1922 — Mar 24-Apr 24, Septic Sore Throat Epidemic; contaminated milk, Portland OR–22
–22 Benson and Sears.[1] “A Milk-Borne Epidemic of Septic Sore Throat in Portland Oregon.”
Date of onset Date of Death Gender Age
- March 24 March 25 Male 2
- March 25 March 27 Male 1
- March 24 March 29 Female 86
- March 24 March 30 Male 66
- March 24 March 30 Male 59
- March 24 March 31 Female 79
- March 25 March 31 Female 8
- March 25 March 31 Male 18 months
- March 25 March 31 Male 11 months
- March 24 March 31 Male 34
- March 25 April 1 Male 10 months
- March 26 April 1 Male 8
- Not noted April 1 Female 52
- March 27 April 2 Male 27
- Not noted April 2 Female 66
- Not noted April 5 Female 40
- March 27 April 5 Female 35
- March 24 April 8 Male 2
- Not noted April 8 Male 72
- March 29 April 12 Male 47
- March 26 April 12 Male 1
- March 26 April 24 Female 52
–22 Flynn. “Deadliest Outbreaks: Oregon’s 1922 Raw Mild Epidemic.” Food Safety News.
Narrative Information
Benson and Sears: “The epidemic here reported, which includes 487 cases of septic sore throat, with twenty-two deaths, occurred almost exclusively among the customers of a single raw-mild dairy. All but one of the patients who died had drunk this milk. Prompt detection of the cause of the epidemic and equally prompt control of the milk supply by heating were made possible by complete cooperation between the clinicians, the city health bureau and the dairy management, and resulted in checking further extension of the epidemic within twenty-four hours after the suspicion of a milk-borne epidemic was first brought to the attention of the health bureau, March 27, 1922.
History of the Outbreak
“A child, aged 2 years, died, March 25, 1922, with the clinical picture of sore throat and acute encephalitis. Other cases occurred in various parts of the west side of Portland on this day and the next two days, all evidently referable to the milk of a single dairy. Several cases appeared in a forty-bed hospital and many in a home for girls, but it was asserted that the latter institution obtained its milk from a different source — a certain pasteurizing dairy. The city health bureau authorized us to undertake an investigation, and on the morning of March 28, it was easily determined that the girls’ home, the hospital referred to above and a predominance of the cases in homes owed their infection to a single raw-milk dairy. On our recommendation, the health bureau at once ordered heating of all the milk of this dairy by whatever method would be feasible, and placed two employes of the bureau in charge op operations at the dairy. Within twenty-four hours after this plan was put in operation, the incidence of new cases of septic sore throat declined to such an extent that the very few which appeared could be ascribed to contact infection….
Conditions at the Dairy
“….We learned that cows having diseased udders were kept in their regular stalls along with healthy cows, and in some instances only the diseased quarter was excluded from the milking. This condition, together with the fact that milkers did not always handle the same shift of cows, but sometimes exchanged shifts, would make it possible for a milker to include milk which should be discarded….
Cultures of Milk Samples
“….Cow 51 had a consolidation of the left front quarter of the udder. The dairyman insisted that the milk of this animal had not been included in the whole milk for two weeks. Examination of the milks from separate quarters showed all of normal gross appearance except that from the left front quarter, which sample appeared grayish and mucinous. On standing twenty-four hours this milk settled out differently from that of the other quarters…The lower half of the milk column consisted of yellowish, creamy pus, containing numerous pus cells and many streptococci in chairs. Cultures revealed 10,000,000 hemolytic streptococci per cubic centimeter in the milk from this quarter, a few in the left rear quarter, and none in the other two quarters…this cow, whose milk gave a pure growth of hemolytic streptococcus of human origin, was the probable source of the epidemic, perhaps from being milked into the heard milk unknown to the operator of the dairy. We learned afterward that this cow, which had a markedly increased temperature, had been kept in the same row of stalls as other cows which were furnishing milk….
“Cow 21 had had no increase of temperature reported, and had been milked in with the herd previous to the onset of the epidemic. Culture of her milk gave an abundant growth of hemolytic streptococci, which…was of the bovine type. It was considered advisable to kill this cow also. Necropsy showed a purulent infiltration of the udder…
“The milk samples from four other cows yielded hemolytic streptococci in small numbers….
“From the data…it will be seen that the culture from the diseased quarter of Cow 51 is the only culture isolated from the entire herd which seems to resemble in essential qualities the organism found in the human cases of septic sore throat….
Cultures From the Dairy Employees
“The one hemolytic streptococcus culture isolated from the dairy employees was from the throat of a milker who had large, red, inflamed tonsils, and who had complained of a mild sore throat. This culture could not be distinguished in any way from those isolated from the patients with sore throat and from the diseased quarter of Cow 51….
Statistics of the Epidemic
“….The dairy supplied 300 families, including 1,200 individuals; one hospital containing thirty-five patients and thirty-four attendants and help, a total of sixty-nine; a girls’ home containing 104 adults, and a small grocery depot which kept no milk book, but which supplied an indefinite small number of customers. At least 1,400 persons were using the milk and cream.
“The total number of cases of septic sore throat arising on this milk route during the week from March 24 to March 31 is computed at 487. Of these, 166 were severe, i.e., either had serious complications or gave trouble from protracted sepsis; 321 were listed as moderate or mild cases. Twenty-three cases, with three deaths, occurred among sixty-nine users of the milk in the hospital; forty-five cases, without fatalities, among 104 users in the girls’ home. The remainder of the cases were in private homes. Four known cases arose among those who obtained this milk through the small grocery agency. Several persons who were not customers of the dairy became infected by drinking the milk in the homes of regular customers, and two deaths are included in this category….
Summary
“It is evident from the data obtained that this epidemic, with 487 cases and twenty-two deaths, was caused by the drinking of raw milk from one dairy, which had been rated as one of the best in the city.
“Similar strains of hemolytic streptococcus were obtained in almost pure culture from the inflamed udder of a cow of the heard, from one miler’s throat, and from the throats of numerous septic sore throat patients and contacts. All theses strains were shown to be of the human type.
“It is probable that the milker in question infected the udder of the cow, producing purulent mastitis; that, on one or more occasions, this cow was milked in with the heard, and that the massed infection thus produces resulted in the epidemic…”
Sources
Benson, R. L. and H. J. Sears. “A Milk-Borne Epidemic of Septic Sore Throat in Portland Oregon.” Journal of the American Medical Association, Vol. 80, 6-2-1923, pp. 1608-1612. Accessed 4-9-2018 at: https://scholarsbank.uoregon.edu/xmlui/bitstream/handle/1794/5039/mscr_1_Milk-borne_epidemic_of_septic_sore_throat.pdf?sequence=4
Flynn, Dan. “Deadliest Outbreaks: Oregon’s 1922 Raw Mild Epidemic.” Food Safety News, 12-14-2011. Accessed 4-9-2018 at: http://www.foodsafetynews.com/2011/12/portlands-best-raw-milk-dairy-killed-22-in-1922/#.Wsucrpch2nK
[1] University of Oregon School of Medicine.(Flynn)