in Wisconsin and came home to Virginia Aug. 26. N. B., (m), 21, 1st symptoms Aug. 27. On Aug. 22 he left Cloquet where he was working at the Cloquet Lumber Co. G. F., (f), 4, suspect, 1st symptoms Sept. 2, blood specimen was taken. No screens Results-All of the above cases except the last two, probably were fly infections. had been placed on the H. boarding house, nor were the proper precautions being taken with the three typhoid cases. Since Inspector's last visit 80 homes have been connected with the sewer and several alleys have been cleaned up. A marked copy of the Regulations was given the Asst. Health Officer. Dr. Crowe was advised to remove the three typhoid cases from the Finn boarding house to the Pest House and to see that the house was properly screened and the rooms disinfected. He also promised that he would vaccinate the boarders. G. F. Widal negative. The Secretary of the State Board of Health of Wisconsin was notified of the case coming from Guerney, Wis. (Index No. 125-XIII.) SUMMARY Typhoid Fever, Virginia City, St. Louis County, October 13, 1913 (All investigations are made upon order from, or with the approval of the Executive Officer of the State Board of Health.) Reason-To continue the study of typhoid at Virginia. History J. H. worked at Saari's camp "B"; died at the More Hospital Oct. 6, was thought to have been infected in Virginia. His married sister (name unknown), lives in Virginia. Inspector saw Dr. Axel Personen at Virginia. He did not know J. H. or his sister. He offered to trace the sister. Visited the following cases at McIntyre Hospital: Sept. 2 18 27 Sept. 20 Secondary to A. K., (m), 27, fellow-boarder. 39 Sept. 24 20 Oct. 6 Secondary to Mrs. L., who has forgotten the date of her first symptoms. Infected either at home near Cook, St. Louis county, or while locomotive fireman on Canadian Northern Ry., headquarters at Cusson, St. Louis county. Oct. 10 At H.'s boarding-house where first case appeared. This case not in hospital. See "Results." Results-All patients are Finns. The first cases were at H.'s boarding-house where M. E. is now. C. B. and A. K. were next door. Flies and contact are chief factors in spread since cases have not been isolated under trained nurses or promptly removed to hospitals. Unscreened privies with earth vaults are used although a trunk sewer is available for house connections one block distant. City water is used in all houses in this section. Advised Dr. H. E. Michelson, Acting Health Officer, to isolate or remove to hospital M. E., and to use typhoid vaccine on the exposed persons. *No typhoid on steamship. No suspicious cases were reported by Ship Surgeon to United States Public Health Service at Port of New York. Men came through Chicago and Duluth from New York directly to Virginia. The epidemiological data show conclusively that the chief factors in the spread of infection were flies and contact. Note that the five earliest cases were imported, that at 109 Oak St., where two early cases were cared for, 9 others developed; at 107 Oak St., 3 others; at 116 Oak St., 2 others; at 204 Oak St., another; at such intervals as to rule out a common contemporaneous route such as water but exactly according to the rule for contact and flies, which act casually and intermittently. Open privies and neglect in disinfection of stools favored flies. Carelessness of untrained nurses and associates favored contact infection. The essentials in the management of typhoid under the conditions existing in Virginia are: 1. Prompt reporting of frank and suspicious cases. 2. Immediate removal to hospital or isolation in well screened room under the care of a trained nurse. 