HUMAN INFECTION 399 



Human Infection. It is necessary that food be protected from 

 contamination during the whole process of preparation and serving 

 to prevent its infection with pathogenic bacteria, as is illustrated by 

 the remarkable instance reported by Sawyer where ninety-three 

 typhoid cases were caused by eating Spanish spaghetti served at a 

 public dinner. Investigation showed that the dish had been 

 prepared by a woman typhoid-carrier who was harboring living 

 typhoid bacilli at the time she prepared the dish. The dish was 

 baked after it was infected, but the baking was shown by laboratory 

 experiments to have incubated the bacteria instead of sterilizing 

 the food. 



Then there is the celebrated case of Typhoid Mary, investigated 

 by Saper. In the pursuit of her work as a cook in and about New 

 York City she is known to have caused at least seven typhoid out- 

 breaks in various families and one extensive hospital epidemic. 



The danger from this source is voiced by Chapin as follows: 

 "There are doubtless 200,000 cases of this disease (typhoid fever) 

 in the United States each year. If only 3 per cent, of these become 

 chronic carriers, and if a carrier remains such only three years, we 

 should have a carrier population of 18,000 persons, practically 

 unknown and taking no precautions against infecting others. If we 

 add to these the 25 per cent, of convalescents, who for some weeks 

 are excreting the bacilli in their urine, it appears that there is a very 

 respectable army of unrecognized sources of typhoid infection." 



This is a situation which will be solved only when all handlers 

 of food in public places are examined for various diseases which are 

 transmissible through food. A move in the right direction has been 

 made by the California State Board of Health which enters into the 

 following agreement with all carriers discovered: 



" I have this day been informed that my excreta contain typhoid 

 bacilli and that, unless unusual precautions are taken, persons will 

 contract the infection from me. Realizing this danger I agree to 

 observe the precautions stated below, and request that I be permitted 

 to remain in free communication with other persons. 



"1. I will take no part in the preparation or handling of food 

 which will be consumed by persons outside of my immediate family, 

 and I will not participate in the management of a boarding house, 

 restaurant, food store, or in any other occupation involving the 

 preparation or handling of food. 



"2. I will not dispose of my excretions in a toilet to which flies 

 have access without first exposing such excretions to either a 5 per 

 cent dilution of liquor formaldehyd or 5 per cent, phenol (carbolic 

 acid). 



"3. I will notify the local health officer of any cases of typhoid 

 among persons with whom I come in contact. 



"4. I will inform the local health officer of any contemplated 



