6 SEWAGE-POLLUTED OYSTERS AS CAUSE OF TYPHOID. 



REVIEW OF LITERATURE. 



Keviews of foreign and American literature on epidemics of typhoid 

 fever due to eating raw, infected shellfish have heretofore been pre- 

 sented by other writers on this subject, and in the present report 

 only brief mention will be made of the more important and recent 

 epidemics of this character. 



(1) In the outbreak of typhoid fever at Wesley an University during 

 1894, Prof. Conn, 1 of Middletown, Conn., showed that 29 cases, or 

 25 per cent, of the students who ate raw oysters at their fraternity 

 banquets contracted the disease within the proper incubation period. 

 All other articles of food which might play any part in transmitting 

 the infection were carefully studied and excluded. He summarizes 

 the chain of evidence as follows: 



1. The dates of the cases appearing at Wesleyan, all between October 20 and No- 

 vember 9, plainly point to a single source of infection to which all of the afflicted 

 students were exposed at about the same time. This must have occurred a little 

 more than a week earlier than the appearance of the first case, and the initiation sup 

 pers perfectly fill the conditions. 



2. That these initiation suppers were the source of infection is rendered certain 

 from the fact that four of the visitors who attended these banquets, and have had no 

 further connection with the fraternities, have developed typhoid simultaneously 

 with the cases in college, and by the further fact that two visiting Yale students who 

 attended the suppers have similarly suffered from typhoid. 



3. The fact that only three out of seven fraternities holding suppers on that even- 

 ing suffered from typhoid, pointed to some article of food or drink used at these three 

 suppers and not used in the other fraternities. 



4. The fact that about 25 per cent of the students attending the suppers have 

 suffered from typhoid, pointed to a universal and very active source of infection, 

 and not to an incidental one. Whatever article of food contained the infectious 

 material must have been eaten by nearly everyone present to account for such a 

 large percentage of cases. 



5. Only one article of food or drink was used by the three societies which was 

 not used equally by the other four fraternities. This article of food was oysters, and 

 they were eaten raw. 



6. These oysters came from a creek, where they had been allowed to fatten for 

 a day or more, within 300 feet of the outlet of a private sewer, and in such a position 

 as to make contamination from the sewer a possibility. At the time that the oysters 

 were there deposited there were two persons in the house supplying the sewer, who 

 were in the incubation period of typhoid fever, the period during which no atten- 

 tion would be paid to their excreta. 



7. Typhoid germs are not injured by sea water or oyster juices, and if they found 

 their way into the oyster would certainly have lived long enough to be sent to Mid- 

 dletown and be served on the tables of the fraternities. 



8. Twenty-three cases of typhoid fever followed among the students in attendance 

 on the suppers at which the oysters were eaten, and 6 cases among persons in attend- 

 ance and not among the present students at Wesleyan. In all of the cases of un- 

 doubted typhoid it has been possible to trace either direct or indirect connection 

 with these oysters. The oysters were also eaten raw by one family in town, and at 

 least one severe case of typhoid followed. 



1 Conn, H. W. The outbreak of typhoid fever at Wesleyan University. (Conn. State Board of Health 

 Report, 1894, pp. 243-264.) 



