20 
TYPHOID FEVER IN DISTRICT OF COLUMBIA. 
can not be corrected voluntarily, then we should recommend its 
enforcement by legislative enactments. 
To sum up the epidemiological findings; 
Eight hundred and sixty-six cases studied. 
About 129 cases, or 15 per cent, contracted their infection outside 
of the District of Columbia. 
About 85 cases, or 10 per cent, were attributed to infected milk or 
ice cream. 
About 54 cases, or 6 per cent, were attributed to infection by 
contact. 
Leaving about 598 cases, or 68 per cent, unaccounted for. 
THE MILK PROBLEM. 
Three separate milk outbreaks occurred in Washington between 
June and November, 1906. Eighty-five of the 866 cases of typhoid 
fever studied during this time were attributed to the use of infected 
milk. The source of the infection was traced to cases of the disease 
at the city dairy or at the dairy farm. Quite probably other cases 
contracted their infection from milk, but the number of such cases 
must remain problematical. In at least two instances employees at 
the dairy lived in houses in which cases of typhoid were being treated, 
and in other ways the relation between the disease, the infection and 
the milk was found to be very close. 
Our inspections have shown that despite the regulations of the 
health department many dairymen deliver milk in bottles to houses 
in which there is typhoid fever. Returned bottles are not disinfected 
as they should be, either with steam or boiling water. The washing 
of the bottles is frequently imperfect, and after washing they are 
exposed mouth upward to dust, flies, and other sources of contamina- 
tion. It was found in most instances that the cans and bottles were 
washed with tap water. 
A few of the dairies have excellent machines for washing and scald- 
ing bottles, but sometimes neglect to heat the water, thus reducing 
the efficiency and one of the objects of the machine. 
The paper caps or stoppers are not handled with sufficient care. 
They are exposed to dust, flies, etc., and are often handled with 
unclean fingers. 
Remembering that milk bottles are frequently used by house- 
holders for other purposes than to hold milk, that they are often 
taken into the sick room, and that they run many risks of contami- 
nation with infection — not only of typhoid but other diseases — it 
would not be unreasonable to require all dairymen to disinfect bottles 
as a routine practice. 
It is easy to understand how a bottle or a limited number of bottles 
of milk may become infected and be the cause of spreading the disease. 
