>tate of (Connecticut. 
[From the Report of the State Board of Health for 1894.] 
The Outbreak of Typhoid Fever at 
Wesleyan University. 
By H. W. Conn. 
Professor of Biology, [From the Report of the State Board of Health for 18(4.] 
The Outbreak of Typhoid Fever at 
Wesleyan University. 
By II. W. Conn, 
Professor of Biology, / TYPHOID FEVER AT WESLEYAN UNIVERSITY. 
243 
THE OUTBREAK OF TYPHOID FEVER AT WESLEYAN 
UNIVERSITY. 
H. W. Conn, Professor of Biology. 
The recent outbreak of typhoid fever at Wesleyan has been 
exceptionally unique in certain respects and of a character that 
makes it especially interesting in the history of epidemics. A 
more typical example of an outbreak of typhoid due to a single 
source of infection has hardly been found in the history of medi- 
cine, and the example furnishes a demonstration of a new source 
of danger for this disease. 
The use of raw oysters has before been suggested as a possi- 
ble source of the spread of the disease. The readiness with 
which they absorb the water, and the fact that they not infre- 
quently lie in positions where contamination with sewage appears 
to be possible, has led to their being suspected in several cases. 
It has hitherto, however, not been possible to trace any distinct 
epidemic to them with anything like demonstrative evidence. 
The conditions which have occurred at Wesleyan have, however, 
been exceptionally well adapted to point out this connection. In- 
deed, if one had planned beforehand a series of experiments 
designed to prove the possibility of oysters as distributing typhoid, 
it would hardly have been possible to have devised a more satis- 
factory series of conditions than those which have attained in this 
outbreak at Wesleyan. 
The history of the outbreak was as follows : 
About October 20th, several students in college were taken 
with a mild form of sickness, accompanied by a slight fever, 
which was not at first regarded as of much importance. The 
number of cases increased, however, and some of them became 
more severe, until after about a week it became very evident that 
some of the cases at least, were those of typical typhoid fever. 
For a week and a half following October 20th, the cases increased 
rapidly, and by November 1st, there were over twenty cases 
of sickness among students, accompanied by fever and with 
more or less typhoid symptoms. After November 1st, the 
appearance of new cases declined, although one or two appeared 
on November 2d, one case on November 5th, and one further case 
as late as November 9th. This limitation of dates is very import- 244 
STATE BOARD OF HEALTH. 
ant in the subsequent consideration of the epidemic. After the last 
date no more cases made their appearance.* In all there have been 
in college twenty-five cases of sickness which have been accom- 
panied by fever. Of these, twenty-three have been pronounced 
by the physician in charge as typhoid fever, and thirteen have 
been of a very severe character. There have occurred four 
deaths. Ten of the cases, although cases of fever and showing 
more or less typhoid symptoms, have been extremely mild, the 
fever continuing only a few days and then disappearing without 
any serious results. One of these mild cases has been especially 
interesting. The student in question was taken with typhoid 
symptoms upon the 5th of November. In this case, however,, 
although most of the typhoid symptoms, such as chill, headache, 
etc., were noticed, there was no fever. The student, however, 
was kept in bed for several days with the anticipation of the fever 
making its appearance, but no fever appeared and recovery fol- 
lowed without any further trouble. It was learned that this stu- 
dent had suffered from a severe attack of typhoid some three 
years ago, and it is at least possible that the effect of the disease 
in the early years was such as to mitigate the symptoms at the 
present time and prevent the run of fever, which would other- 
wise have occurred. In general the epidemic at Wesleyan must 
be regarded as of an ordinarily severe type. Out of twenty-three 
cases, four deaths makes a rather large percentage, a fact which 
is partly accounted for from their being all young people. In 
some of the othei' cases the disease was extremely severe, 
although recovery finally ensued. At the same time there were 
some ten cases of very mild character. 
* One further case of fever it is necessary to mention. A member of one 
of the three fraternities was taken sick on Dec. 16th with what proved to be 
a mild case of typhoid fever. This student had, however, been in college 
only a short time previously. During the excitement over the typhoid he 
had gone to his home and had remained there for a month. He had returned 
to college in December but had not been back quite two weeks. It becomes 
impossible therefore to say whether this case is to be regarded as a case of 
secondary infection through the fraternity club house, or whether he con- 
tracted it at his home. His stay at home was too long to make it possible 
that he had contracted the disease before leaving college, and the period sub- 
sequent to his return before he showed signs of the disease was rather too 
short to make it very probable that he contracted it in his club, although 
long enough certainly to make this possible. It has been regarded as prob- 
able therefore that this case was contracted away from Middletown, although 
it is certainly not impossible that it was a case of secondary contagion con- 
tracted through the club house where so many earlier cases had occurred. TYPHOID FEVER AT WESLEYAN UNIVERSITY. 
245 
As soon as it became evident that the disease in college was 
typhoid fever, the seriousness of the matter was at once recog- 
nized, and a committee consisting of Prof. J. H. Van Vleck, pro- 
fessor of mathematics, Prof. Wm. North Rice, professor of 
geology, and the author of this report, was appointed to investi- 
gate the trouble, to determine if possible the cause of the out- 
break. This investigation did not begin until November 4th, for 
it was not until this date that the really serious aspect of the case 
was appreciated. At this date it was not known that the limit 
of the new cases had been reached, nor to what extent the numer- 
ous cases of slight illness would prove to be typhoid. At that 
time a few cases had been pronounced typhoid, the rest being 
simply suspicious. 