3. Exclusion of all but necessary attendant from patient's room. 4. Protection by typhoid vaccination of persons too ignorant or too careless to take proper precautions. TYPHOID FEVER SPREAD THROUGH A CITY MILK SUPPLY. Since a milk-borne epidemic of typhoid fever is rather a novelty in Minnesota, Summaries Nos. 97-XIII and 132-XIII are given: SUMMARY Typhoid Fever, St. Paul City, Ramsey County, September 8, 1913 BY DR. H. A. BURNS Reason-To assist the St. Paul health authorities in a widespread exposure to typhoid fever from an infected milk supply. History-The J. B. Dairy Co. was suspected of delivering an infected milk supply to between 200 to 250 families. Mr. R. J. was taken sick Aug. 30th, but worked at the Dairy unti Sept. 1st. He was taken to the hospital Sept. 8th. J. C. J. had been feeling badly for severa days, but owing to his brother's illness and the scarcity of help, he was milking and deliver1 ing for four days while prodromes were developing. During the time of prodromes in the Jbrothers, 13 cases developed in St. Anthony Park among the customers of the J. B. Dairy. Inspector investigated the dairy in company with Dr. Paul Cook, Asst. Health Commissioner of St. Paul, found Mr. J. C. J. working, but complaining. Temperature 102. No history of exposure could be found to account for the J. brothers' illness. Results Advised that J. C. J. be taken around on the milk route in order to get the list of patrons. Also advised that these people be informed of their exposure and that typhoid vaccine be on hand at the St. Paul City Health Department for their use. (Index No. 132-XIII.) SUMMARY Suspected "Typhoid Carrier," Athens Township, Isanti County, October 20, 1913 BY DR. H. A. BURNS Reason-To obtain history and specimens of blood and feces of a supposed "typhoid carrier." History-G. A. (m), 27, while working at J. Bros.' Dairy, St. Paul, was ill several days in July with symptoms of "walking typhoid." He quit work about Aug. 1, going to Isanti county. About Sept. 21, Rasmus J. became ill and on Sept. 8 this case was diagnosed as "typhoid fever." În Sept. the total number of cases reported in the City of St. Paul was 58. Between Sept. 1 and 20, 32 cases of typhoid fever developed in St. Anthony Park, St. Paul, being supplied with milk as follows: 24 used milk from J. Bros.' Dairy. 6 used milk from N. N. G.'s Dairy. 1 used milk from H. Bros.' Dairy. 1 used milk from University Farm Dairy. J. Bros.' milk was believed to be the medium of infection for nearly all of the primary cases. G. A.'s illness was suspected to have been mild typhoid and that he infected the milk. Other cases were classed by the City Health Dept. as secondary infections by flies or contact, or as primary infections from unrelated sources. Inspector, with Dr. A. E. Johnson of Isanti (V) saw G. A. at J. W.'s farm where he worked since August. G. A. states that his illness was due to eating wild raspberries. It lasted only one day. He was well before and has been since. He stated that Rasmus J. was ill for several days late in July and continued his dairy work, although complaining somewhat of his illness. Results-Every evidence of good health bears out G. A.'s statement about short duration and character of his illness. Laboratory Division tests of his blood showed "Widal reaction absent," of his feces "No typhoid or typhoid-like colonies were found." If G. A.'s statement about his employer, Rasmus J. is true, further investigation is necessary to determine character of the illness and the probability of infection of the milk. LIST OF INVESTIGATIONS. Smallpox, Chickenpox. Forty-four epidemiological investigations of smallpox and chickenpox were made during the period Aug. 1, 1912 to Jan. 1, 1914, in twenty-six counties. The field work required eighty-three days. County Aitkin... Cottonwood.. Fillmore. Lac qui Parle. Lyon.. Meeker.... Mille Lacs. Olmsted. Polk. Pope.. Ramsey. (B) Round Grove township. (B) Minneota village. 27, XIII 36, XIII 35, XIII 56, XIII 63, XII 63, XII 70, XII 38, XIII 82, XIII 80, XII 80, XII (B) Acoma township.. (C-B) Milo township (B) Onamia township. (W) Haverhill township (W) Oronoco township. (W) Pleasant Grove township. Marion township. (C) Leven township. (B) Rose township. (B) Poplar River township 19, XIII (G) Lamberton township.. 94, XIII (B) Hector village.. 26, XIII 71, XII 162, XIII 117, XIII 39, XIII (B) Havanna township. 57, XIII 65, XII (B) Woodbury township. 78, XII (G) Marysville township 166, XIII Middleville township. 166, XIII Waverly village. 166, XIII 166, XIII |