by

Alex van der Ham

(Oct. 2024)

At the start of the 20th century the small provicial town of Schneidemühl (pl: Piła) was witnessing a true boom in population. Growing from only 15,000 inhabitants in 1890, to well over 20,000 only ten years later. Part of the reason for this growth was the rise in railway lines, six of which ended in Schneidemühl. As a result, one-fourth of its population was either employed in the rail industry, or was family to those who were. With the rise in population, so did the number of people suffering from typhoid fever.

Typhoid fever had been endemic to Schneidemühl for a long time, with about ~40 cases per year around the turn of the 19th century. In an attempt to safeguard the growing population from this terrible disease, a 50 m deep well was struck in 1901, to provide clean water to the town and its many inhabitants. This successfully worked to decrease the number of annual cases to ~6 - 20 per annum. Further efforts to improve sanitation were started in 1906, with the introduction of canalization. The canalization meant waste water from households was directly guided into the river Küddow (pl: Gwda), which cut the town in half. Cleaning of the water, however, was all but nonexistent. Five years later, about 80% of Schneidemühl's 25,000 inhabitants were connected, but this, unfortunately, did not stop it from being struck by a true epidemic of typhoid fever during the summer of 1911.

The first case of typhoid fever presented itself on the 16th of June 1911. The next day, the number had already risen to 31 and two weeks later, 203 cases had been recorded. This number would steadily grow to 349 by the first of December the same year, at which point it affected 1.3% of the towns population. The source of the epidemic was quickly identified. Given the explosive rise in initial number of cases, a common source of infection seemed likely. With the entire town having access to clean drinking water, milk from the collective dairy farm became the main suspect. After a number of smaller farms had been excluded, attention was focused on the biggest dairy, the Zentral-Genossenschafts-Molkerei. This collective dairy collected milk from the ~40 dairy farms in the region, processing a total of 4500 L of milk and 6 - 800 L of cream per day, making it a major provider of dairy products in the region. The suspicion arose for a few reasons: 1) the large number of cases reported from the vicinity of the dairy farm, 2) the initial case in June was an employee from this farm, 3) only employees from this dairy farm, but none from any of the other dairy farms, became ill, 4) with the exception of the initial case, the employees of this farm only became infected three weeks after the initial case, thus excluding contraction of the disease from other people and, lastly, 5) a conspicuously large number of children affected. Moreover, the potential of dairies acting as hotbeds of typhoid fever was already well documented (see below).

After these initial indications, the exact origin of the infection could quickly be pinpointed: due to the rise in demand for dairy products, the collective dairy had acquired new milk wagons. At some point, these contained butter milk which had began to spoil during the months of May and June, which had been exceptionally warm that year. Moreover, a large number of cases were reported in the town prison, which had received butter milk from this dairy. Inquiring into every single one of the farms that provided milk to the collective dairy, the exact farm that provided the infected milk, could be established.

So, what do the numbers say? Contrary to what was initially believed, the first cases of typhoid fever had already been reported the 2nd or 3rd of June. With a known incubation time of on average 2 weeks, this puts the initial date of infection mid-May. After a few weeks of the disease slowly spreading, a surge in cases only took place after one of the workers at the collective dairy got infected. Once the dairy was identified and closed, the epidemic died down as quickly as it had started, with less than 20 new cases per week by the following month. Of the 349 people who would ultimately get infected, 250 infections could be traced directly to the dairy, 72 people contracted typhoid fever via person-to-person contact (including 10 nurses), with the remaining 27 cases being of unknown origin. Of these people, 33 would succumb to the disease, putting the mortality at 9.4%. Not included in the infection numbers are those people outside of Schneidemühl who also fell victim to the epidemic. Because waste water was being dumped into the Küddow river untreated, combined with the exceptionally warm weather (ideal for bacterial growth), meant that people who used the river water for drinking and household cleaning, also got infected. Cases as far as 50 km downstream, in Czarnikau (pl: Czarnków), were reported.

As soon as the outbreak was noticed, measures were taken to limit the spread of the disease. Schools and public baths were closed, as was of course the collective dairy, and the local market. River bathing was, however, allowed again already after one month, whereas schools were re-opened to disease-free children on August 8th. The local hospital, an elderly home (actually a former hospital), a barracks, and one of the schools were all converted into temporary sickbays to separate the infected from the healthy population. Those patients who, for one reason or another, could not be interred there, were allowed to stay home, be it with a warning sign posted on the door informing passersby of the sick inside. Citizens were advised to boil milk before consumption, and only eat butter made from pasteurized milk. The pasteurization of milk had actually been known since its namesake Louis Pasteur developed his method in 1864. In fact, pasteurization of milk was mandatory in Prussia at the time, but it seems some dairy farms, especially those in the relatively recently acquired eastern territories of the Prussian empire, had difficulty obtaining the required instrumentation.

