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Bottles or cans in some way contaminated at the home or dairy in 
the city and without previous disinfection are again filled with milk 
at the dairy farm may be the means of conveying infection from the 
dairy farm back to the city. 
the dairy . — Milk after it reaches the city dairy is exposed again 
to the danger of becoming contaminated by persons handling it or 
by flies, dust, etc. 
At the average large city dairy there are a number of employees 
who reside at their own homes. At times some of these persons may 
come directly from the bedside of a case of unrecognized typhoid 
lever in the family to the dairy and, as is the case too frequently, 
without being required to change their clothes or to wash their hands 
in a germicidal solution, engage in handling the milk. 
In some American cities many of the dairies are located in the 
most unhygienic sections, and frequently cases of typhoid fever are 
cared for in houses adjoining the dairy or even in the same building. 
In these instances it is easy to understand how flies may pass from 
the dejecta of a patient to a can or bottle of milk and so be the 
means of conveying the infection. Cans or bottles returned from 
houses in which there are typhoid patients and which have been 
handled by persons caring for the sick and not disinfected before 
being refilled may be the means of disseminating the infection in 
the milk. 
From the water used for washing the bottles or cans, etc., at the 
city dairy, the typhoid bacillus may reach the milk. Considering the 
immense dilution in which the typhoid bacillus must usually exist 
in water taken from a large volume, such as a river or lake, for supply- 
ing a city, it may be that persons are rarely infected directly by the 
organism in the water; but the occasional typhoid bacillus in the 
water, upon being introduced into the milk and there multiplying, 
may infect persons drinking that milk. 
At the grocery . — In the studies of Kosenau, Lumsden, and Kastle® 
on the prevalence of typhoid fever in the District of Columbia there 
were found a number of instances in which typhoid patients were 
being cared for in rooms above or to the rear of small grocery 
stores. In these stores milk was sold in small quantities, often as 
little as a cent’s worth at a time, so that a quart bottle would be 
divided among several customers. The same hands that nursed the 
patient purveyed the milk. In such instances not only is there a 
likelihood of infection being sent out in the milk directly from the 
store, but these much-handled bottles may do damage when returned 
to the dairy. 
® Hygienic Laboratory Bulletin No. 35, Report on the Origin and Prevalence 
of Typhoid Fever in the District of Columbia, 1907. 
