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Richmond times-dispatch. [volume] (Richmond, Va.) 1914-current, July 11, 1915, Image 43

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Persistent link: https://chroniclingamerica.loc.gov/lccn/sn83045389/1915-07-11/ed-1/seq-43/

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id Danger toEvcrytodyiKcalth
emeiy for It.
That a Dlst of Bak** ?P^ettl
tmi^re - for Typhoid Gonna. The Three
0, Indicate the Temperatures of the
in Removed from the 0ven?One-Half Inch
padU and Near the Bottom. The Typhoid
1 be0Q Placed in the Mass Before Cooking
Surviyed in a Few Colonies Less Than an Inch Below the Baked
Surface, While in the Centre of the Dish, with Its Mild Temper
ature of 82.4 Degree*, the Colonies Were Abundant and Active.
' Vasb their hands
fflnf?<Tknt The family
?1?*1 direction* tow to
"A* *ot convey germs
aathociHea ts to detect
ih "sanjtar7 Isolation."
A <F*iranttne. as
K dlJeaaes last for
w w*t??and are then
- Carriers
the n?w State Depart
ho la & carrier of the
'er. diphtheria, scarlet
?aes <hall be subjected
itlona 0f <he state Do
pre t?ft iCga] aspect to
Oq ^Ich account the
Henr^ b. Hemenway's
Principles of Public
"Uch Individuals and of
n maj ho a matter of
Perplexity This must
typhoid fever patient
long lis hin infectious
ape complete sterlliza
?*t? 0<J"r'er ,f* entitled
ahlmielf 6f> laat othefs
Is as tecessary for the
typbolfj patient "
to typhoid fever, there
rlers?-the acute, the
?air- ?ie periods when
'ary ?ccordlng to the
Si***! disease. How
? soT here that acute
ictually had the given
firms for a few weeks
?c carriers continue to
i?en gtrms for months
nd th?, temporary car
"ho harbor and dis
He periods, alternating
i of ?Joh germs.
cases of cholera and
ndeed ? because they
eotlcra Measles. scar
tfectlOfls may. In given
notle4). The patients
are B'ck They go to
jit nest you, all ansu*
bows, attend theatres?
rowdsj factories and
those people who offer
P# In preventive mod
How a Dish of Baked Spaghetti
Gave 93 Eaters Typhoid Fever
By Wilbur A. Sawyer, M. D.
Director of the Hygienic Laboratory of the California State Board of Health, Berkeley, California
coma down with tha
onvey.jig? This ques
^eader while we were
Is 'be<iau8e, Just as ft
arrel, 00 It takea two
js difease?first, the
ondltl(,n of the body
tlssue8 to the attacks
?bust s.nd naturally In
though you have the
k^ave the disease tha
Miam* carrying; sn<J
r your neighbor who,
the attack8 of those
has been barren for
s bceri fruitfuL
irp haa been proved.
r many 0f us are con
of 8Uch -distribution,
arlseii. Carriers can
laboratory inveatlga
jir i? discovered.cornea
fbi quarantine Is not
fir sufficient. That is
*!them and to. be snso
Mo?V people have
s sooo ae the danger
tors I* explained will
:ly cl?an. And all of
ell developed can do
tp the ybanda at. tha
(From His Official Report of the Case.)
THE City of Hanford, California, experienced an
explosive outbreak of typhoid fever In the lat
ter part of March, 1914. The epidemic con
sisted of ninety-three cases, all of which were traced
to a church dinner. The Infection came from a typhoid
carrier among those who prepared and served the
food?a woman who did not suapect that she had over
had typhoid fever.
Of special Interest were the incubation periods,
which were. In the majority of instances, less than
eight days. The shortest was three days.
The disconcerting observation was made during the
Investigation that under conditions which are not at,
all unusual, baking can actually Incu/btte the Inner
portions ot masses of food Instead of sterilizing them.
The epidemic began with one case on March 20.
During the following three days the dally number of
nerw cases rose rapidly to the maximum, nineteen.
After that the number fell quickly. The last case de
veloped on April 16.
The total number of cases In the outbreak was
Three of the severe cases resulted In death and sev
eral others In serious danger.
A number of persons Infected at Hanford travelled
considerable distances during the incubation period.
This illustrates how typhoid fever Is carried into
cities which are not responsible for the Infection. Two
of the ninety-three persons travelled over two hun
dred miles to San Francisco and developed the dis
ease there. Three of the cases developed in Fresno,
thirty miles north of Hanford. Although typhoid
fever was conveyed to San Francisco, Fresno. Exeter,
Alpaugh, Tulare. Armona and Selma and^to ranches
In the country around Hanford, no secondary Infec
tions from these cases have come to my attention.
