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TABLE OF CONTENTS.

Page. 1. INTRODUCTION

11 2. MILK AS A CAUSE OF EPIDEMICS OF TYPHOID FEVER, SCARLET FEVER, AND DIPHTHERIA

19 Typhoid fever.. Bacillus Typhosus in milk.

23 Summary of epidemics.

24 Stamford epidemic

25 Scarlet fever-----

27 Summary of epidemics..

29 Scarlet fever in Norwalk, Conn.

29 Diphtheria ---

32 Klebs-Löffler bacilli in milk.

33 Summary of epidemics --

36 Outbreak of diphtheria in Dorchester, Milton, and Hyde Park. 36 Epidemics of sore throat and pseudo-diphtheria.

37 Character of milk epidemics..

37 (a) Explosive onset -

37 (6) Disease follows the milk

38 Elkton epidemic

39 (c) Special incidence in milk drinkers.

10 (d) The better houses suffer greater invasion.

40 (e) Age and sex.

41 Source of milk contamination.--

11 (1) From hands of milker-

11 (2) Air and dust of the stable

14 (3) The milk pail.-

44 (4) Water supply-.

44 (5) Milk cooler

44 (6) Cans

15 (7) Transportation.--

15 (8) Distributing dairy.

15 (9) Bottles

15 Montclair epidemic--

46 Points of interest in reporting milk epidemics..

47 Busey & Kober-Summary of epidemics_

47 Milk epidemics-----

49 Table 1.-Typhoid

49, 116 Table II.-Scarlet fever.

93, 134 Table III.-Diphtheria

105, 1-13 Table IV.-Sore throat and pseudo-diphtheria.

113 (3)

Page.

149 151 152 152 153 154 151 154

155 158 159

161 163 164

173

171 175 177

3. THE MILK SUPPLY OF CITIES IN RELATION TO THE EPIDEMIOLOGY OF TY

PHOID FEVER-
Milk and other dairy products as factors in spread of infection.-
Ways in which the milk may become infected.

At the dairy farm.
At the dairy-
At the grocery-

At the home.
Determination of milk outbreaks...
Measures to prevent the dissemination of the infection of
typhoid fever.--

The prevention of the introduction of infection into milk..

The destruction of infection in milk. 4. FREQUENCY OF TUBERCLE BACILLI IN THE MARKET MILK OF WASHING

TON, D. C.

Introduction
Review of literature_-
The number of tubercular cows in the dairies supplying Washing.

ton, D. C.----
Results of tuberculin tests elsewhere than in herds supplying

Washington.---
Characteristics of Rabinowitsch's butter bacillus.
Collection of samples and technic------
l'se of tuberculin to eliminate infection with other acid-fast or-

ganisms_-
Table of results of autopsies on guinea pigs_

Résumé --
5. THE RELATION OF GOAT'S MILK TO THE SPREAD OF MALTA FEVER.

Characteristics of Malta fever.----
Geographical distribution of the disease.
Methods of infection ----
Epidemiology of Malta fever..
Susceptibility of goats to Malta fever.
Methods through which the infection is acquired by the goats --
Clinical indications of infected animals.
Outbreak of Malta fever on the Joshua Nicholson..
History of the investigation of the disease at Gibraltar, and pre-

ventive efforts and legislation.--6. MILK SICKNESS

Definition.---
Synonyms
Historical
Distribution-
Etiology and pathology-
Symptoms
Treatment

Bibliography
7. RELATION OF cow's MILK TO THE ZOO-PARASITIC DISEASES OF MAN

Remoteness of danger of infection through milk.---
Methods of possible contamination of the milk with prerentive
measures

Water-born parasites_

179 179 191 1.93 1.955 195 196 199 203 203 203 204

206 203 211 211 211 212 213 217 218 218 221 223

02 225

224

Page.

224

225

225

225 227 229

229

230 232 233 234 235 239 210 241 241 243 246 217

219

7. RELATION OF cow's MILK TO THE 200-PARASITIC DISEASES OF MAN

Continued.
Methods of possible contamination of the milk with preventive
measures-Continued.

Improper disposal of fecal matter.
Personal habits.---
Fecal material from animals.

Infections from dogs and cats..
8. MORBIDITY AND MORTALITY STATISTICS AS INFLUENCED BY MILK

Quantities of milk consumed.---
Milk and disease--
Statistics of infantile mortality --
Diarrheal diseases and milk --
Mothers' milk and lessened infantile mortality
Infantile mortality, a class mortality----
Scientific artificial feeding and the mortality rate.
Milk and tuberculosis.-
Milk and typhoid fever----
Scarlet fever and diphtheria.

Milk and Asiatic cholera. 9. ICE CREAM

Summary of chemical data relating to cream.
Summary of chemical data relating to ice cream.
Bacteriological investigations of ice cream in the District of

Columbia
The significance of a pure ice cream supply in relation to the

public health ----
Definitions and descriptions of ices in trade and other books.
Ice cream standard.--
The quantity of butter fat in ice cream.