At the very outset suspicion was thrown upon two wells on the 
college campus. These wells had been used by the students for 
years. The college buildings were supplied with city water, but 
some of the students preferred to drink from the wells, although 
they had been cautioned against their use. One of the wells was 
about thirty feet from the location of an old abandoned cesspool, 
and for this reason this well was naturally regarded at first with 
suspicion. A chemical analysis was immediately made of the 
two wells. One was found to be chemically good, but the other 
was found to contain an exceptional amount of albuminoid ammo- 
nia, the actual amount being six parts in a million. Although 
chemical examination alone gives little indication of the health- 
fulness of water, this amount of albuminoid ammonia was very 
large and plainly indicated some undesirable contamination of the 
water. It is to be noted that the examination was made shortly 
after a heavy rain, which had followed a long drouth, and this 
may account for the exceptionally large amount of albuminoid 
ammonia. The use of the wells was, of course, immediately 
stopped on suspicion, but it appeared almost at once that the out- 
break of the epidemic could not be attributed to the wells. In 
the first place many people in town were accustomed to drink of 
the wells as freely as the college students, and no outbreak of 
typhoid appeared among the townspeople. The wells were on 
the back campus, close to the athletic field, and visitors to the 
games occurring in the fall, used the water even more freely than 
the college students. These visitors, too, were mostly young 
people, just in the most susceptible age for taking typhoid. There 
was, however, no outbreak of typhoid in town at the time of the 246 
STATE BOARD OF HEALTH. 
cases in college. Further, there had been no case of typhoid in 
college which could by any possible means have contaminated 
the wells in question for a great many years. The college is on the 
top of a high hill, so that no contamination from drainage of other 
houses was possible. Recognizing that typhoid infection usually 
comes from other cases of typhoid, it seemed hardly possible to 
trace the trouble to these wells, because of the lack of chance 
for contamination. Moreover, after questioning the students 
who were sick with typhoid, it appeared that several among them 
certainly had not drunk of the well that was contaminated, and 
some of them had not used any of the water from either wells. 
As a confirmatory test, however, a bacteriological study of the 
water was made according to the method of Dr. Vaughn. A 
sample of the water from each well was inoculated into bouillon 
and allowed to grow in a culture oven at 35° C. for a couple of 
days. At the end of this time twenty drops of the culture was 
inoculated into the abdominal cavity of white rats. The white 
rats did not suffer in the least, as they certainly would have done 
had typhoid terms germs been present in the water originally. 
Moreover, the bacteriological examination showed that the wells, 
although contaminated with albuminoid ammonia, were some- 
what exceptionally free from bacteria, which would grow in a 
culture oven. All these facts, of course, showed conclusively 
that the college wells could not be regarded as the cause of the 
outbreak. When it was found, further, as will be presently 
noticed, that the sickness was confined to the members of three 
societies among the students, while, of course, the use of the well 
water was not thus confined, it was necessary to abandon the 
wells as a possible source of the typhoid. 
At first there seemed to be no point of connection between the 
students who were sick. Their rooms were in both of the college 
dormitories and in two fraternity club houses, while others 
roomed in private houses in town. These facts excluded the 
lodging houses from suspicion. Nor did the students board at 
the same tables. Most of them boarded in fraternity clubs, 
but a few in private boarding places in town. One of the first 
points that was noticed after the investigation was begun was 
that the ladies among the college students, about fifty in num- 
ber, were wholly exempt from the disease. This pointed to some 
source of contamination open to the gentlemen that was not open 
to the ladies, and at once ruled out any possible contamination TYPHOID FEVER AT WESLEYAN UNIVERSITY. 
247 
through lack of sanitation in recitation rooms or round the col- 
lege buildings in general. The first connection between the cases 
which served as a point of departure in the further investigations 
was in regard to the fraternity relations of the patients. Among 
the gentlemen students there are seven college fraternities, which 
comprise in their membership most of the students. With three 
exceptions all of the cases of typhoid were found in three of 
these fraternities. These three exceptions will be noticed later, 
but the confinement of the cases within these narrow limits was 
certainly suggestive. It was especially so when the number of 
cases occurring in three fraternities was considered. It was very 
evident that in these three fraternities there was some extremely 
potent source of typhoid infection. The members of the three 
fraternities comprised about 100 students, and among them at least 
twenty-three have been sick with typhoid fever of more or less 
severe symptoms. This is an exceptionally large per cent., and 
anything which could produce such a large proportion as this 
must have been an universal source of contamination to all the 
members of the society and not a purely incidental one. The 
presence of such a large percentage of cases among three frater- 
nities plainly showed that it was necessary to look for the cause 
in these fraternities, in spite of the three seemingly exceptional 
cases. It indicated, moreover, that the source of the typhoid 
could not be an incidental one, in which the chance of contagion 
was slight, but an extremely prolific source to which practically 
all of the members of the fraternities were exposed. All con- 
ceivable sources of contamination were, however, investigated, 
and in the following pages the investigations are given in some 
detail in order that it may be seen that the search was a thorough 
not a hasty decision that the oysters were to blame. 
