DISEASES COMMUNICABLE IN MILK 87 



outbreaks rouse the community to instant action and something usually 

 is done which checks the outbreak when it is on a rising tide. As an 

 instance of the other kind of epidemic that at Belleville, 111., may be 

 cited. In the 7 months from July, 1911, to January, 1912, there were 



23 cases of typhoid fever which if the same distribution of cases had con- 

 tinued throughout the year would have been equivalent to a typhoid 

 morbidity rate of practically 14 per 10,000 of population and which is 

 not excessive. As a matter of fact the cases being distributed in the 

 practice of several physicians and among people who as a whole were 

 unacquainted with each other attracted absolutely no attention but when 



24 cases appeared in February and 41 in March bringing the rate up to 

 nearly 56 there was alarm at once. It was found that over 85 per cent. 

 of all the cases were due to the milk of a single dairy which all this time 

 had been kept infected by a carrier who only at irregular intervals came 

 into contact with the milk supply and infected it. The increased number 

 of cases in February and March was in part explainable by the fact that 

 during these months the contact of the carrier with the route was more 

 regular. Had typhoid fever been a reportable disease in Illinois at that 

 time suspicion would probably have fallen on the dairy in question sooner. 

 Hill tells of the experience of North Branch, Minn., where one of the 

 physicians pointed out that in his 17 years of practice during the first 

 12 there was no typhoid fever but that in the last 5, native cases of un- 

 known origin had not been infrequent. Acting on this information a 

 list of 21 cases of typhoid fever that had appeared in the town in the last 

 5 years was made and inquiry showed that 17 of the patients were regular 

 customers of a dairyman who had come to town 5 years before, besides 

 which, two were occasional customers and two more might have been. 

 It developed that the wife of the dairyman who had typhoid fever 22 

 years before washed the cans. This woman showed a positive Widal 

 reaction but typhoid bacilli were not isolated from her stools. She was 

 forbidden to have anything to do with the dairy and the proprietor was 

 told that if another primary case of typhoid fever appeared among his 

 customers the dairy would be closed up. Rumors of this were hinted 

 about the town so that trade fell off and the family moved away, after 

 which there was no more typhoid fever. Thus all the cases of typhoid 

 fever in North Branch were due to the occasional infection of the milk 

 supply. 



The explosive sort of epidemic is usually thought of as being typical 

 of milk-borne outbreaks, but the smoldering kind must be very common 

 especially in communities that lack a modern health department and 

 laws compelling compulsory notification of contagious disease. No 

 doubt too, much of the sporadic and residual typhoid that persists in our 

 large cities, were all the facts known, might be traced to occasional or 

 intermittent infection of the food supply by carriers and others. 