And with that, the typhoid epidemic vanished from Schneidemühl as quickly as it had appeared - the total of 349 infected and 33 dead forgotten to history. But hopefully this article will aid to keep their story alive.

The title of this section is that of a 1902 article written by one Dr. Robert Behla, where he gives a comprehensive summary of what was known at the time about the relationship between milk and typhoid fever in general, and the role of dairies in the spread of typhoid fever in particular.[iii] The following text is a summary of his work, translated from the original German.

The rise in typhoid fever outbreaks in the late 19th and early 20th century, can be linked to the industrialization of society during this time period. Relevant to the present story the upscaling in the production and distribution of milk presented itself as a particularly pernicious source. Where for the longest time milk was obtained direct from the cows owned by the consumer, or was distributed within a small community, the late 19th century saw a gradual rise in dairies (de: Molkereien), which took the milk from a number of local farms, processed it, and returned it back to the farmer or sold it on. In 1891, there were already 639 such dairies registered in Germany, a number that would rise to 2135 by April 1st 1902, processing a combined 500 million liters of milk annually. There were three types of dairy that could be distinguished: those which turned milk into butter and returned it to the supplier of the milk (de: beschränktem Betrieb), those which produced skimmed milk and butter milk (de: beschränktem Vollbetrieb), and those which made all of the above products and sold them to people other than the supplier of the milk (de: Vollbetrieb). In general, the rise in dairies was seen as a positive development. They allowed for the production of dairy products such as butter, cheese, pig fodder, ice cream, milk sugar etcetera, in a much more practical and economical fashion, than could be achieved in a domestic setting. Moreover, the establishment of enterprises allowed for these products to be produced by skilled labor, under more controlled and hygienic conditions, and, with the regularization of its production and trade, the adulteration of milk by addition of water was rendered obsolete, as milk was now being sold by fat content, rather than volume or weight. Lastly, the industrialization of milk made it accessible to those living in the city, who did not have direct access to cattle.

But, all of this came at a price. After water from its various sources, milk is the most potent carrier of typhoid germs. In fact, when Robert Behla wrote his work in 1902 he was far from the first to have noticed an apparent correlation between dairies and outbursts of typhoid fever. He cites two works, by Schlegtendal[iv] and Ricken[v], for a combined 30 outbreaks in the period 1892 – 1901 for which the role of dairies could be unequivocally established. He recounts a particular outbreak in the village of Studzin in Kolmar in Posen (pl: Chodzież) in 1897. There, the owner of a dairy threw a big party for the wedding of his daughter. At this wedding, whipped cream was used for the cake and ice cream, made with milk from one of the local farmers. In the family of that farmer, typhoid was known. First the wife and daughter fell ill, then about 2/3 of the wedding guests, followed by several other people in the village through contact with the infected wedding guests. In total, 90 people would get infected, 9 of whom ended up passing away. Where the suspicion was on the dairy, it was shut down immediately and the entire village isolated for 3 months, before the epidemic was finally over.

[i] Veröffentlichungen aus dem Gebiete der Medizinalverwaltung. I. Band - 4. Heft. Entstehung, Ausbreitung und Bekämpfung der Typhusepidemime in Schneidemühl im Sommer 1911. von Kreizartz Dr. Lewerenz

[ii] idem. Klinische Beobachtungen aus der Schneidemühler Typhusepidemie im Sommer 1911. von Dr. Rommel und Dr. Hermann

The two works referenced above are bound together, and were retrieved from the archive of the Zentralbibliothek in Göttingen.

[iii] Behla R., Die Sammelmolkereien als Typhusverbreiter. Accessed from: Klinisches Jahrbuch, 1903, Bd. 10, p. 245 [scan available upon request]

[iv] Schlegtentdal, Die Bedeutung der Molkereien für die Verbreitung des Unterleibstyphus. Deutsche Vierteljahrschrift für öffentliche Gesundheitspflege, 1900, Bd. 32, Heft 2, p. 287

[v] Ricken, Unterleibstyphus und Molkereien. Zeitschrift für Medizinalbeamte, 1901, No. 12, p. 74