One of the first points to be considered was the plumbing of the 
fraternity club houses. It was hardly to be expected, however, 
that this could be the source. The three houses were at a dis- 
tance of about half a mile from each other and were connected 
with at least two different sewers. There was at the time very 
little typhoid fever in town to contaminate the sewage. In two 
of the houses some of the students lodged, but in the third none 
of the students roomed, the house being used simply as a club 
house. Considering all of these facts, it is absolutely incredible 
that these three houses should simultaneously have such defects 
in their plumbing as to produce nearly twenty-five cases of typhoid 248 
STATE BOARD OF HEALTH. 
within two weeks. An examination of the plumbing showed it 
to be in good condition. Two of the houses were new and fitted 
with the best of modern plumbing, and there was no reason for 
suspecting any defect in the third house. The lack of typhoid in 
the city, the connection of the houses with different sewers, the 
large percentage of cases among the members of the fraternities 
and the simultaneous appearance of the disease in three houses, 
altogether ruled out the plumbing as a possible source of infec- 
tion. 
After thus excluding the plumbing the next attempt was made 
to trace the infection to the tables of the fraternity clubs. Most 
of the members of the fraternities boarded at these dubs, and the 
few who did not board there regularly occasionally took meals at 
the clubs. An examination was therefore made into the sources 
of supplies of the three clubs. But the result of the researches 
in this line were not promising. 
Water: The three fraternities used at their tables the ordi- 
nary city water from the city reservoir, and this, of course, at 
once exempted water from the possible sources of infection 
inasmuch as there was at the time scarcely any typhoid fever in 
the city. While it might be claimed that the city water was 
a possible source of typhoid, no one could believe that its effects 
could have been confined to members of three college fraternities 
and produce there twenty-five cases. 
Ice: The use of ice in ice water was in a similar way ex- 
empted. The same source of ice which was used by the three 
fraternities in question, was used by all the other college frater- 
nities, and by the townspeople generally. 
Milk: The question of the milk supply was among the first to be 
considered, inasmuch as milk has so frequently been known to be 
the cause of typhoid outbreaks. But careful examination showed 
that this could not be the cause. The three fraternities were sup- 
plied by two different milkmen, whose farms were several miles 
from each other, and who had not exchanged milk with each oth- 
er in any way, such as to give a common source of milk to the 
three fraternities. Moreover, each of these milkmen supplied one 
or more of the other college fraternities, which were exempt from 
typhoid, and each of them had a large patronage in town. This, 
of course, made it impossible to believe that their general milk 
supply could be a source of typhoid. Each of these milkmen 
furnished all of his milk from his own farm with an occasional TYPHOID FEVER AT WESLEYAN UNIVERSITY. 
249 
exception. Occasionally each would borrow milk from other 
sources but always at the end of his daily route while the club 
houses were at the beginning of the route. No typhoid fever had 
occurred either on or in the vicinity of either of these milk farms 
within six months, nor was it possible to trace any of the cows 
to an infected locality. These facts, together with the lack of 
any typhoid fever among the other patrons of these milkmen 
excluded the milk as the source of infection. 
Ice Cream.-The clubs occasionally had ice cream but had 
obtained it from different sources, and inquiry showed that the 
cream from which it was made came from widely separated dairy 
farms. The cream was also widely used in town. 
Miscellaneous.-No better results came from the examination 
of the other articles of food used in the clubs. The three clubs 
patronized different meat men and different grocers. Their 
butter was derived from various places and the same was true of 
their fruit. The same dealers in groceries, meat, butter and 
fruits and fish which supplied these three fraternities, also sup- 
plied the other fraternities in college and many people in town. 
The attempt was also made to determine whether any special lot 
of food had been use by the fraternities in question which could 
possibly have been a single source of infection, but no such article 
of food was found which had been used by these three fraterni- 
ties. Various different articles were suggested by the one fra- 
ternity or the other as perhaps open to suspicion. One mentioned 
a lot of bad ham, another a lot of canned fruit. But investiga- 
tion showed that these particular articles of food were not used 
in common by the three fraternities in question, or that they were 
used equally by the fraternities that had been exempt from 
trouble. 
A suggestion was made early that a lot of new football suits 
that had been purchased for the football team might have been 
the source of original infection, there having been some reason 
for suspecting that certain slight cases of blood poisoning had 
arisen from these suits. The possibility of contamination of 
these suits with typhoid material was recognized. It is, of 
course, possible that they may have been made in families where 
there was a case of typhoid and have thus become contaminated 
by infectious material. The chance is doubtless very slight, but it 
was at all events worth inquiry. The inquiry, however, was 
futile. Only a few of the men who had used the suits had suf- 250 
STATE BOARD OF HEALTH. 
fered from typhoid, while several of the sick men had nevei' 
touched them. Nor could these suits have furnished any con- 
nection with the three societies in question since they were used 
equally by members of all the college fraternities. 
