ividual may serve in the capacity of nurse or attendant to a
sick person, and also assist in the handling of the milk, either in
milking the animals or caring for the milk after it has been drawn.
Busey and Kober report twenty-one outbreaks of typhoid fever in which
dairy employees also acted in the capacity of nurses.

_3. Pollution of milk utensils._ The most frequent method of infection
of cans, pails, etc., is in cleaning them with water that may be
polluted with disease organisms. Often wells may be contaminated with
diseased matter of intestinal origin, as in typhoid fever, and the use
of water at normal temperatures, or even in a lukewarm condition, give
conditions permitting of infection. Intentional adulteration of milk
with water inadvertently taken from polluted sources has caused quite a
number of typhoid outbreaks.[105] Sedgwick and Chapin[106] found in the
Springfield, Mass., epidemic of typhoid that the milk cans were placed
in a well to cool the milk, and it was subsequently shown that the well
was polluted with typhoid fecal matter.

_4. Pollution of udder_ of animal _by wading in infected water_, or by
washing same with contaminated water. This method of infection would
only be likely to occur in case of typhoid. An outbreak at the
University of Virginia in 1893[107] was ascribed to the latter cause.

_5. Pollution of creamery by-products, skim-milk, etc._ Where the milk
supply of one patron becomes infected with pathogenic bacteria, it is
possible that disease may be disseminated through the medium of the
creamery, the infective agent remaining in the skim milk after
separation and so polluting the mixed supply. This condition is more
likely to prevail with typhoid because of the greater tolerance of this
organism for acids such as would be found in raw milk. The outbreaks at
Brandon,[108] England, in 1893, Castle Island,[109] Ireland, and
Marlboro,[110] Mass., in 1894, were traced to such an origin.

While most outbreaks of disease associated with a polluted milk supply
originate in the use of the milk itself, yet infected milk may serve to
cause disease even when used in other ways. Several outbreaks of typhoid
fever have been traced to the use of ice cream where there were strong
reasons for believing that the milk used in the manufacture of the
product was polluted.[111] Hankin[112] details a case of an Indian
confection made largely from milk that caused a typhoid outbreak in a
British regimen