MILK-BORNE TYPHOID 207 



does, pass through the intestinal wall into the nearest lymphatic 

 glands, leaving no visible trace on the intestine. Further, owing 

 to the fact that children swallow their pulmonary expectoration, 

 secondary infection of the intestine may rapidly follow primary 

 infection of the lungs. Hence it comes about that, in many cases, 

 the intestine and mesenteric glands are affected, and yet such a 

 condition cannot be taken as evidence of the infection by food. Dr 

 Still concludes that (a) the commonest channel of infection with 

 tuberculosis in childhood is through the lung ; (&) infection through 

 the intestine is less common in infancy than in later childhood; 

 (c) milk, therefore, is not the usual source of tuberculosis in infancy ; 

 and (d) inhalation is much the commonest mode of infection in the 

 tuberculosis of childhood, and especially in infancy. Dr Still has 

 placed on record 5 cases of tuberculous ulcer of the stomach in 

 children. 



Taking a broad view of the facts, it would appear that whilst 

 tuberculosis is not chiefly spread by means of milk, there is 

 unmistakable evidence, derived from pathological and clinical 

 experience, proving that tuberculous milk can, and does on occasion, 

 set up some form of tuberculosis (bovine or human) in the bodies 

 of man and other animals consuming the milk. 



Milk-borne Typhoid Fever 



Dr Michael Taylor of Penrith was the first to establish the now 

 well-known fact that milk may act as a vehicle of the virus of 

 enteric fever. That was in 1857.* Since that date more than 160 

 epidemics of this disease have been traced to a polluted milk supply. 

 Schuder states that 17 per cent, of all typhoid epidemics are due to 

 the consumption of infected milk. 



The steps in the process of infection are briefly as follow. Enteric 

 fever affects the intestine, and hence the excreta, especially in the 

 early stages of the disease, are charged with large numbers of the 

 causal bacilli. It is now known that the sweat, expectoration from 

 the lungs, and the urine of a typhoid patient may also contain the 

 typhoid bacillus. Indeed, the urine in 25 per cent, of the cases 

 generally contains large numbers of the bacillus (Horton Smith).f 

 There is also evidence to shqw that the bacilli may remain in the 

 urine for long periods after convalescence, even for months^ and 

 possibly for years. The bowel discharges and the urine are, therefore, 

 the two chief channels by which the typhoid bacillus is excreted. 

 It, therefore, readily gains access to the soil, to drains, and eventually 



* Edin. Med. Jour., 18.58, pp. 993-1004. 

 + Lectures on Typhoid Fever, 1900. 



