ENDEMIC TYPHOID FEVER FROM INFECTED MILK
Journal of the American Medical Association
Last October eleven patients with typhoid fever were admittted into the Medico-Chirurgical Hospital in less than one week. All of these patients came from an apartment house in two adjoining blocks on North Eighteenth street, Philadelphia. Seven of the eleven patients came from one apartment house from which some twenty-odd patients were taken down with the same disease in two weeks' time. The Board of Health officials made a thorough investigation regarding the sanitary conditions of the house
... itions of the house and pronounced it perfect. Inquiries concerning the drinking water used by these patients were made and it was found that they all either used filtered or boiled water. The food and milk supply was next considered. A culture made from the milk proved the presence of the typhoid bacillus in it. Dr. Eugene Swayne, resident physician at the hospital, being interested as to the probable source of contamination of the milk, thoroughly canvassed the neighborhood threatened with an epidemic of typhoid fever. He soon learned that the-same milkman supplied all of the apartment and boarding houses from which many typhoid patients were removed to a number of the different hospitals in this city. Dr. Swayne next visited the milkman's dairy, and there learned that the proprietor and one of his servants were both sick with the disease. The son was convalescing.from typhoid fever and was filling the milk bottles from a tank by siphonage, starting the flow by sucking with the mouth at one end of the tube. A culture made from this end of the tube revealed many typhoid bacilli. I do not know of any other instance where infection of the typhoid bacillus was transmitted through the saliva. Of course, it undoubtedly has occurred quite frequently, but has never been reported or traced so in detail. The initial manifestations in these patierits were so vague that they did not suspect of being attacked by a serious illness. For a week or ten days they had a feeling of weariness, with some aching in the limbs, abdominal tenderness in the right iliac fossa on pressure, and a tendency to constipation. During this period they slept badly, experienced chilly sensations, the appetite was poor and at the end of a week's time were forced to remain in bed out of sheer exhaustion. The temperature now began to rise above normal and ascended in the highly characteristic manner. Each evening it was a little higher than the preceding day at the same time, until the end of the second week, when it had reached its fastigium, which was not over 103 F. in most of the cases. However, in two patients it reached 105 F. on one occasion, due probably to the indiscretion of the friends that called to see them in the afternoon. During the entire illness of these patients the temperature readily responded to the cold sponges when it reached 102.4 F. or above. Delirium of a low muttering type occurred in one patient and lasted only for three days. It may be mentioned in this connection that this same patient also had epistaxis and diarrhea. Tympanites was present in one patient, to some extent; he also had one intestinal hemorrhage, but made a speedy recovery. The complications present in these cases were otitis and phlebitis in one, and phlebitis in another. In both patients the phlebitis manifested itself in the common femoral vein of the left leg. The interesting features of these cases were the slightly enlarged spleen, a few rose spots and a positive Widal reaction in all of the patients before the eighth day of the disease, no other abnormal physical signs being present. The treatment of these patients was much alike. A few changes were necessary in those who had slight complications. Under the prophylactic treatment great care was exercised properly to disinfect the excreta with a 5 per cent, solution of nhenol. The linen was soaked for a half-hour in a 1 to 2000 solution of mercuric chlorid before sending it to the laundry. The individual eating utensils were boiled immediately after using, and the nurse and other attendants instructed to disinfect thoroughly their hands after coming in contact with the patients. The ordinary hygienic measures were carried out in each case. A mouth-wash, consisting of eight drops of beechwood creosote in three ounces of eucalyptus water, was employed after each feeding The rooms were well ventilated, avoiding unnecessary draughts of cold air, with an even temperature not exceeding 65 F. During the active stage of the disease the diet consisted of liquid foods, such as would be entirely absorbed, leaving little or no residue. Six ounces of predigested milk every two hours was the main article of diet, alternated occasionally with so much lemon albumin, orangeade or whey. Water was given ad libitum. After the temperature had been normal for a week they were allowed soft food sparingly at first, and in another week's time were gradually allowed regular house diet. Medicinally thev were all given as an intestinal antiseptic and antipyretic two grains, each, of quinin sulphate and phenyl salicylate (salol). -In some of the severer cases they were given a half-ounce of whisky' every four hours, with one-fortieth of a grain of strychnin sulphate, so that the patient received ample stimulation. The patient wlio had intestinal hemorrhage received fifteen minims of terebene every hour for six doses, then every three hours for three days. There wrere no further signs of hemorrhage and the terebene was discontinued. The eleven patients all recovered withont relapse or recrudescence. The manner in which these patients were infected proves again that the excretions and secretions of convalescing typhoid patients are loaded with typhoid bacilli and often are the source of epidemics, more so than during the active stage of the disease, because precautions are taken no longer after the patient is up and around. Peritoneal Absorption of Oxygen.-H. Gutierrez has been much pleaeed with the results of flushing the abdominal cavity with oxygen after abdominal and gynecologic operations. He describes a typical case in the Cronica Med. Mexicana, x, i; bilateral pyosalpinx had caused disturbances for eight months, with pelviperitonitis and cachexia. Ablation of the tumors was very difficult owing to extensive adhesions and one pus pocket ruptured. The Mikulicz tampon could not be used under the circumstances. Gauze drainage was supplemented by introducing through a drain tube from 40 to 60 liters of oxygen with free outlet. The temperature rose only one degree Centigrade the day after the operation and then returned permanently to normal, and the wound healed with remarkable rapidity and completeness, while the general condition improved to correspond. The oxygen treatment was continued daily for two weeks before the tube was removed.