# Popular Science Monthly/Volume 69/July 1906/Shorter Articles

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THE EPIDEMIC OF TYPHOID FEVER AT PALO ALTO.
In the spring of 1903, the university community at Palo Alto was startled to find that in about two days upwards of one hundred and thirty students and about a hundred other people—most of them living in the town of Palo Alto, but a considerable number also in fraternity houses on the university campus—were attacked by typhoid fever. The Students' Guild, the cooperative hospital association of Stanford University, immediately' set to work upon the problem of furnishing hospital service, while the department of hygiene of the university and the board of health of the town of Palo Alto devoted themselves to the investigation of possible causes for the outbreak.
The university town, with a population of about four thousand, was entirely new and its health conditions were ordinarily of the very best, there being no slums, cesspools or foulness of the ordinary sort. Every sanitary precaution had been taken in the lodging of students. The water supply was above suspicion, being drawn from deep-driven wells. The whole difficulty was finally traced to a single small daily, the milk of which had been the source of the infection.
A full account of all elements concerned in this case has been published in a pamphlet for free distribution, by Professor J. C. L. Fish, of Stanford University, president of the Board of Health of Palo Alto, together with analyses of reported cases by Dr. C. D. Mosher, and a discussion of the source of infection of the milk supply by Dr. William F. Snow. In view of the lesson to be derived from this case and from the nearly parallel outbreak at Cornell University which preceded it, an account of the method of infection may be found interesting and useful.
The report shows that there were no cases of typhoid fever in Palo Alto, so far as known, between 1894 and 1903. On investigation it was found that the one thing in common which connected the different houses in which cases were reported, was the milk supply. On further investigation it was found that the milk man got a portion of his milk from a Portuguese dairy about five miles from the university on a little brook tributary to Los Trancos Creek. Samples of the water used in washing the cans and cooling the milk were examined by bacteriologists and found to contain large quantities of the bacillus coli communis, the well-known bacillus of typhoid fever.
The investigation of the sources of infection at the Portuguese dairy reads like the plot of a tragedy. The scene is laid in the month of December, 1902, at Stanford University and Palo Alto and the immediate vicinity. The dramatis personæ are taken from homes all over the country. The Serpa house, where the trouble begins, is situated on the banks of the Madera Creek, three miles above Mayfield. A cousin, from San Francisco, comes to visit the Serpas. Soon after his arrival lie complains of feeling ill, and Mrs. Serpa nurses him; she does not consider him sick enough to demand the services of a physician. One week later the relative is better, but Mrs. Serpa is quite sick herself and Serpa calls in a doctor, who pronounces the case one of typhoid fever. A few days more and two of the Serpa children are taken ill with symptoms identical with those of the mother and the cousin. Serpa now becomes thoroughly ​frightened and abandons what little cooperation in medical and sanitary precautions up to this time he has given to the physician. Confusion reigns in the Serpa house, and many friends come from the surrounding ranches to nurse the sick and to sympathize with distressed husband and father.
The San Francisco cousin, Serpa's wife and the two sick children of Serpa die of typhoid fever. Friends. again come to console and remain to be consoled by food and drink. Among the guests are N. and N.'s wife from the N. dairy, P. and the family of P. from the P. dairy, an aunt and her daughter from San Gregorio (a seacoast town forty miles away) and a Portuguese family living on Los Trancos Creek on the road from the P. dairy to Palo Alto.
When the aunt, with her daughter, leaves the Serpa house, she takes with her two of the Serpa children. The first act ends with the general breaking up and dispersion of these solicitous friends to their respective homes.
The second act begins January, 1903. N. and the wife of N. lie sick at the N. dairy with typhoid fever. N. dies.
P. lives on the banks of Los Trancos Creek, a few hundred feet above the intake of the dairy water system; there are no buildings higher tip on the drainage area of the system. Nineteen Filipino wood choppers and a hundred lumbermen are employed in the hills surrounding the P. dairy; they visit the dairy ranch. On the banks of the creek, near the pig pen and just above the dairy water supply intake, are primitive out-house facilities for these laborers.
P.'s child is sick with fever. P. complains of a general malaise. At the aunt's house in San Gregorio, the aunt and her daughter and the two Serpa children are ill with typhoid fever. In the Portuguese houses on Los Trancos Creek, on the road from the P. dairy to Palo Alto, are five cases of typhoid fever. At Stanford University and Palo Alto there are two hundred and thirty-six cases of typhoid fever. The black pall of death hangs over the university and Palo Alto. Parents all over the country sit in darkened homes with bowed heads and mourn for the dearly beloved son or daughter, while the health officers work with sleepless activity. "By the process of elimination and by the sequence of events connecting the typhoid fever at the Serpa house with the P. illness, the outhouse on the bank of the P. creek, the rains and the impounded water at the dam, the conclusion is reached that the P. milk was infected through admixture with the creek water used at the milk house of the P. dairy."
Dr. Clelia D. Mosher's contribution to the 'report' contains an exhaustive study of the symptoms, relapses and complications of the reported cases. The analysis is based on the detailed reports of the physicians, supplemented by statements from the families and the individuals affected, together with a careful investigation of the death records. The total number of cases reaches 23G; this number includes 24 known eases for which no reports were obtained, occurring among students who had left Palo Alto after the outbreak of the epidemic.
The ages of the patients vary from two months to sixty years. Dr. Mosher shows that the most susceptible age, between fifteen and thirty years, is far above the average and explains the number of children infected by the fact that milk was the source of infection. Edith V. Matzke.