64 
TYPHOID FEVER IX DISTRICT OF COLUMBIA. 
Hart,^ Rossi, ^ and SchlegtendaR have collected many outbreaks 
attributed to this source. 
A recent outbreak of typhoid fever in Kolozsvar was not only 
traced by Konradi'^ to milk, but the typhoid bacillus was actually 
isolated from 2 of the 33 samples of milk examined. It appears 
that one of the dairymen bad a mild case of typhoid fever, which 
did not prevent him from doing the milking and thus infecting the 
milk directly. 
Magratb’s^ recent investigations in Massachusetts have again 
shown that our skepticism regarding the purity of milk is not mis- 
placed. The disease has been prevalent in Massachusetts this sum- 
mer, and the State board of health, vdth its usual efficiency, has 
investigated the situation promptly and thoroughly. 
In most of the outbreaks investigated it was found that milk was 
the agent through which the infection was conveyed. The epidemics 
in Wellesley and Xeedham were traced to a single farm, and the 
disease has ceased to spread since this fact became knovm and proper 
precautions were taken. 
The typhoid bacillus grows and multiplies in milk with great 
rapidity, especially if the milk is not kept cool. In fact, milk is one 
of the best culture media for the typhoid bacillus. Unfortunately, 
the milk mav teem with mvriads of these organisms vdthout in the 
least changing the appearance, the odor, or the taste of the milk. 
We therefore have no ready means of knovdng whether a particular 
glass of milk may or may not be contaminated with the typhoid 
bacillus. 
Milk epidemics often break out with the same explosive violence 
as water epidemics. They are characterized by the fact that they 
usually affect the children and women especially. 
Buttermilk and cream, and possibly other dairy products, also 
may act as vehicles of infection. Several of the 85 cases attributed 
by us to milk probably received their infection in buttermilk or 
cream. 
Ice cream in particular must engage the attention of the sani- 
tarian, for it is known to be a vehicle by which the infection is spread. 
It is admitted, in the District of Columbia at least, that the worst 
milk is often used for the purpose of making ice cream. Further, 
the making and handling of this delusive delicacv is often under the 
poorest possible sanitary conditions. 
The use of ice cream during the thirty days prior to onset of illness 
■" a Hart. Brit. med. journ., Jime-Aug., 1895. 
& Rossi. La clinica moderna, 1897. 
c Schlegtendal. Heut. Vierteljahrschr. f. 6ft'. Ges.-Pflege, Bd. 32, p. 287. 
Konradi, D. Centblt. f. bakt., I Abt., vol. 40, 1905, p. 31. 
e Magrath, . Boston med. and surg. journ., editorial, vol. 155, 1906, p. 522. 
