TYPHOID FEVER MILK-BORNE OUTBREAKS 



317 



Milk became infected probably 

 through water-pollution owing to 

 dair)Tnan and subsequently two of 

 his children suffering from typhoid 

 fever. 



Probable exciting cause. — Human 

 source through polluted water con- 

 taminating the milk. 



Reporter and reference. — Dr Bal- 

 lard. Loc. Gov. Bd. Rep., 1874, 

 P- 79- 



Moseley and Balsall Heath, 1873. 



Total number of cases — 96 in 50 



families. 



Deaths 10 



Number of families invaded 



supplied by milkman . . 47 



Number of polluted milk sources i 



Number of milkmen ... 4 



Circumstances implicating the milk 

 sup>ply. — Boy at milkman's house ill 

 of typhoid fever, suffered there for a 

 fortnight and died. Two wells polluted 

 from a pri\y into which typhoid 

 excreta had been throwTi. The water 

 of the well was added accidentally or 

 intentionally to the milk. Dr Ballard 

 summed up his view of the causation 

 in this outbreak as follows : — (i) Two 

 wells upon adjoining premises occupied 

 by milk sellers became infected early 

 in November with the infectious matter 

 or virus of enteric fever, through the 

 soakage from a privy into them of 

 excremental matters containing that 

 matter of infection. (2) Through the 

 medium of water drawn from these 

 wells the milk supplied by these milk 

 sellers became infected, and many of 

 their regular customers who drank the 

 milk suffered from the disease. (3) 

 The same infected milk having been 

 sold to two other milk purveyors, 

 some of the persons using the milk 

 supplied by these milkmen also suffered 

 in a similar manner. (4) There is no 

 e\'idence that the disease spread in 

 these districts in any other way than 



through the consumption of the in- 

 fected milks. 



Probable exciting cause. — Human 

 source. 



Reporter and reference. — Dr Bal- 

 lard. Loc. Gov. Bd. Rep., 1874, 

 p. 92. 



Marylebone. 1878 {J^uly and August). 



Total number of cases — 244 in 143 



families. 

 Number of cases amongst 



drinkers of suspected milk . 218 



Percentage on total cases . . 90 



Number of polluted milk sources i 



Number of milkmen . . , i 



Circumstances implicating the milk 

 suf>ply. — It was found that, with one 

 exception, wherever the milk of this 

 supply was distributed there enteric 

 fever was distributed. The epidemic 

 was almost exclusively amongst 

 wealthy people or their servants. 

 The disease not only picked out 

 certain houses, but also picked out the 

 milk drinkers in those houses, and 

 more particularly those who drank 

 cold milk in large quantities. 



The milk of six of the farms supply- 

 ing the dairy was free from suspicion, 

 but the seventh was not so. This farm 

 was situated in Buckinghamshire. 

 On 8th June the farmer died from 

 typhoid fever. (On 12th August a son 

 of the farmer also had typhoid.) The 

 undisinfected excreta were deposited 

 in an ash-heap, from which they found 

 their way by soakage into the water 

 used for dairy purposes. 



Whilst these are the bare facts, it is 

 imp>ortant to note that they were by 

 no means obvious at the time of the 

 inquiry. On 8th June the farmer died 

 suddenly in the fourth week of an 

 attack of ambulant typhoid fever. 

 Owing to the suddenness of fatality 

 and to the presence of some heart 

 disease the typhoid was overlooked, 

 and the death certified as due to heart 



