Conclusions.

(1) No cases of scarlet fever among the workmen employed at the depot were found.

(2) Employees were found at work in whose families cases of scarlet fever existed.

(3) A more careful medical inspection of men engaged in the handling of milk is necessary.

IV. INVESTIGATION OF THE DRIVERS ON THE SEVERAL MILK ROUTES OF "X."

A study of the distribution of the cases of scarlet fever over the various milk routes in Cambridge, Somerville and Everett showed:

(1) The cases were not limited to one or two routes, but in Everett and Somerville cases occurred on seven of the nine routes, and in Cambridge on seven of the eleven routes.

(2) As nearly as can be ascertained by a rough estimate of the sequence in which the wagons are loaded at the depot, the infected milk left the depot not at any one period, but throughout the day, from 11 o'clock of the morning of the arrival of the milk until 7 o'clock of the next morning.

(3) The routes in charge of the drivers who were either themselves infected, or in whose households cases of scarlet fever developed, showed no greater number of cases than other routes.

(4) The milk routes supplying Cambridge, Somerville and Everett distribute milk on the day of its arrival, while the routes supplying Boston distribute milk early the next morning. In this connection it is to be noted that the epidemic reached its climax one day later in Boston than it did in Cambridge, Somerville and Everett.

Conclusions.

The infection of the milk probably occurred before the sealed jars were loaded upon the wagons for distribution along the various milk routes.

GENERAL CONCLUSIONS CONCERNING THE EPIDEMIC.

(1) The sudden onset of this epidemic, together with its wide distribution, point to a common source of infection.

(2) The simultaneous appearance of the explosion in Cambridge, Somerville, Everett, and, allowing for the fact that the milk distributed in Boston is delivered a day later than it is in the above-mentioned cities, in Boston, suggests that the period of infection was synchronous for these places.

(3) The explosive nature of the outbreak, shown by the fact that 67.66 per cent. of the cases occurred within six days, and the further fact that a large proportion of the stricken persons were taken sick on days during which the same installment of milk was distributed, indicate that the period during which the milk was infected was very brief, probably one day only.

(4) The fact that in the cases investigated in Boston 80 per cent., in Cambridge 85 per cent., in Somerville 86 per cent. and in Everett 83 per cent. an average of 84 per cent. - of the persons stricken obtained milk of the same dealer, and had nothing else discoverable in common as a means of infection, justifies the conclusion that the vehicle of contagion was the milk supplied by the dealer "X."

(5) The warm weather prevailing during the first part of January, when the outbreak occurred, was favorable for the multiplication of disease organisms introduced into the milk.

(6) Investigation of the farms supplying milk sold by "X" showed:

(a) That at least one farm is unsanitary, and unfit to produce clean milk.

(b) That the milk cans used are not properly cleaned, and that cans are used for purposes other than the bringing of milk to the Boston market.

(c) That this dealer is not enforcing his rule, which requires the exclusion of milk from farms on which cases of infectious diseases are reported to exist.

(d) That a more careful supervision of the farms supplying milk for public sale is imperative.

(7) From investigation of the employees at the milk depot of "X" it appears:

(a) That certain employees were at work, in whose families there existed cases of scarlet fever.

(b) That more careful medical supervision of the men engaged in handling the milk after its arrival should be required of the milk contractors.

(8) From investigation of the methods employed in testing milk at the milk depot it is evident that the least objectionable of those now in use is conducive to infection of the milk.

(9) From investigation of the drivers of the several milk routes it appears that the milk was probably infected before it was delivered to their hands in the sealed glass bottles in which it is distributed.

(10) A more careful supervision of the methods of milk contractors distributing milk in Boston and its vicinity is imperative; and this

supervision should include not only the methods of handling and delivering milk after its arrival in the city, but also the farms from which the milk is obtained.

NEW LEGISLATION.

The Legislature has passed the following acts:

AN ACT TO AUTHORIZE THE TAKING FROM CONTAMINATED WATERS OF CLAMS AND QUAHAUGs for Bait.

Be it enacted, etc., as follows:

SECTION 1. Whenever, upon the request of the state board of health under the provisions of section one hundred and thirteen of chapter ninetyone of the Revised Laws, the commissioners on fisheries and game have prohibited or may hereafter prohibit the taking from contaminated waters or flats in any city or town of any clams or quahaugs, the board of health of such city or town may grant permits in writing to any person to take from such waters clams or quahaugs to be used for bait only, and in such quantities and upon such conditions as they shall express in their permit.

SECTION 2. Any person holding a permit from the board of health of a city or town shall keep in his possession, and on his person, while acting thereunder, any permit obtained by him from said board of health, and shall at all times display the same upon the request of any person authorized to enforce the provisions of this act. Violation of this section shall be punished by a fine of not less than ten dollars nor more than fifty dollars, and in addition the permit shall be revoked and shall not thereafter be issued within twelve months.

SECTION 3. Any person who violates any of the provisions of such permit shall forfeit the permit and shall be punished by a fine not exceeding one hundred dollars, or by imprisonment for a term not exceeding three months, or by both such fine and imprisonment.

SECTION 4. Whoever sells, or exchanges, or exposes or offers for sale or exchange, or buys any clams or quahaugs, taken under the provisions of this act, shall be punished by a fine of not more than one hundred dollars, or by imprisonment for a term not exceeding three months, or by both such fine and imprisonment.

AN ACT RELATIVE TO THE LABELLING OF CERTAIN PATENT OR PROPRIETARY DRUGS AND FOODS.

Be it enacted, etc., as follows:

SECTION 1. Chapter three hundred and eighty-six of the acts of the year nineteen hundred and six is hereby amended by striking out section one and inserting in place thereof the following: - Section 1. Upon every package,

bottle or other receptacle holding any proprietary or patent medicine, or any proprietary or patent food preparation, which contains alcohol, morphine, codeine, opium, heroin, chloroform, cannibis indica, chloral hydrate, or acetanilid, or any derivative or preparation of any such substances, shall be marked or inscribed a statement on the label of the quantity or proportion of each of said substances contained therein. The size of type in which the names of the above substances shall be printed on the labels as above, shall not be smaller than eight point (brevier) caps: provided, that in case the size of the package will not permit the use of eight point cap type the size of the type may be reduced proportionately. The provisions of section nineteen of chapter seventy-five of the Revised Laws, so far as they are consistent herewith, shall apply to the manner and form in which such statements shall be marked or inscribed.

SECTION 2. No dealer shall be prosecuted under the provisions of this act when he can establish a guaranty signed by the wholesaler, jobber or manufacturer residing in this Commonwealth, from whom he purchases such articles, to the effect that the same is not misbranded within the meaning of this act, designating it. Such guaranty, to afford protection, shall contain the name and address of the party or parties making the sale of such articles to such dealer; and in such case said party or parties shall be amenable to the prosecutions, fines and other penalties which would attach, in due course, to the dealer under the provisions of this act.

SECTION 3. Section two of chapter three hundred and eighty-six of the acts of the year nineteen hundred and six is hereby repealed.

SECTION 4. This act shall take effect on the first day of March in the year nineteen hundred and eight.

An official publication of the State Board of Health of Massachusetts, issued monthly from the office of the Board, 141 State House, Boston, Mass.

New Series.

APRIL, 1907.

Vol. 2. No. 4.

ENTERED AT THE POST-OFFICE AT BOSTON, FEB. 15, 1906, AS SECOND-CLASS MATTER. ACT OF JULY 16, 1894.

WRIGHT & POTTER PRINTING CO., STATE PRINTERS,

18 POST OFFICE SQUARE.