General conclusions.. 10. THE CHEMISTRY OF MILK

Preface--
The composition and general characteristics of milk.
Changes in the composition of milk.
By the action of heat and acids_

Heat and acid coagulation.
Effect of heat on milk enzymes_
The digestibility of raw and boiled milk.

Effect of heat on enzymes in general.
By the action of milk enzymes ---
By the digestive ferments—the rennin coagulation of milk
By the action of bacteria and other micro-organisms_

The lactic acid fermentation.-
Abnormal fermentations of milk.

Milk poisons-galactotoxismus.
Legal standards governing the sale of milk-

United States and State standards.

Harwood's views on milk standards.
Milk adulterations
Skimming, watering, and the addition of foreign substances
Significance of watering in relation to the public health..

Artificial coloring matters and milk preservatives.-
Effect of artificial coloring matters and preservatives on

digestion and health.-

203 267 278 200 201 307 309 310 322 323 323 326 332 333 335 312 3.53 3.53 301 360 370 371 372 373 374 375 376

378 Page.

389 389 394

397 406 409

IN

10. THE CHEMISTRY OF MILK—Continued.

The Washington milk supply

Methods of analysis.--
Conclusions regarding the Washington milk supply-----
Table I, results of the chemical analyses of Washington

milks

Table II, milks below standard and those containing dirt.--

References to the literature of milk.---11. THE NUMBER OF BACTERIA

MILK AND THE VALUE OF BACTERIAL
COUNTS

419
423
426
427
429
429
431

The initial contamination of milk.
Legal standards.---
The practical value of bacterial examinations of milk.
Bacterial counts in Washington.--

Methods

Results tabulated
Results of bacterial counts of market milk in Washington in

1906 and 1907---

Bacterial counts in other cities 12. THE GERMICIDAI. PROPERTIES OF MILK.

Introduction
Examples of the germicidal action..
The effect of temperature---
Relation to agglutination..
Germicidal action compared with that of blood serum.
Relation to phagocytosis ----
Is the “ germicidal" action specific?-
The effect of dilution ----
The effect of heating and freezing--
Review of the literature upon the subject.-

Summary and conclusions...
13. THE SIGNIFICANCE OF LEUCOCYTES AND STREPTOCOCCI IN MILK.
14. CONDITIONS AND DISEASES OF THE COW INJURIOUSLY AFFECTING THE

MILK

Importance of a wholesome milk supply --
Milk from unhealthy cows as a factor in the spread of disease.
Tuberculosis ----
Tubercle bacilli in other dairy products_
Value of the tuberculin test.-
Actinomycosis.----
Botryomycosis
Foot-and-mouth disease-
Anthrax
Cowpox
Rabies
Mammites mastitis or garget.
Leucocytes in milk.
Gastro-enteritis
Milk sickness -
Septic or febrile condition..
Abnormal appearance and conditions of milk_
Slimy, stringy, or ropy milk---
Bitter milk

431
441
447
447
451
452
461
464
465
467
468
469
471
475
477

487 489 490 490 494 496 500 501 501 501 501 502 502 502 503 503 504 504 504 505

Page.

INJURIOUSLY

AFFECTING THE

14. CONDITIONS AND DISEASES OF THE COW

MILK—Continued.

Colored milk.
Taste and odor-
Poisonous milk.
Colostrum

Recommendations
15. SANITARY INSPECTION AND ITS BEARING ON CLEAN MILK.

Clean milk.
What is contamination?.
Sources of contamination
Milk utensils ----
Cleaning milk utensils.-
Milk houses
Caring for the milk.-
The city distributing plant-
Sanitary inspection of dairies.
Directions for scouring dairies_
Sanitary inspection of city milk plants.
Twenty-one suggestions..

The cows.
The stables,
The milk house...

Milking and handling milk.
16. SANITARY WATER SUPPLIES FOR DAIRY FARMS_

Requirements of a sanitary water supply --
Sources of water supply--
Sources of pollution.--
Purification of water in the soil...
Protection from pollution.-
Abundance of supply-

Convenience of supply----
17. METHODS AND RESULTS OF THE EXAMINATION OF WATER SUPPLIES OF

DAIRIES SUPPLYING THE DISTRICT OF ('OLUMBIA-18. THE CLASSIFICATION OF MARKET MILK.

Class 1, certified milk.
Class 2, inspected milk.

Class 3, pasteurized milk..
19. ('ERTIFIED MILK AND INFANTS' MILK DEPOTS.

Certified milk--

Copy of agreement with dairymen.
Organization of the medical milk commissions.
Functions of the commissions -
Working methods and standards.
The standards of purity---
Regulations for the production of

Results accomplished...
Infants' milk depots.--

Formula for modified milks..
Cities in the United States in which are located infants' milk

depots

505 505 506 506 506 509 511 511 512 311 514 515 515 516 517 518 519 522 522 523 523 523 525 528 529 530 533 3+

538

511 5.7 500

500 561 503 50.3 567 572 -373 573 170 577 JSO JS1 581

583

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