An attempt was made to connect the three societies together 
by the roommates of the students who had suffered from the dis- 
ease, but this proved also futile. Most of the students roomed 
with members of their own fraternity and in many cases the room- 
mates of those that were sick had not suffered from the disease at 
all. No case of contagion from patient to patient has occurred in 
the whole epidemic. There was found to be no common connec- 
nection between the three fraternities by means of their room- 
mates and this line of investigation was abandoned. It was 
learned that at the first of the disease no special precaution had 
been taken in the fraternities in regard to the dishes that were 
used by the members that were sick, and a possible chance of 
distribution of the disease from the individual through the 
fraternity table was thus suggested. But against that theory 
arose the fact that all of the cases developed within two weeks of 
other. If they had come from one or two original cases and been 
thus transported through the dishes at the tables no such close 
aggregation of the cases together would have been found. In- 
deed, upon inquiry it was found that there were no early cases of 
fever which could have served as the source of others. The first 
case appeared about October 20th, and within a week from that 
time at least fifteen other cases had made their appearance. These 
facts, of course, indicated plainly a common source of infection 
and made it impossible to believe that any first case was the 
source of the others. Its simultaneous appearance in three socie- 
ties made it impossible to explain the outbreak by contamination 
from first cases through carelessness at the eating tables. 
The attempt was then made to determine the location of all 
typhoid cases in the city, to find out if a possible connection of 
the three houses with any of these cases could be found. This 
again proved impossible. An interview with all the city physi- 
cians showed a remarkably small number of cases in the city for 
this time of the year. None of them were in any way related to 
the three clubs, nor in position to make contamination from them 
possible. The only imaginable method by which such cases 
could have produced the violent outbreak in the clubs is by 
infecting the food or drink of the clubs. No such possible infec- TYPHOID FEVER AT WESLEYAN UNIVERSITY. 
251 
tion could be found for none of the patients had any connection, 
either direct or indirect, with the college or club supplies. 
In short, all the lines of investigation upon the relations of the 
students, the conditions of their fraternity houses, and the tables 
at the fraternity houses led to negative results, giving no point 
of common union between the three fraternities in question, 
which was not shared equally by the four other fraternities and 
the ladies in college, and equally by the citizens in town. 
As soon as it was seen that the ordinary table of the fraterni- 
ties was not likely to give the cause of the trouble it became 
necessary to look elsewhere. When the dates above mentioned 
as the limitations of the outbreaks are considered they are found 
to be very suggestive. All cases occurred between the twentieth 
of October and the ninth of November. The period of incuba- 
tion for typhoid is not exactly known but it is from about eight 
to twenty-eight days, varying widely and sometimes even slightly 
exceeding these two limits. When, therefore, it was learned 
that all of the cases appeared within two weeks of each other, it 
became evident at once that there ought to be found one single 
common source of infection in these three fraternities occurring 
within two weeks previous to the first case. These dates at once 
threw into suspicion a series of fraternity suppers held at the 
society initiations upon the twelfth of October. The date of 
these suppers, October 12th, it will be noticed, is just exactly the 
proper date to explain the outbreak of typhoid on the twentieth 
of October, and its disappearance after the fourth week follow- 
ing the suppers, about November 10th. Indeed these dates in 
themselves are almost sufficient to demonstrate these initiation 
suppers as the source of infection. It was now seen, too, that by 
taking into consideration the initiation suppers, was found an 
explanation of one of the three cases which had appeared among 
members of the college not in any of the three fraternities. One 
of the members of the college who had suffered from the typhoid 
had attended the initiation banquet held by one of these three 
clubs, but had not boarded with the clubs either before or subse- 
quently. 
The menu of the suppers on these initiation nights was at once 
carefully examined in the various college fraternities. It was 
found that nearly everything used at the initiation suppers was 
exempted as a possible source of infection, in the same way that 
the articles of food on their ordinary tables were exempted. The 252 
STATE BOARD OF HEALTH. 
water, the ice, and the milk and cream came from the same 
sources from which they were derived in subsequent weeks, and 
as we have seen, none of them could have possibly been the cause 
of the trouble. The ice cream which was used in the three fra- 
ternities was obtained from two different sources, and the cream 
from which the ice cream was made was also obtained from two 
different dealers living a long distance from each other. More- 
over the cream from each of these farms had supplied other fra- 
ternities and had been used constantly during the fall by people 
in town without producing any trouble elsewhere. Fruit was 
regarded as a possible source since it is eaten uncooked. But 
inquiry showed that the fruit must be exempted, because the 
source of fruit in the fraternities in question, was the same as 
that of the other fraternities not suffering, and the same as that 
large number of people in town. Each of the three fraternities 
had salad on their tables, chicken salad in one case, and lobster 
salad in the others. Neither the chicken nor the lobster could be 
blamed, since they were derived by the three fraternities from 
three different sources. The celery used in the salad was re- 
garded as a source of possible danger. The celery was purchased 
from different dealers, but these dealers obtained it all from the 
same man. This man produced the celery on a farm in Crom- 
well. During the fall he occasionally washed his celery in the 
water of the Connecticut river, his own well being dry at the 
time. This was at first regarded as suspicious. But further in- 
quiry showed that the same dealer furnished nearly all the celery 
that is used in the city, and had consequently furnished hundreds 
of families from the same source. While, then, it is possible that 
the celery contaminated by the river water, might have been the 
cause of an occasional case of typhoid, it was impossible that it 
could have caused the excessive large proportion of cases which 
had occurred as the result of the initiation suppers. It could not 
have localized itself in the participants of these three suppers 
without producing a corresponding epidemic in the city. 
After going through the entire bill of fare at these suppers 
tracing up the origin of every article of food or drink, there 
were found to be only three other articles of food in common at 
the three. These were ham, derived from the same dealer, 
a small amount of fruit, and oysters from the same fish dealer. 
The ham was of necessity excluded for two reasons. First, 
it was cooked before it was eaten ; and secondly, the same dealer TYPHOID FEVER AT WESLEYAN UNIVERSITY. 
