155 
in handling it. Some persons after passing through an attack of 
typhoid fever continue to discharge the bacilli in their stools or urine 
for years. One of these “ bacillus carriers ” working in milk at a 
dairy farm or dairy may contaminate a can of milk from time to 
time and be the source of infection for a number of cases. 
There have been reported recently several outbreaks of milk-borne 
typhoid fever traced to infection from bacillus carriers. Albert a 
reports an outbreak in October, 1907, at Cedar Falls, Iowa, in which 
13 cases occurred in the three families supplied with the suspected 
milk. The man who owned the cow and did the milking had had 
typhoid fever one year previous to the outbreak. He was found to 
have a slight cystitis and typhoid bacilli were demonstrated in the 
urine. No source other than the urine of this man could be discovered 
to account for the infection in the milk. 
Lumsden and Woodward b report an outbreak in September and 
October, 1908, in Washington, D. C., in which 54 cases occurred. The 
cases were among the customers of two different dairymen, both of 
whom, however, received a part of their milk supply from a certain 
farm. All the evidence obtained pointed to this farm as the source 
of the infection in the milk. No history of recent sickness on the 
farm could be ascertained. A search for bacillus carriers among the 
persons on the farm was made and in the specimen of feces obtained 
from one of the milkers — a woman who had had an attack of t} 7 phoid 
fever about eighteen years before the time of the outbreak — typhoid 
bacilli were found in large numbers. No source other than the feces 
of this woman could be discovered to account for the infection in the 
milk. 
Scheller, c in the course of an investigation of an unusual preva- 
lence of typhoid fever in a section near Konigsburg, Germany, 
directed his attention to the milk supply. He discovered, among 
those who handled the milk, a woman who was excreting in her 
stools and urine typhoid bacilli. There appeared to be no doubt 
that this woman, who had had an attack of typhoid fever seventeen 
years before, constituted the source of infection for the outbreak. 
There were on the estate 180 persons; of these, 140 neither consumed 
nor in any way handled the milk and the excreta of all of them 
were found to be free from typhoid bacilli. Of the 40, however, 
who either handled or consumed the milk, 18 were found to be bacillus 
carriers. Only 4 of the 18 had had an attack of typhoid fever and 
these 4 had had the attack some years before. Some of the car- 
riers were excreting the typhoid bacilli in the feces, some in the urine, 
° Hyg. Lab. Bull. No. 41, Jan., 1908, p. 49. 
6 Journ. Am. Med. Assn., March 6, 1909, vol. lii, pp. 749-752. 
c Centblt. f. Bakt., vol. 46, 1908, p. 385. 
