A MILK-BORNE TYPHOID EPIDEMIC

H. H. THOMPSON
1912 Journal of the American Medical Association  
line specimen of Oxyuris vermicularis. This was washed and transferred to a drop of water on a microscopic slide, and examined under the microscope with a magnification of 75 diameters. The worm, as a whole, presented no movement, but from almost one extremity to the other, with the exception of the awl-like pointed tail, contained, in its inner anatomy, a seething mass of eggs within a tubular structure that was in active state of contraction and expansion in various portions of its somewhat
more » ... s of its somewhat serpentine course. This canal extended from the cephalic end of the worm to the caudal portion and back again, with numerous turns on itself on the way. One portion of this canal was engaged in shoving an egg, and another portion a great bunch of them, forward, only to be repelled by greater waves of peristalsis Bending them back again, until overcome by still greater eontractions which Forced the ovillar mass onward to the terminal portion of the canal. This opened at right angles to the body of the worm, back of the cephalic portion on the right, side. Tin1 contents, on reaching this point, seemed to rest awhile, as ii were, in the "quiet before the storm," when presently a series of most violent contractions would occur accompanied by the discharge of the eggs, one at a time, from the body of the worm. At times one or two made their exit in orderly succession, and on other occasions the violence and rapidity of their departure reminded one of the action, in miniature, of a modem magazine rille. After transferring the parasite from one slide to another nuil tints securing a half dozen specimens of the ova in "pure culture," I transferred it to ¡i slide, allowing the water to evaporate, nnd then mounted the specimen in Canada balsam. The uterine contractions still continued, less forcibly however, and not until the entire mass of ova within the worm had been expelled into the balsam did such muscular action cense. (The specimen is shown nt this stage in the sketch.) The entire time for the discharge of ¡ill the eggs occupied mure than two hours. The eggs are elliptical in outline, one Bide of flic ellipse being of greater convexity llian the oilier, witli a capsule light greenish yellow in color, and measuring over ¡ill 28 by 51 microns. The worin is (i mm. long and presents a crenaled appearance ¡n ils anterior third. 4008 Baring Street. Noblesville is a typical county seat town of the central part of Indiana, with a population of about 5,000, where, previous to the year of this milk-borne epidemic, there had been only a few scattered cases of typhoid yearly. The sewage system was good and of ample proportions, and the city's water-supply came from deep-drilled wells, the ones supplying the largest amount of water being 300 feet deep and well cased. The principal milk-supply was from a dairy conducted by a man who made every effort to supply the people with pure milk and who tried in every way to run a strictly modern plant. But, as in every other city, there were several who sold milk in different parts of the city. Among these was a Mrs. H., who, living a mile from town, had established a milkroute that supplied about thirty-five families. During the latter part of August and the whole of September, 1906, her husband suffered a severe attack of typhoid with a marked relapse. His case was a serious one and marked by three hemorrhages of sonic considerable moment. He had contracted the disease while working at his occupation, that of baker, in a nearby city where the disease was al that lime prevalent. During the relapse of his disease he had been attended by a capable man who gave explicit direction as to the proper care of the excreta, but it is doubtful if they were carried out, as the patient was nursed by his wife and daughter. During the early days of the attack, however, and before the nature of the attack was definitely determined, all excreta were thrown into the privy on the premises without anv attempt at disinfection, nor was the vault later properly cared for with any disinfecting material. About the middle of January, 1907, an epidemic began in Noblesville. lasting through February. In all twenty-five cases developed during that time, three of which ended in death ;' and all hut a ¡\'\v were of rather nuire virulence than usual. The city water was repeatedly examined and the results did not. explain such a state of affairs. Then attention was directed to the milk-supply of the city. It was very quickly ascertained that, of the eighteen families affected, fifteen were purchasing their milk from Mrs. Tl., these families, too, being the only families in which there was more than one case. An inspection of the dairy and methods of Mrs. II. showed a frightful and shameful state of affairs. It was her custom, since she had only four cows of her own, to collect the needed extra milk from the neighboring farmers night and morning and keep it in dirty cans from ten to twelve hours till bottled for delivery. Asked as to how she cared for her cans and bottles, Mrs. 11. replied that slie "washed them wiih suds and then rinsed them in the clear, cold wafer from the well." The accompanying diagram shows the location of the well and out-buildings and from their relation it: will be readily seen how this "clear, cold water from the well" was the intermediary between the typhoid ¡ind the milk. As the diagram shows, the well was situated directly about 20 feet to the rear of the house within (be barn lot. This is a "dug well," 30 feet deep, walled with brick und with a driven well in the bottom, 30 feet deeper. Thirty-five feet farther on in the lot was a cow stable, hack of which, about 30 feet, was the hog-pen and shed. At the .time of my visit the roof of this was encumbered with carcasses of two newly-born lambs on which the chickens were greedily feasting. Thirty-five feet to the southwest of the well was the privy into which, during the previous August and September, had Ç House
doi:10.1001/jama.1912.04260030330013 fatcat:u33vsvaz3ban5mi453tc6yycsm