253 
furnished other fraternities with ham. Add to this the difficulty 
of understanding how the ham would have been contaminated, 
and it was evident that the blame could not be placed here. The 
fruit was equally used by other fraternities and by townspeople 
and was therefore of necessity excluded. 
As soon as attention was turned to the oysters, however, the 
problems began to be solved at once. To those engaged in the 
investigation, one of the most striking phenomena was the quick- 
ness with which the puzzling questions were answered as soon as 
they were studied in the light of the oysters as a possible source 
of contamination. It was found that the ladies in the college did 
not hold any special supper on the evening of October 12th, nor 
eat raw oysters either then or subsequently. It was found that of 
the other four fraternities, two did not use oysters at all at the 
initiations suppers ; one obtained oysters from Hartford dealers, 
who obtained them from a different source than the Middletown 
dealers. The fourth used the oysters from the same source as the 
fraternities in question, only had used them cooked, while the 
three fraternities that had suffered from typhoid had eaten the 
oysters on the half shell and consequently raw. As soon as it 
was conceived that the oysters might be the cause of the trouble, 
one more of the exceptions above mentioned was explained, for 
for one of the students belonging to another fraternity, who had 
suffered from a mild fever, stated that at about the time of the 
initiation banquets, he had eaten raw oysters in the oyster deal- 
er's store in town. This, of course, made it possible to bring 
this case within the same source of infection. Inquiry as to the 
use of the oysters in town revealed nothing which relieved the 
oysters of blame. Quite a number of families were supplied 
from the same lot of oysters, but so far as could be learned only 
one family bought them to eat raw and this family has subse- 
quently moved from town and has been lost track of. Further 
facts concerning this case will be mentioned later. The at- 
tendants in the oyster dealer's store had probably eaten of the 
raw oysters, inasmuch as they did frequently do so, although they 
had no definite recollection of this particular lot. Neither of 
them had experienced any evil results. This, of course, is not 
surprising since ordinarily not much more than ten per cent, of 
those exposed to typhoid suffer from the exposure, and even 
among the students at the banquet not quite one in four took the 
disease. If the people in town who ate the oysters had not gene- 254 
STATE BOARD OF HEALTH. 
rally cooked them before eating them, a larger number of cases 
would have been expected. 
The oysters at these suppers were served on the half shell as 
a single course at the beginning of the supper. It was, there- 
fore, extremely probable that all persons wTho attended the ban- 
quets ate of them except such as had special dislike of oysters. 
In order to be certain of this, however, inquiries were made, where 
it was possible, of the students who were sick, and letters of in- 
quiry were sent to all who had gone away. From the replies to 
those inquiries it has been possible to trace direct connection 
with the oysters in all cases except one. One student does not 
remember having eaten the oysters. He did, however, attend 
one of the three banquets, though he ate little, being unwell at 
the time. Up to the present time this student has been too ill to 
be personally questioned, and his presence at the banquet where 
the oysters were served certainly gives at least an indirect con- 
nection with the oysters, even if his memory should not later dis- 
close a closer connection. It has been ascertained that the four 
young men who have died did eat of the oysters at the suppers 
in question. 
It was learned that at these same suppers were quite a number 
of persons who were not students of the college. Some of these 
were a number of alumni of the college and five students from Yale. 
Letters were at once sent to these persons to determine whether 
they ate of the oysters, and whether they had suffered from 
any sort of fever since that time. It was not expected that there 
would be such a large proportion of cases among the alumni, 
inasmuch as they are older men, and typhoid is especially apt to 
attack young people. Reports have been received from twenty- 
four of the alumni who ate of the oysters. Among them have 
been found several cases of slight illness, chills, diarrhoea, weak- 
ness, etc., which appeared at about the same time that the cases of 
typhoid appeared in Middletown. These may or may not have had 
some connection with the infection. But there have been found 
four cases of genuine typhoid fever, most of which had been diag- 
nosed as typhoid before there was knowledge of the connec- 
tion with Wesleyan cases. None of the cases had been severe, 
but all appeared simultaneously with those in college. 
Of the five Yale students who attended the banquet, two de- 
veloped typhoid fever. These two cases appeared quite late, 
developing the second week in November. The date of their ap- TYPHOID FEVER AT WESLEYAN UNIVERSITY. 
255 
pearance was just about four weeks after the suppers, and at just 
about the same time that the last case appeared at Wesleyan. 
There were two other cases of typhoid at Yale, which were 
certainly not traceable to the suppers nor to eating oysters. This, 
of course, indicates that there is some other source of infection at 
that place, and possibly these two students who attended the sup- 
pers at Wesleyan may have received their infection elsewhere. 
It is, however, a very remarkable coincidence that of the four 
cases at Yale, two should have been those in attendance upon 
these suppers, and that both cases should have developed within 
the known period of incubation of the disease after the initiation 
suppers. While not certain, therefore, it is extremely probable 
that these cases were due to the same source as the outbreak at 
Wesleyan. 
These last facts, of course, proved to practical demonstration 
that the cause of the infection was to be looked for in the initia- 
tion suppers. The cessation of the cases at the end of four 
weeks, the appearance of at least six cases among the visitors 
who came to the banquets, and went away immediately without 
having anything else to do with the college, are sufficient in 
themselves to indicate beyond peradventure that the initiation 
suppers are to be regarded as the source of infection. And 
when, further, it is seen that only one article of food or drink 
was used in common by these three societies, that was not used 
equally by the other fraternities in college and by people in town 
in general, it becomes equally certain that this one article of food 
must have been the source of infection. 
