27 
I It is evident that Schiider did not include in his list the approxi- 
mately 90 t}^phoid epidemics collected by Car0e.® These occurred in 
I Denmark between 1878 and 1896, and were reported as in all prob- 
j ability due to milk. It is also apparent that he did not include the 
j combined milk typhoid epidemics collected by Hart, and Busey and 
: Kober, 138 in number, which had been previously compiled. 
I Undoubtedly the relative importance of the various agencies by 
' which typhoid fever is distributed varies with the locality and condi- 
tions. The various factors, water, milk, flies, and contact, have dif- 
ferent values in the city and in the town. They will naturally also 
i vary in importance with the season, the latitude, and the local cus- 
toms. Improved water supplies have eliminated water as a factor 
in many places, while regulation of the production, handling, and 
sale of milk is lessening its influence for harm in some communities. 
It would seem that water has been so apparent as a frequent carrier 
of the infection that other agents have not been looked for, or at least 
not commonly found, until improved water supplies had demon- 
strated that there were other factors at work. The experience in 
Massachusetts has been given by Harrington ^ as follows : 
! In the public mind outbreaks and epidemics of this disease (typhoid) are 
commonly associated with polluted drinking water, but when water supplies 
are properly guarded, as in Massachusetts, for example, they are more com- 
monly found to be caused by contaminated food, and especially by that one 
which is most subject to pollution and which offers the specific organism the 
most favorable conditions for preserving its virulence and increasing its num- 
bers — namely, milk. During the past two years, of 18 local outbreaks of 
typhoid fever in different parts of Massachusetts investigated under my direc- 
tion, 14 were traced to milk. 
Jensen® also makes the statement: 
The principal means by which typhoid fever is distributed in places where 
there is a safe and hygienic water supply is through milk. 
BACILLUS TYPHOSUS IN MILK. 
V. C. Vaughan‘S reported in 1890 the isolation of a bacillus from 
the water of a dairy well, and from the milk sold by the dairy. There 
had been one or more cases of typhoid in the family of the milkman, 
and one or more cases existed in every family patronizing this dairy.® 
The bacillus was highly pathogenic to white rats and guinea pigs. 
It was nonliquefying and toxicogenic. The bacillus resembled but 
®Car0e (K.), Ugeskrift for Laeger, 1898, V, p. 1009. 
^ New York Med. Jour., 1907, p. 697. 
c Essentials of Milk Hygiene, English ed., 1907, p. 106. 
Vaughan (V. C.), Ann. Report State Board of Health, Michigan, 1891, p. 216. 
® Vaughan (V. C.), Trans. Seventh Internat. Cong, of Hyg. & Demography, 
1891, Vol. Ill, Section III, p. 121. 
