–48 Flynn. “Raw Milk Killed 48 in Boston Outbreak — 100 Years Ago.” Food Safety News, 3-16-2012.

–38 Vaughan. Epidemiology and Public Health. 1922, p. 124.

Narrative Information

Flynn: “Editor’s Note: In May 1911, as many as 1,400 people in the Boston area were infected with micro-organisms — most likely staphylococcici or streptococci — spread by contaminated raw milk during an outbreak that killed 48. At the time, the illnesses were called septic sore throat or simply tonsillitis. The incident remains one of the 10 deadliest outbreaks of foodborne illness in U.S. history….”

“The lesson drawn from the outbreak is that even a most carefully supervised milk supply is open to the danger of grave infection from carrier or unrecognized cases of disease,” wrote biology professor C.E.A. Winslow. “The only real safeguard against such catastrophes lies in pasteurization, carried out by the holding system and preferably in the final packages.

“Professor Winslow made those recommendations 100 years ago, in the Journal of Infectious Diseases, about the 1911 Boston staphylococci or streptococci outbreak that killed 48 people. It was originally caused by drinking contaminated raw milk and spread because it was “communicable by contact,” especially among people in the same household.

“Winslow’s 39-page article, titled “An outbreak of tonsillitis or septic sore throat in Eastern Massachusetts and its relation to an infected milk supply,” records the details of one of the most significant public health events in U.S. history.[1]

“Winslow says the outbreak was first recognized at a medical meeting in Boston on May 11, 1911 when physicians attending realized they each had been treating at least 20 to 30, and in some cases as many as 60 and 70 patients, for “tonsillitis of a peculiar and characteristic type” within the last week.

“Severe headaches, acute abdominal pains and high temperatures of 103 to 105 degrees were the common symptoms. “It was commonly called tonsillitis, but differed from ordinary tonsillitis in some respects, and was held by many physicians to be a new and peculiar pathological condition,” Winslow wrote.

“At the meeting, the physicians reported something else. Most of the families with illnesses were customers of a single milk supplier — Dearfoot Farms.

“Winslow says many of the doctors were ‘loath to believe’ that Dearfoot Farms ‘could possibly be involved.’ The company had been supplying Boston and its suburbs with milk for 28 years, and ‘had been universally regarded as a pioneer in the work of dairy inspection and in the marketing of clean milk…’

“In 1911, tonsillitis was not a “reportable” illness – doctors did not have to report it to health authorities. Wilson’s investigation depended on the medical community volunteering information, and that’s how he discovered that some areas with illnesses were not directly supplied by Deerfoot. He eventually collected more than 1,400 records directly from physicians.

“ ‘The disease was not ordinary follicular tonsillitis, but more nearly what the English recognize as septic sore throat,’ Winslow wrote. ‘In early stages there was merely a diffuse redness over the tonsils and adjoining regions, but follicular patches often appear later and in many cases a membrane simulating that of diphtheria.’

“Winslow said the disease was “severe,” and “occasionally fatal among the old and the weak.” He said there were actually two epidemics — one centered in and around Boston, Brookline and Cambridge, and another in the area around Marlboro, 25 miles inland.

“In his interviews with physicians in Boston, Winslow identified 1,043 outbreak-related cases, with the illnesses peaking on May 14 and “practically ceasing” after May 22. In 56 percent of the affected households, there was only a single case.

“Two-thirds of the deaths were among people older than 55, and one-third of those were over 75. Adults suffered more than children; only 15 percent of the cases were under age 16. Females were infected at twice the rate of males.

“Winslow discovered that the distribution of the epidemic “exactly coincided” with Deerfoot’s two main milk delivery routes. His study of customer lists found that about one in four on the routes were infected….

“ ‘Throat cultures examined at the Boston Board of Health Laboratory and elsewhere showed no constant organism but Professor Theobald Smith, of the Harvard Medical School, has four cultures isolated from internal organs in the more severe cases, all of which are streptococci of apparently the same type,’ Winslow added….

“The 48 deaths included 17 males and 31 females. The victims lived in Boston (19); Brookline (6) and Cambridge (23).

“ ‘Probability pointed to one of the two more universal vehicles, water or milk, and since the water supplies of the three communities are distinct, more particularly to milk supply,’ Winslow wrote.

“Deerfoot Farms had two milk supplies, Southboro and Northboro, with a cream supply common to both. It was milk from Southboro that corresponded to the spread of the bacteria. ‘On the whole, the general correspondence between Southboro milk and tonsillitis appears too close to be accidental,’ Winslow noted….

“Outbreaks early in the last century, like the one in Boston, eventually brought an end to the widespread distribution of raw milk, and most milk was pasteurized from then on to prevent the spread of disease and death….” (Flynn. “Raw Milk Killed 48 in Boston Outbreak — 100 Years Ago.” Food Safety News, 3-16-2012.)

Vaughan: “Both in England and in this country since 1875 there have been numerous epidemics of septic sore throat in which the hemolytic streptococcus has been believed to be the active causative agent. In Boston in 1911 there was a sharp outbreak with 1,034 reported cases and 38 deaths…..This sore throat differs largely from ordinary tonsillitis and is marked by extreme prostration and is likely to be followed by many and varied severe complications to which death is due. In some…epidemics there was good reason for believing that the streptococcus was distributed in the milk supply. At first it was believed that the virulent streptococcus was of bovine origin, because in some of the dairies supplying the infected milk mastitis was found among the cows. Even the best of milk contains streptococci, but usually these are of the nonhemolytic variety, although hemolytic streptococci are occasionally found in perfectly good milk and in that, the use of which is not followed by any disease. Later, and as a result of more exhaustive research, it was believed that the streptococcus of epidemic sore throat is not of bovine origin, but is a human strain which comes originally from the throats of milkers although it may be accidentally transferred to the udder of the cow. It is possible that a human strain of the hemolytic streptococcus may be greatly increased in virulence by passage through the tissues of the udder of the cow. There are questions connected with streptococcic sore throat which are awaiting solution.” (Vaughan. Epidemiology and Public Health. 1922, pp. 124-125.)

Sources

Flynn, Dan. “Raw Milk Killed 48 in Boston Outbreak — 100 Years Ago.” Food Safety News, 3-16-2012. Accessed 4-8-2018 at: http://www.foodsafetynews.com/2012/03/raw-milk-killed-48-in-boston-outbreak-100-years-ago/#.Wsqm3Zch2nI

Vaughan, Victor C., MD, assisted by Henry F. Vaughan and George T. Palmer. Epidemiology and Public Health: A Text and Reference Book for Physicians, Medical Students and Health Workers Vol. I, Respiratory Infections. St. Louis: C. V. Mosby Co., 1922. Google preview accessed 4-8-2018 at: https://books.google.com/books?id=duUxAQAAMAAJ&printsec=frontcover#v=onepage&q&f=false

[1] http://www.jstor.org/stable/30071894

1911 — May, Septic sore throat (from hemolytic streptococcus in milk), Boston, MA –38-48