Salmonella typhi

“ There were anecdotal reports of widespread illness among employees in both establishments, as well. CDC was contacted on September 25 and was asked to participate in the investigation of this outbreak. Following subsequent publicity, hundreds of affected patrons telephoned to report illness. Illness was not limited to patrons of the two initially reported restaurants, but involved employees and patrons from 10 independent establishments. A total of 715 persons met a clinical case definition (below) or had a positive stool culture for Salmonella typhimurium. ”

“ Sixty-six (20 percent) were culture-positive for Salmonella typhimurium; this group includes 26 employees who denied any illness. Of the eight restaurants where culture-positive patrons were documented from the second wave only, seven had at least one employee with early onset of disease (on or before September 20) . In one restaurant, the work history of a salad maker with culture-proven, early onset illness coincided with patron exposure. In another establishment, multiple salad makers became ill early on ”

“ The Dalles outbreak did not come from one food source from one site nor did it occur at one time. The sources of The Dalles outbreak were eight salad bars. And the outbreak came in waves.
Salmonella is not easy to catch, like the common cold or flu. It is difficult to pass from one person to another in ordinary encounters. It almost always occurs from eating food that has been contaminated, improperly cooked, or left out of the refrigerator too long. Salmonella feeds on protein and usually occurs in meat, poultry, eggs, fish, milk or cheese. Not green lettuce salad. ”

“ Over the next 6 weeks, a public health team – which included persons from the local and state health departments and from the CDC – continued this extensive investigation, collecting additional data and samples, conducting numerous interviews, and carrying out complex studies. Ultimately, investigators identified a total of 751 persons with cases of Salmonella gastroenteritis. With an outbreak this large, investigators were initially optimistic that they would be able to find a common pattern or thread that could explain the occurrence of illness in so many people. ”

“ There are harmless forms of bacteria which are capable of growing upon less food than the disease-germs require and they often multiply in badly-polluted waters. Typhoid-fever germs live for a longer or shorter period, and finally die without growth. The few laboratory experiments which have seemed to show an increase of typhoid germs in water have been made under conditions so widely different from those of natural watercourses that they have no value. ”

“ Causes of its outbreak.That all insanitary conditions in respect of drainage of houses and localities furnish the most ready means for the introduction of the contagion of typhoid there is a general agreement, as there is equally that the most certain means of preventing its appearance or spread are those which provide a thoroughly trustworthy and secure drainage, a safe method of disposal of sewage, and a pure and abundant water supply. Typhoid fever is much less directly communicable from the sick to the healthy than typhus. ”

“ The guinea pig is susceptible to the virus as well as the monkey but only shows temperature rise. Nicolle has shown that lice do not become infective until about the tenth day after feeding on typhus blood. The virus is found in the blood of man and in the spleen and blood of monkeys and guinea pigs.
Plotz has isolated a Gram-positive pleomorphic bacillus from the blood of typhus patients which has been named B. typhi exanthematici. This organism is of historical interest only and apparently has nothing to do with the causation of typhus fever. ”

“ Probably the most effective method of preventing typhoid food infection is to investigate every case of typhoid fever and trace it, so far as practicable, to its origin. In this way typhoid-carriers may be discovered and other foci of infection brought to light. Carriers, once found, may be given proper advice and warned that they constitute a danger to others; the complete control of typhoid-carriers who are not disposed to act as advised is a difficult problem and one not yet solved by public health authorities. ”

“ The one who is attacked by typhoid fever may not be the one who has left dirt for the disease to breed in.
Typhoid fever germs are bred chiefly in manure piles, sewers, or cess-pools, and would not be transmitted to man directly, but there are several indirect ways in which they may be carried. Flies also breed in the same places. Their legs become covered with typhoid germs, and then they fly into houses directly on the food and cooking utensils. ”

“ Nor will it live in the soil or in water indefinitely, and a great deal of study has been expended in trying to determine just how long typhoid fever germs will live under different conditions. It has been found, for example, that drying kills the typhoid bacillus in a few hours, although a few may survive for days. Experiments have also shown that it cannot leave a moist surface. It cannot, for instance, jump out of cesspools and drains and take to flight through the air, conveying the disease. ”

“ But at last medical experimenters traced the disease to a certain kind of mosquito, and now, if we drain the swamps and screen our houses and stay in doors after sundown, we do not get yellow fever, nor malaria either. In the same way, if we keep our bodies clean with soap and hot water, we do not get bitten by lice, and so do not die of typhus. If we take pains with our drains and water supply, so that human excrement does not get into it, and if we destroy the filth-carrying housefly, we do not have epidemics of typhoid. ”

“ The third mode of infection, by contact, the more or less direct transfer from person to person, is by far the most important factor in the spread of communicable disease in temperate climates. Malaria is our only important insect-borne disease. Typhoid may sometimes be spread by flies and often by water or milk—diphtheria and scarlet fever and tuberculosis and tonsilitis, sometimes by milk. On the other hand, diphtheria and scarlet fever and tuberculosis and, in cities with good water supplies, even typhoid fever, are all more commonly transmitted by contact than in any other way ”

“ He sees to it that no infectious disorders are imported into the country—the spreading of which would give him much practice. He traces every typhoid case to its ultimate dirty barn, or infected water supply, and counts that day well spent whose low declining sun has seen him stamp out a possible typhoid epidemic at its source. ”

