41 
Among the well to do therefore it frequently happens that infectious 
milk finds more victims, while among the poor the children are the 
ones most likely to suffer. 
( e ) Age and sex . — Women and children are usually credited with 
drinking more milk than men and it is generally believed that a 
greater incidence of the disease in them is a characteristic of milk- 
borne outbreaks. 
SOURCE OF MILK CONTAMINATION. 
(1) From hands of milker .— Many dairy employees take no pre- 
cautions to keep the hands clean, and in fact the milker who washes 
his hands before milking is the exception and not the rule. He may 
have a mild attack of typhoid fever and remain at work or may be 
in the early stage of a severe attack, which will later remove him 
from the cow shed, or he may be one of those unfortunate beings — 
unfortunate for the community rather than himself — a chronic bacil- 
lus carrier.® Under any of these circumstances he may be, and usu- 
ally is, discharging typhoid bacilli in the excretions, and any care- 
lessness in toilet is apt to deposit bacilli on the hands and under the 
finger nails. In the act of milking it is more than likely that he will 
wash at least some of them into the milk pail, and especially so if he 
resorts to a custom, all too common, of moistening his hands by 
squirting milk upon the palms preliminary to milking. 
In this connection, Dr. Henry Albert reports a very interesting in- 
stance occurring in the autumn of 1907 at Cedar Falls, Iowa. 
A certain gentleman had typhoid fever a year ago and recently 4 cases of 
typhoid fever developed in his own family, 7 hi the family of one neighbor and 
2 in the family of another neighbor. The man who had typhoid fever a year 
ago owned cow, did his own milking, and supplied milk to the 2 families in 
which the cases, respectively, 7 and 2, developed. The man who is supposed to 
be the source of this infection is apparently perfectly well but has a slight cysti- 
tis and on the examination of his urine, typhoid bacilli were isolated. The water 
used by this man and his family came from a rather shallow well. It contained 
a large number of Colon bacilli but no typhoid bacilli were found. This water 
was however not used by any member of the other 2 families. Just how the 
bacteria gained entrance to the milk, whether from the hands of the bacillus 
carrier or from the water used for cleaning milk pails is difficult to determine, 
but it seems very certain that the milk was the medium through which the in- 
fection of the 9 cases in the neighboring families was carried. 
a Goldberger, Bull. No. 35, Hyg. Lab., U. S. Pub. Health and Mar. Hosp. Serv., 
Wash., p. 167. 
