 84 per cent. in the four cities. The accompanying diagram shows graphically the course of the

epidemic and the interrelation between the cases and the milk supply. Recognizing, accordingly, the relationship between the epidemic and the milk furnished, investigation of the epidemic became an investigation of the business of the concern, which we will designate as "X."

In the first place, the milk business of "X" consists of a large wholesale trade and a retail trade. The cases of scarlet fever were traced back almost without exception to the retail, or bottled milk. Consequently, an investigation of this retail milk was undertaken. The retail milk, that is, the milk which is brought to Boston, bottled at one milk depot, and delivered, for the most part, by "X's" wagons through Somerville, Cambridge, Everett and Boston, comes to Charlestown in two separate cars. One of these cars, Car No. 5, is filled with cans that are gathered by various collectors and loaded upon the cars from six stations, Hollis, Pepperell, Groton, Willows, Graniteville and Westford. The other car, from which the retail milk is obtained, Car No. 9-2, gathers its load from New Braintree, Barre, Coldbrook, West Rutland, Rutland, Jefferson, Muschopauge, Quinapoxet, Oakdale, Berlin and Hudson.

Car No. 5 arrives in Charlestown at 10 o'clock, having put off half of its load at West Somerville. Upon arrival at the milk depot, a large metal vat is placed in the car as it stands on the siding, and this vat is connected by a metal tube with a pipe leading into the depot. The milk is first tasted can by can in the car and then emptied into the vat, whence it flows into a common reservoir in the depot. Then it is pumped over a large cooling apparatus into a strainer, from which it is bottled by machinery and corked. Next the bottles are crated and loaded on the wagons for distribution, or stored in a cold room for later demand, and at 10.15 the milk in Car No. 5 is thus emptied. Car No. 9-2 arrives at Charlestown at 10.20, and at 10.30 the milk is brought therefrom to Car No. 5 and mixed with the milk of the latter.

Wagons begin loading for routes in Malden, Somerville, Everett, Revere and Cambridge at 10.30 A.M. From midnight to 7 o'clock the next morning, wagons for routes in Boston and routes in parts of Cambridge and Watertown are loaded.

Infection of the milk is possible:

First. At the farms where the milk is produced.

Second. By the taster of the milk before it is emptied into the vat when the cans are emptied at the milk depot.

Third. By the milkmen at the depot handling the cans, bottles and apparatus concerned in the process of mixing, cooling, straining and bottling the milk.

Fourth. By the drivers of the various routes in the process of delivering the milk.

I. INVESTIGATION OF THE MILK FARMS SUPPLYING “X.”

Number of farmers supplying milk to cars Nos. 5 and 9-2,

222

100

27

15

12

4

16

(1) The possibility of a direct infection of the milk from the 16 cases investigated was not proved.

(2) None of the 16 cases was directly connected with the farms supplying milk.

(3) One farm supplying milk was found to be in a filthy condition, and unqualified to supply clean milk, and not satisfying the conditions advertised by "X" as to the condition of the farms supplying "X" with milk.

(4) The milk cans returned by "X" for use by farmers are not properly cleaned.

(5) The milk cans used in bringing milk to Boston are being used by the farmers for other purposes.

(6) At South Merrimac a farm supplying milk to "X" was found upon which there had occurred three sudden deaths, one on December 31, one on January 1 and the third on January 7. The last case was reported by the attending physician as one of typhoid fever. Milk was shipped from this farm up to January 6, and again on January 16 and 17.

Investigation of these cases showed that they probably were due neither to scarlet fever nor to typhoid fever.

Conclusions.

(1) Milk was supplied to "X" by at least one farmer in violation. of the advertised rule that "notice of infectious diseases among the persons concerned in the handling of milk shall be given to the contractors, and the shipment of milk stopped."

(2) A more careful supervision of the farms supplying milk is imperative.

II. INVESTIGATION OF THE MILK TASTER EMPLOYED AT THE MILK DEPOT OF "X.”

On January 3 the taster regularly employed by "X" was replaced by a substitute. As this date corresponds closely with that upon which the milk was probably infected, this man and his family were carefully examined. The man showed a tongue with markedly prominent papillæ, back and chest covered with pimples, but no signs of desquamation, or other symptoms warranting a diagnosis of scarlet fever. Examination. of his family showed that his thirteen-year-old daughter had much enlarged tonsils, a tongue with markedly enlarged papillæ, and signs of a fine scaly desquamation over the lower legs, signs suggestive, but not diagnostic, of scarlet fever.

Inspection of the method of tasting the milk showed that the milk taster plunged a long spoon into the can to be tasted, lapped the spoon, shook it and plunged it into the next can. The spoon was produced from a dirty pocket, and was plunged into the milk without washing or without rinsing between the lapping of the spoon and immersion into the next can.

Other methods of tasting the milk, such as licking a finger dipped into the can, or licking the plug of the can, were reported, but not observed.

Conclusions.

(1) At a time when infection of the milk distributed by "X" might have caused the epidemic, there was employed at the milk depot of "X" a substitute milk taster whose condition suggested that he had had scarlet fever, and in whose family existed a person with signs strongly suggestive of this disease.

(2) The method of tasting milk, now in use, is exceedingly favorable to infection of the milk if the taster is suffering from contagious disease. (3) Some cleaner method of testing milk should be utilized, such as the use of destructible throat sticks, in order to avoid infection of the milk by a dirty spoon.

III. INVESTIGATION OF WORKMEN EMPLOYED AT THE MILK DEPOT

66

OF "X."

On January 14 a physician examined all of the men designated by "X" as engaged in handling the milk in any manner from its arrival on the cars to loading it on the delivery wagons. The throat and tongue, the skin of the chest and arms of each man were examined. Number of men examined, about fifty. Results of the examination: suspicious throats, six.

It appeared that cases of scarlet fever were present in the household of at least two of these employees.