It will be seen that after the blame had been placed on the 
oysters all of the exceptional cases were explained except 
one. This one still remains an exception. One member 
of the faculty had an attack of fever at about the same 
time as the other students. He had not attended any of the 
banquets. Whether this was a case of typhoid fever is at 
least doubtful. The fever was slight and only lasted a few days, 
disappearing without leaving any evil results. Appearing with 
the other cases it was naturally regarded as of the same nature, 
but it would not have been considered as typhoid if it had oc- 
curred as an isolated case. Whether this person ate of the raw 
oysters it has been impossible to determine. Raw oysters were 
served at his boarding house at about the time of the banquet but 
whether he ate of them is uncertain. It seems more probable 256 
STATE BOARD OF HEALTH. 
that this case was an isolated case of fever having no connection 
with the others. 
As soon as these facts became clear the source of the oysters 
in question was investigated. These oysters were obtained 
from Fair Haven, Conn. It should be stated that the dealers 
who furnished these oysters have aided in the inquiry and 
given all the information possible. They have been perfectly 
frank in their dealings and have aided the investigation even to 
the injury of their business. Nothing but commendation should 
be given them, for no blame attaches to them, and the error in 
fattening the oysters was corrected as soon as its evils were un- 
derstood. Inquiry showed that the oysters in question had been 
taken from deeper water in Long Island Sound and had been 
brought into the mouth of a creek known as Quinnipiac River, 
and allowed to lie in fresh or brackish water a day or two for 
fattening before they were taken out of the water and sent to 
the consumers. During this period of fattening the oysters are 
known to absorb fresh water and to swell up and become quite 
plump. The object of this treatment is partly to thus " fatten " 
the oysters and partly to wash them. Close to the oyster beds 
where this fattening occurs are the outlets of a number of private 
sewers. At a distance of some three hundred feet from the beds 
where the oysters were fattened was an outlet from a private 
sewer from a house in which were two cases of typhoid fever. 
The patients were a lady and her daughter. The cases were 
severe, the lady dying on the twenty-first of October, and the 
daughter convalescing only after five weeks' sickness. The ac- 
companying diagram shows the exact relations of these localities. 
The oysters were placed to freshen at the place marked " oys- 
ters " between two stakes. The outlet of the sewer is shown at 
the bank of the river under the lower end of the wharf, and the 
distance from the outlet to the oyster ground is, as shown by the 
diagram, between 250 and 300 feet. When the grounds were 
surveyed it was further noticed that at the rising tide an eddy 
was found to be setting along the shore from the region of the 
sewer outlet up stream, in the direction of the oyster beds. This 
condition would plainly make it possible for typhoid contamina- 
tions from the sewer to be carried to the oysters. 
Examination as to the dates of the cases of typhoid occurring in 
the house on the sewer showed that the two persons in question 
were taken sick at just about the time that the oysters sent to Q Ul N N I P/AC STREET. 
Quinnipiac River 258 
STATE BOARD OF HEALTH. 
Middletown were collected. The oysters were sent to Middletown 
on October 10th, and the doctor was first called to these cases on 
October 11th. The period of incubation of typhoid fever is 
known to be somewhat variable and had certainly existed some- 
time before the doctor was called. From the fact that when the 
doctor was called the lady was suffering from a severe chill and 
fever, it was plain that the conditions were such that infection 
through the sewer might naturally have taken place at least for 
several days prior to the period of the first visit of the doctor ; 
for during this incubation period the persons may appear well 
and yet the presence of the typhoid germs render their excreta 
infectious. Indeed, the danger might be even greater at this 
stage than subsequently, since as soon as the disease is plainly in- 
dicated nurses will be pretty sure to disinfect the excreta and 
thus diminish the danger. This would bring the time of possi- 
bility of infection at just about the period when the oysters sent 
to Middletown were collected. 
The question arose at once whether the typhoid germs would 
live under the conditions presented in these oysters or be killed 
by the salt water or the oyster juices. That the germ is not 
killed by salt water has been shown by both Freytag and Foster, 
both of whom have found that the typhoid organism will live for 
weeks in a concentrated salt solution. Specimens of the oysters 
were, however, submitted to Dr. Charles J. Foote, of the Yale 
Medical School, for testing the question directly. The report of 
this work will appear elsewhere, but the general result was to 
show that the typhoid organism will live in the oysters long 
enough to have the oysters taken to Middletown and be eaten. 
In these experiments the bacilli typhi abdominal! were forced in 
between the shells of the oysters from the creek and were found 
alive and capable of growth at the end of forty-eight hours. This 
is all that is required to account for the outbreak at Middletown. 
The conditions under which these were obtained is 
evidently the ideal condition for the contamination of the oyster 
by the typhoid infection. The oysters certainly absorbed fresh 
water while lying on this creek. Whether they do this on rising 
or on falling tide is a matter of no special importance, for if the 
water becomes contaminated with the typhoid germs and the 
sewage, the rising as well as the falling tide would serve as a 
source of infection. The tide does not rush in and out with one 
steady sweep but currents and eddies run hither and thither at TYPHOID FEVER AT WESLEYAN UNIVERSITY. 