Early In the Investigation it was definitely deter
mined that the infection came from food served at a
public dinner and supper held in a public hall. March
17. All of the ninety-three persons who developed
typhoid fever ate food served there. Eighty-five of
the patients attended one or both of the meals and
received their infection In this way. The other eight
were Infected from eating food brought to their homes
from the hall by friends.
While the infection was easily traced to the public
dinner, the source from which the food became in
fected was at flr'st obscure. Fifty-five of the patients
were Interviewed and information was obtained from
others through their physicians. The facts regarding
the kinds of food eaten at the dinner were tabulated
?nd studied.
The dinner was a church dinner partaken of by
Rbput 160 persons, about 125 eating at noon and 45
In the evening.
How the Typhoid
"Carrier" Was Traced Down
The bill of fare at the noon meal consisted of
chicken pie, mashed potatoes, Spanish spaghetti,
baked beans, potato salad containing onions and hard
boiled eggs and served on lettuce, bread and butter,
olIveB, several kinds of pie, cheese, Iced tea and coffee.
At the evening meal ice cream and cake were added
to the list. Most of the food was donated, and was
prepared at various homes or at the hall-, Butter,
bread and potatoes were bought from stores whose
other customers remained well.
Next to the chicken pio the. Spanish spaghetti was
the dish eaten by the largest number of the persons
who became sick. Since the chicken pie was of three
or more lots, the spaghetti was the only dish eaten In
common by most of tbe typhoid patients. A few, how
evar, were positive that they had not eaten the
Only a few ate the baked beans. Many did not eat
the potato salad. Tbe lettuce leaves on which the
salad was served were donated from a private garden,
which had been watered with city water and fertilized
with horse manure from the barn on the nremlses.
The family had'been eating this lettuce and had re
mained entirely well.
Twenty persons had sufficient connection with the
dinner to need special Investigation. 81xteen of these
were women who were actively engaged In preparing
or serving the food.
One member of this group presented a history which
made it aeem probable thaft she was a chronic typhoid
carrier. Mrs. X had formerly kept a 'boarding house
In Hanford. Seven and a half years before. In Octor
ber, 1906, one of her twelve or fifteen boarders came
down with typhoid fever. The source of his Infection
was obscure. A week after thlB case had appeared
another man who was boarding with Mrs. X developed
typhoid fever. Again the source of infection was not
clear. In March, 1912, two more cases appeared in
the boarding house of Mrs. X.
This history of lour previous cases of typhoid fever
among the contacts of Mrs. X made it seem probable
that she was a chronic carrier and was the source of
infection, not only of the four boarders., bnt also of
the ninety-three persons Infected at the dinner on
March 17. Later the proof that she was a chronic car
rier, was recelvfed by telegram from the laboratory.
The one article of food with which Mrs. X came, in
contact before the dinner was the Spanish spaghetti.
She had prepared this dish at her home, up to the
point of the final baking, which took place at the hall
just before the dinner This final baking would ap
pear at first glance to Justify tjbe elimination of the
spaghetti as the dish responsible for conveying the
?tant and It was noted that the cheese had melted.
After fifteen minutes the dleh was removed from the
oven. The surface was not properly browned, and
tbe temperature In the middle of the spaghetti had
risen only one degree above room temperature (80.8
to 62.6 degrees F.) In the following half hour, while
the dish was standing in the rooa, tha temperature at
the middle rose to 69.8 degrees P., aa the heat gradu
ally penetrated to the lnher portions. Cultures taken
from various depths all developed colonies of typhoid
A Tempting Dish
Full of Active Germ3
A large hot-air sterilizer was then heated and kept
between 220 and 888 degrees V. The pan of spaghetti
was Introduced and subjected "to this heat for thirty
" minutes. When the dish waa removed the surti.ee
was of a golden brown color. The appearance and
aroma suggested that the spaghetti was thoroughly
cooked end very hot. The temperature near the top
was 129.2 degrees F. and at'the middle 78.4 degrees F.
Ten minutes later the temperature at the middle was
75.2 degrees F.. and the dish waa then returned to the
oven. Cultures taken at various levels showed that
the typhoid bacilli were alive even close to the surface.
In the next baking the over was kept at a tempera
ture ranging between 405 and 417 degrees F. Alter
half an hour the pan was removed. The surface .was
dark brown, and the points sticking up from it Were
charred. The liquid around the margin was boiling
vigorously and the whole dish was slssllng. . The tem
perature Just under the surface waa 181.4 degrees F.