“ While typhus fever is a disease of overcrowding and poverty, typhoid may occur where such conditions are entirely excluded; and the connexion of this malady with specific emanations given off from decomposing organic or fæculent matters, or with contamination of food or water by the products of the disease, is now almost universally admitted. Alike in sporadic cases and in extensive epidemic outbreaks the existence of insanitary conditions in house drainage, water supply, &c., can in the majority of instances be made out. ”

“ Finally, it is possible to acquire the disease by direct contact—not that the germs of typhoid are in the air in the room where a typhoid fever patient is lying, but rather that the nurse in some way soils her hands and then infects herself by putting her fingers in her mouth, or handles dishes or food afterwards used by other people, and so infects those others. It is not uncommon, for example, to see food partly consumed by a sick person given to children, or it may be that a child in the sick room is fed dainties prepared for the use of the patient. ”

“ Typhoid Fever, one of our most dangerous diseases, is caused by germs (bacteria) that enter the body through the food canal. They attack certain glands in the walls of the small intestine, where they produce toxins that pass with the germs to all parts of the body. Typhoid fever germs spread from those having the disease to others, chiefly through the discharges from the bowels and the kidneys. The germs contained in these, if not destroyed by disinfectants, find their way into the soil, or into sewage, where they may be picked up by water and widely distributed. ”

“ Indeed, it is a humiliating fact that, in those chest-cases where medical science has made the most marvellous discoveries, the actual amount of disease is probably greater than ever it was. The doctors are even quarrelling among themselves, whether certain illnesses are contagious or non-contagious. There is no doubt that scarlatina is contagious; but, at the time of the illness of the Prince of Wales, it was sharply debated whether typhoid fever was infectious or not. ”

“ We have thus shown that the typhoid or house fly is a general and common carrier of pathogenic bacteria. It may carry typhoid fever, Asiatic cholera, dysentery, cholera morbus, and other intestinal diseases; it may carry the bacilli of tuberculosis and certain eye diseases. It is the duty of every individual to guard so far as possible against the occurrence of flies upon his premises. It is the duty of every community, through its board of health, to spend money in the warfare against this enemy of mankind. ”

“ The disease invariably results from taking food contaminated with sewage. Water is the chief vehicle by which the disease is spread, and therefore during epidemics of typhoid all water that is intended for drinking purposes should be boiled. Milk, watercress, oysters, salads, etc., also convey the disease. Milk is a common method of spreading typhoid, either by the milk being diluted with water, or else the cans having been carelessly washed out. Pure milk, absolutely free from water, cannot convey typhoid. Typhoid fever rarely attacks the same individual twice. ”

“ The risk is especially great where typhoid is prevalent, as is the case in Pittsburgh, where as far back as the health records go the disease has been practically epidemic and where up to 1908 the typhoid rate was higher than in any other city. That the contagion of typhoid fever is contained in the discharges of the patient, and that the specific organism may live in these for a long period is well known, but only in the past decade has the part played by house flies in the dissemination of the disease been emphasized: "Flies are attracted to all kinds of filth. ”

“ Some people resist powerfully the encroachment of all infectious diseases, while others seem fated to have an opportunity of testing in their own person every prevailing malady. Experience teaches, however, that typhoid fever, unlike many other diseases of the group, is favored in its development by unhygienic surroundings. Bad air, bad food, uncleanliness, and over-population of a house or quarter of a city, create a condition in the system favorable to a rapid and virulent development of the fever after an infection by the germs. ”

“ Typhoid fever, the report found, "is disseminated by the transference of the excretions of an infected individual to the alimentary canals of others." Infected individuals included those in the early and undiscovered stages of the disease, and also convalescents who had passed through the attack but continued to excrete typhoid bacteria. ”

“ It would appear that typhoid is not only a common disease among Europeans in the tropics, but that it is also a very virulent one, with a death-rate twice as heavy as the death - rate of typhoid in England. According to my experience in China, not only is the tropical form grave from the outset, but it is extremely liable to relapse. In England the death-rate is put down at about 1 in 8 attacked; but in India the elaborate and carefully prepared statistics show a death-rate of rather over 1 in 3. Typhoid in India, indeed, kills more European soldiers than does cholera. ”

“ Ice may harbor the germ for many months, for freezing does not kill it, and epidemics have been traced to this source. Clothing, wood, utensils, door handles, etc., which have been contaminated by contact with discharges from patients, may also prove mediums of communication of the typhoid germ to healthy individuals. Typhoid germs escape from patients sick with the disease chiefly in the bowel discharges and urine, sometimes in the sweat, saliva, and vomited matter. ”

“ How do flies carry typhoid fever germs? 6. How do these germs get into milk?
Remember. 1. Typhoid germs come from people who have typhoid fever; they are found in the urine and bowel discharges. 2. No one should ever answer Nature's calls except in a place provided for that purpose. 3. No sewage should be allowed to go into any stream until all the germs in it have been killed. [119] 4. Disease germs will live in running water fully as long as they will in still water. 5. The discharges from a single person may infect a whole city. ”

“ We have only to consider what is the chief channel by which the contagion gets exit from the system, to know by what means we are most likely to prevent its passing into the surrounding atmosphere. In typhoid fever the poison passes off in the stools; and what we have to do is to see that these are promptly and properly disinfected and disposed of. In small-pox, scarlet fever, typhus fever, and measles, it is eliminated by the skin, and we can not altogether prevent its getting into the atmosphere ”

“ Typhoid fever may be prevented by boiling all water before it is drunk or used in cooking, by cooking oysters thoroughly, by most scrupulous drenching of all raw vegetables which may have been watered with liquid manure, and by preventing insects from gaining access to typhoid patient's dejecta or clothing before thorough disinfection has been practiced. ”