259 
all times. As already noticed some of these currents run in the 
proper direction to carry the sewage toward the oysters on 
rising tide. It is not to be expected, however, that all of the 
oysters in question would he similarly infected. Some of them 
might perhaps be entirely free from infection of typhoid germs 
while others would be quite badly contaminated. This would 
depend upon whether a current chanced at the right moment to 
carry typhoid material to the oysters. It would not be surprising, 
therefore, to have certain lots of the oysters give rise to a large 
number of cases of typhoid while others from the same bed, taken 
at perhaps a different tide, when the currents and eddies were 
slightly different, might have produced no such effect. The 
extent of the danger it is very difficult to determine. It would 
depend upon the closeness of the sewer, the direction of the eddies 
and currents, and especially upon whether the germs would mul- 
tiply in the oysters or simply remain alive there. If they actually 
multiply the dangers would, of course, be much increased. The 
results of Dr. Foote's investigations into this matter are there- 
fore of special importance. 
It would be, of course, extremely interesting to follow up the 
oysters obtained from these localities and to determine whether 
elsewhere the same oysters have produced typhoid fever. This 
is extremely difficult to do. In the first place most of the oysters 
which are used by the public in general are cooked before they 
are eaten, and cooking destroys the typhoid germs with the 
greatest readiness. It is not to be expected, therefore, that the 
oysters would generally produce the trouble. Again, it is known 
that only about ten or twelve per cent, of persons exposed to 
typhoid fever take the disease. The percentage of cases in col- 
lege was exceptionally large because all of those eating of the 
oysters were of the age most susceptible to this disease, but the 
same oysters used elsewhere would be used by people miscella- 
neously and it would be, of course, difficult to note very posi- 
tively the evidence of typhoid as produced by the oysters. The 
exceptional conditions occurring at Wesleyan of a large number 
of young persons eating of the oysters at one time had made it 
possible to trace the connection in this case. But when the 
oysters are scattered as they are in ordinary trade, are generally 
cooked before being eaten, and when we remember that only a 
small pei' cent, of cases of persons exposed take the disease, it is 
evident that it is impossible without very extended investigation 260 
STATE BOARD OF HEALTH. 
to trace the connection elsewhere. At Amherst college, how- 
ever, conditions have occurred quite similar to those at Wesleyan. 
At the same time that the typhoid appeared in Wesleyan a few 
cases of the disease developed at Amherst. After the epidemic 
at Wesleyan had been traced to the oysters, it was learned from 
the dealers that the Fair Haven oysters had also been sent to 
Amherst. Letters of inquiry were consequently sent to Presi- 
dent Gates, suggesting that possibly the Amherst students were 
suffering from the same cause as those at Wesleyan. Inquiry on 
the part of the President resulted in showing the following facts : 
There have been seven students at Amherst who contracted 
typhoid, one of them contracted it at his home, most all of the 
others were members of a single fraternity. These students 
did not room together nor all board together. It was learned, 
however, that their fraternity did hold an initiation supper upon 
the evening of October 12th, the same date as that of the Wesleyan 
suppers, and were served with raw oysters, all but one of those 
sick ate raw oysters on or about October 12. Inquiry showed 
that the oysters came from Fair Haven, although it has not been 
learned whether from the same dealer who supplied Wesleyan or 
not. The conditions, it will be seen, were almost identical with 
those at Wesleyan, and while it is hardly justifiable without fur- 
ther evidence to assume that the Amherst typhoid was due to the 
same lot of oysters, the coincidence in dates and in condition 
render it extremely probable. 
A final piece of evidence confirming in a striking manner the 
view that the oysters were to blame has been recently obtained. 
It was learned that a young man in Boston who had been suffer- 
ing from an extremely severe case of typhoid fever had visited 
Middletown at about the date of the banquets. Inquiry revealed 
the fact that he was taken with the disease simultaneously with 
the Wesleyan students, and that he had eaten raw oysters while 
in Middletown. It further appeared that the oysters which he 
ate were from the same lot as those which supplied the Wesleyan 
banquets, and that he had in fact partaken of the one lot, which, 
as mentioned on a previous page, had been sold by the Middle- 
town dealer to be eaten raw. This is plainly a striking confirma- 
tion of the fact that the lot of oysters sent to Middletown was 
exceptionally infected. 
It may be well to summarize the chain of evidence which 
leads to the conviction of the oysters as the cause of the Wes- 
leyan epidemic. TYPHOID FEVER AT WESLEYAN UNIVERSITY. 
261 
1. The dates of the cases appearing at Wesleyan, all between 
October 20th and November 9th, 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 suppers 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 at- 
tended 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 evening 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 twenty-five per cent, of the students 
attending the suppers have suffered from typhoid pointed to a uni- 
versal and very active source of infection, and not to an inci- 
dental 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 so- 
cieties 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 al- 
lowed 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 attention 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 Middletown 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 six cases among persons in attendance and not among 262 
STATE BOARD OF HEALTH. 
the present students at Wesleyan. In all of the cases of undoubted 
typhoid it has been possible to trace either direct or indirect con- 
nection with these oysters. The oysters were also eaten raw by 
one family in town, and at least one severe case of typhoid fol- 
owed. 
9. The use of oysters from the same locality by the students 
at Amherst college produced, or at all events, was followed by 
an outbreak of typhoid fever among the students who ate of 
them. 