At the mldlde It was 82.4 degrees F., and near the
bottom it was 118.4 degrees F. An hour later the tem*
peratures had become nearly equalized and were 114.8
degrees F. near the top, 108.6 degrees F. at the middle
and 109.4 degrees F. near the bottom. This showed
that the Interior of the dish did not reach even a pas
teurizing temperature.
Cultures taken at the surface soon after the pan had
been removed from the oven showed no typhoid colo
nies and very few of the other kinds. Cultures taken
at a distance of half an inch from the surface showed
a few colonies of the typhoid bacillus, most of the or
ganisms having been killed. Cultures from a depth of
two and a half inches showed abundant colonies of
typhoid bacilli. In these cultures the typhoid colonies
were Identified by their appearance on Endo medium
and Russell medium and also by agglutination hy ant
typhoid serum.
In this way It waa shown that sterilization of the
pan of spaghetti at the dinner in Hanford was not only
Improbable, but practically Imposlble. The maas of
the spaghetti there waa much greater than In the ex
periment and conditions were leas favorable for thoi*
ough baking.
The thickened sauce, consisting so largely of milk,
was suspected of being the culture medium In which
the multiplication of the typhoid bacillus took place.
Ten c. c. of the sauce, which had been set aside when
the' experimental dish was prepared, was put In a test
tube and sterilized in the autoclave. The same amount
of sterilized milk was used for comparison. Each
tube was inoculated with 0.0001 c. o. of a twenty-four
hour broth culture of the typhoid bacillus Isolated from
Mrs. X. The tubes were thoroughly shaken and then
Incubated at 98.6 degrees F.
The*laboratory experiments completed the explana
tion of the Manford outbreak by ahowlng that the
sauce used In making the Spanish spaghetti waa a
good culture medium and that the dish had not been
sterilized after leaving the houa;e of the typhoid carrier.
Moreover, It was demonstrated that sooked dishes
must be considered as possible Conveyers of Infection
unless it csn be shown that the method of cooking
would produce complete sterilization.. The slowness
with which heat penetrates dishes like the Spanish
spaghetti shows that very prolongsd heating would be
necessary for stsrlllsation of fafge dishes of such food.
Ordinary baking merely incubates the interior of theae
maeaeS of food.
How the Typhoid
Germs Resisted the
The Spanish spaghetti was prepared as fonu?rs: On
the Vlay before the dinner the spaghetti was toolled In
water. Then It was washed and separated with city
water running from a tap. On the same day a Spanish
sauce was made out of a quart of milk, two cans of
tomatoes, butter, seasoning, cooking soda and the
strained liquid in which dried peppers had been boiled.
Probably a little flour was added for thickening. These
Ingredients were put together and cooked.
On the day of the dinner, at about 10 a. m., the spa
ghetti and the sauce were mixed In a large diBhpan and
covered with cheese. The weather was warm and
would have been conducive to the multiplication of
bacteria. The spaghetti arrived at the hall between
10 and 10:30 a. m., and was put into the oven of a gas
stove immediately. Tbe late arrival of the spaghetti
caused tbe women to fear that there would not be
sufficient time for the proper baking of this important
Item on the bill of fare. When the first patrons ar
rived they were served with the upper and warmer
layers of tbe spaghetti, as it was thought that the
dpener portions would not be as hot as desired.
The evidence would be strong that the spaghetti
carried the infection If it could be shown that this
dish was a good culture medium and was not sterilized
by the baking. Experiments were therefore under
taken at the State Hygienic Laboratory to clear up
these two points.
A dish of Spanish spaghetti was prepared as nearly
as possible according to the methods used b> Mrs. X.
The spaghetti and sauce were prepared Separately.
Some of the sauce was put In flaBks and sterilized and
set aside to be tested for its properties as a culture
medium. The remainder of the sauce and the spa
ghetti were inoculated with a broth culture of the
typhoid bacillus of the strain from Mrs. X. The fol
lowing day the sauce and spaghetti were thoroughly
mixed In a small dlshpan and covered with one ponnd
of grated cheese.
The dish was not as large as the one prepared by
Mrs. X, and would therefore be more easily heated
through. This mass of Spanish spaghetti was 5 inches
deeo and ranged from 9 to 13 inches in diameter. The
even.of an ordinary gas' range was heated to baking
temrerature, and the dish of spaghetti was put in.
After seven minutes the door was opened for an in
'Typhoid Mary" in a Group of Hospital Patienta at
Brother Island. New York.
Diagram of a Banquet Table on Which Food Waa Infected by a Typhoid
Carrier, Showing the Average Oiatribution of Contagion. I, Light Cases]
T. Severe Typhoid; N, Uninfected; V, Vacant; ?, Doubtful; S, Safe Food.

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