TYPHOID EPIDEMIC. 7 1 



arrived at the Francis Farm and remained until August 30th, 

 or thereabout. Prior to his coming to the farm his little sister 

 had been ill, her illness appearing on or about July i6th. 

 After the boy's return from the farm he was not altogether 

 well, and on September 7th, or thereabout, he had to be sent 

 to a Philadelphia hospital, where his illness (according to his 

 mother), has been reported as " a touch of typhoid." These 

 are strongly suggestive of " walking typhoid." 



A surface privy is used at the Francis F'arm, located 

 eighty to ninety feet (measured by stepping off the distance) 

 from the place where the milking is done. In the barn the 

 buckets of milk are poured through a cloth strainer into a 

 large can or churn, and this strainer wet with milk is exposed 

 throughout the milking to flies. The privy is also open to 

 flies through the seats and through the trap door at the back 

 of it. This trap door was off its hinges and had one or more 

 boards missing from it, giving flies direct access in the light 

 to the contents of the privy. In addition to the infection 

 from flies, there wavS a possible direct infection from the hands 

 of the sick child, as it was difficult to keep the children out 

 of the dairy barn. The milk cans also are so located in the 

 3'ard back of the house, that they or the lids to them may 

 have been touched and handled by the boy. 



It was learned through the H . Day Nursery that none 



of the other children who had been to the Francis Farm since 

 the end of July have been ill in any way suggestive to the 



nurses of typhoid fever. The L . case does not therefore 



seem to be in all probability one of the cases to be included 

 with the other (secondary) infections in Cheltenham and vici- 

 nity, but appears as the only probable primary case to which 

 the typhoid fever in Cheltenham and vicinity can be traced. 



It is therefore my opinion that the cases of typhoid fever 

 in Cheltenham and vicinity originated at the Francis Farm, 

 and from the Italian boy, L ., from South Thir- 

 teenth Street, Philadelphia. 



(Signed) D. W. Horn. 



