Merited celebrity attaches to the exploits of the typhoid-carrier, Mary Malloy, who, in pursuing her career as cook in and about New York City, is known to have caused at least seven typhoid outbreaks in various families in which she worked and one extensive hospital epidemic. Similar cases of typhoid food infection by employees in restaurants and public institutions are by no means uncommon, and show the necessity of protecting food from contamination during the whole process of preparation and serving. Acting on this principle, the Department of Health of New York City has inaugurated a comprehensive examination of the cooks and waiters (approximately 90,000) employed in the public restaurants and dining-rooms in that city. Results have been obtained in the discovery of typhoid-carriers and of cases of communicable disease that amply justify this procedure as an important measure for protecting the community against the dissemination of infection.
Some foods by their origin are exposed more than others to typhoid contamination. Such vegetables as lettuce, celery, radishes, and watercress, which are commonly eaten without cooking, are more likely to convey typhoid than peas, beans, and potatoes. A typhoid outbreak apparently due to watercress has been reported from Philadelphia.[50] At a wedding breakfast to forty-three guests on June 24, 1913, watercress sandwiches were served, and subsequent inquiry showed that nineteen of the guests partook of these sandwiches. Eighteen of this number became ill with typhoid fever within a month, the illness developing in most cases after the guests had scattered to their summer homes. Those who did not eat watercress sandwiches were not affected. Typhoid infection by uncooked celery has also been reported.[51]
The practice of using human excreta as fertilizer in truck gardens is sometimes responsible for a dangerous contamination of the soil, which is communicated to the growing plants and persists for a long time.[52] Even scrupulous washing of vegetables is not sufficient to render them bacterially clean. In the future the danger to the community from this source is likely to become increasingly serious unless the growing use of this method of soil enrichment is definitely checked.
In 1915 an increasing number of typhoid cases in South Philadelphia led to an investigation by the state health department.[53] This disclosed the fact that the majority of the cases were clustered in and about three public markets.
These are all curb markets—fruits, vegetables, pastry, clothing, and miscellaneous merchandise of every description are dumped on push-carts and pavements without regard for any sanitary precautions. The patrons of these markets handle and pick over the exposed foodstuffs, thus giving every opportunity for the transmission of disease....
The greatest number of cases occurred in the immediate vicinity of the Christian Street Market. This market is largely patronized by the inhabitants of the section known as "Little Italy." The patrons of the South Street Market are principally Hebrews, while the Seventh Street Market is patronized in the main by Hebrews and Poles.
The following conclusion was reached regarding the particularly large number of cases among persons of one nationality:
Our inspectors have found that the different methods used by the Italians and Hebrews in the preparation of their food are responsible for the larger number of cases being found in the vicinity of the Christian Street Market in Little Italy. It is the custom of the Italians to eat many of the fruits and vegetables raw, while the Hebrews cook the greater portion of their food. It is presumably due to this custom that the members of the Italian colony have suffered to a greater extent than the other residents of the district.
A bacterial examination of various kinds of vegetables obtained from push-carts and curb markets led to the finding of the typhoid bacillus upon some of the celery. It would naturally be difficult to determine in such cases whether the typhoid bacilli were derived from infected soil in which the celery was grown or whether the contamination occurred through improper handling.
Bread, when marketed unwrapped, is subject to contamination from flies and from uncleanly handling. Katherine Howell[54] has shown that unwrapped loaves of bread sold in Chicago were more or less thickly smeared with bacteria and were coated on the average with a much larger number than wrapped loaves. In some cases typhoid fever has been directly traced to bread. Hinton[55] has recorded the occurrence of seven typhoid cases in the Elgin (Illinois) State Hospital, which were apparently due to a typhoid-carrier whose duty it was as attendant to slice the bread before serving. When this typhoid-bearing attendant was transferred to another department where she handled no uncooked food, cases of typhoid ceased to appear.[56]