Typhoid Fever Epidemic Occurring During the Summer of 1928

Abstract

DURING the past 26 years San Francisco has experienced 3 outbreaks of typhoid fever traceable to milk. The first occurred prior to the earthquake and fire of 1906, and the second during the summer of 1908. In both instances the cause was an acute case of typhoid fever at the producing dairy and came to the attention of the Department of Health through the reporting by the physician of the case after it had been hospitalized. It was not until 10 days later that cases of typhoid were reported in different sections of the city served by these two raw milk dairies. Subsequent to the removal of the patients and the general sanitation of the dairies the situation cleared up. The outbreak of 1908 resulted in agitation for and, in 1910, the adoption of a pasteurizing ordinance which has since been continuously in force. The third outbreak occurred during the summer of 1928, and came as a complete surprise because the water supply is carefully supervised and chlorinated, and, except for certified and guaranteed milk which represents but 0.5 per cent of the 52,000 gallons daily distributed, all bulk milk is pasteurized. The process and machinery, thermometers and the pasteurized milk are carefully checked each week. Except as above stated, no typhoid fever has occurred as a result of milk or water pollution for more than 20 years. San Francisco has always a number of cases of typhoid fever reported (see Figure I for 1928), but the source of infection has been traceable to water or other causes outside of the city and county. The first intimation of infection in the 1928 outbreak came in May, when 4 cases were reported with a history of having been infected in San Francisco some time between the middle and latter part of April. At the time, a number of instances of diarrhea and bowel disturbances had been reported by physicians, but nothing definite was obtainable