These facts, taken together, form a chain of evidence practi- 
cally complete at every point and leaving no room for doubt. 
Whatever may be said in regard to oysters in general, the Wes- 
leyan outbreak of typhoid was caused by a special lot of contami- 
nated oysters.. 
Uncooked oysters are thus to be regarded as a possible source 
of typhoid fever. 
It is a very important point to determine to how great a dan- 
ger the public is exposed from this source. Is the distribution 
of typhoid by oysters a rare incident or is it a constant and con- 
siderable danger ? These questions are being everywhere asked. 
Upon this matter at present little can be given beyond personal 
opinion. But the question is such a vital one that a word of per- 
sonal opinion here may perhaps be pardoned. 
In the first place it appears evident that the public opinion at 
first exaggerated the amount of the danger. The lot of oysters sent 
to Wesleyan was very thoroughly infected, but there is no good 
evidence as yet that other lots of oysters from the same place 
were equally dangerous. The oysters sent to Amherst were prob- 
ably also infected, but these probably belonged to the same lot 
as those sent to Middletown. Beyond this it has as yet been im- 
possible to trace with certainty other instances of typhoid to the 
Fair Haven oysters. If it were true that all the oysters fattened at 
the same place were similarly infected, it would be expected that 
quite a number of cases of the disease should be traceable to the 
oysters. In New Haven especially, where the Fair Haven oysters 
are used largely, there would presumably have been found an 
exceptionally large amount of typhoid. There has been some 
considerable typhoid in the city during the months of October 
and November, and in a few cases it has been presumably traced 
to oysters, as shown elsewhere in the report of the State Board TYPHOID FEVER AT WESLEYAN UNIVERSITY. 
263 
of Health. But there is hardly the amount that would be 
expected if the oysters were all subject to a contamination such as 
that which affected those sent to Middletown. Indeed, the con- 
sideration of the conditions at the oyster beds would lead to the 
belief that the contamination of the oysters would be excep- 
tional. Where the oysters were placed near the mouth of a small 
sewer, and when this sewer came from a house containing typhoid 
patients, the danger of their contamination would be at its maxi- 
mum. Should they chance to be placed near the mouth of a 
large city sewer the danger, though a more constant one, would 
be much less likely to produce any considerable contamination of 
a large lot of oysters, since the typhoid material would be mixed 
by so much water as to distribute it widely and in a very dilute 
condition. Only an occasional oyster would thus be infected. 
At Fair Haven, however, when a proper eddy brought the mate- 
rial from the vicinity of the sewer toward the oysters, the chances 
were good for the whole lot to become infected. Perhaps oysters 
might lie in the same place many a time before and after, and 
not be injured thereby, because no eddy happened at the right 
moment to sweep typhoid material in their direction. The dan- 
ger from typhoid infection is, therefore, probably somewhat ex- 
ceptional even under the conditions existing. Where the oysters 
are fattened at a distance from sewers, the danger practically dis- 
appears, and even where they are open to infection from large 
overflow of a city sewer, the danger is certainly less than in the 
fortunately exceptional case of the oysters in the vicinity of a 
private sewer containing typhoid excretions. 
The extent of the danger will plainly depend very largely 
upon the question whether the typhoid germs actually grow and 
multiply in the oyster, or whethei- they simply remain alive there 
for some time. It may be that the oysters furnish a good cul- 
ture ground for the typhoid germs, which grow rapidly when 
once within the shell. This would, of course, greatly increase 
the danger, for one lot in a fattening bed might infect others. On 
the other hand, it may be that the germs do not grow in the oys- 
ters, but that only such individual bacteria as find entrance re- 
main alive. In this case the infectious material would be found 
only in the juices in the shell and adhering to the outside of the 
shell. The danger would, of course, be much less. Which of these 
two conditions represents the facts cannot at present be stated. 
It is hoped that experiments now in progress will settle the mat- 264 
STATE BOARD OF HEALTH. 
ter. But according to either view, oysters may serve as a means 
of transportation of typhoid wherever they are fattened in the 
vicinity of sewers ; and wherever they are placed in the mouths of 
fresh water streams for this fattening process, there will always 
be the chance of contamination from sewage. Few of the fresh 
water streams in the vicinity of our large cities fail to have 
sewage emptying into them. While, then, we cannot determine 
the extent of the danger, and while, in the opinion of the writer 
this danger is not very great, it must be recognized as a danger. 
Probably not a few of the obscure cases of typhoid which 
develop each fall shortly after the oyster season opens, and which 
cannot be traced to any source, may be due to contamination 
through oysters. It is, of course, impossible to determine the 
truth of this suggestion, but now that the possibility has been 
pointed out, we may hope that our health boards may in future 
years be able to determine the real extent of the danger. One 
thing is sure : The public health is placed in jeopardy when oys- 
ter dealers, for the sake of producing plumpness, place oysters 
in the mouths of fresh water creeks in close proximity to sew- 
ers. It is hoped that one result of the epidemic at Wes- 
leyan will be to lead to greater care in this direction, both on 
the part of the oyster dealers themselves, whose business will 
certainly be greatly injured by the repetition of such outbreaks 
of typhoid as that at Wesleyan, and on the part of our Boards of 
Health, who have in their keeping so much of the public weal. 
Wesleyan University. 
Middletown, Conn., 
Dec. 11th, 1894. v