42 
years, and being well, remain at work and continue a menace over 
long periods of time. 
'Wdien it is considered that available evidence seems to show that 
between 2 and 4 per cent of typhoid convalescents become chronic 
bacillus carriers, the probability that some of them are employed at 
dairies in milking cows and handling milk is very great. 
Several epidemics, due to milk infected by these chronic typhoid 
bacillus carriers, have been reported. Others will undoubtedly be 
found with increasing frequency as epidemics are studied with this 
possibility in mind. 
Dr. Henry Albert reports a small but interesting outbreak of this 
kind 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 in the family of one neighbor and 
2 in the family of another neighbor. The man who had typhoid fever a year 
ago owned a 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 1 
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 infection of the 9 cases in the neighboring families was carried. 
Branthwaite reports an outbreak at Brentry Reformatory, an in- 
stitution for the detention and treatment of habitual inebriates. The 
reformatory consisted of IG buildings, scattered over about 98 acres 
of ground. The institution was practically isolated from other com- 
munities and housed usually about 265 persons. It ran its own dairy. 
From 1899 to 1906 the institution remained free from infectious dis- 
eases. The first case of typhoid occurred in September, 1906, and by 
November, 1907, 28 cases had developed. The patients fell ill at 
irregular intervals and always in groups of from three to five. The 
first patient was a woman who had been in the institution several 
months, and therefore removed from the possibility of outside in- 
fection. Careful search was made as to the possible introduction of 
the disease, but in spite of all precautions others continued to be 
attacked. A detailed investigation pointed to the milk as the carrier 
of infection. All milk had been regularly sterilized, and therefore 
if it were the cause it was necessarily due to defective methods or 
to subsequent contamination. A new sterilizing plant was installed, 
and all handling of milk after heating was limited to two persons, a 
