EPIDEMIC OF TYPHOID FEVER, AT PLYMOUTH, 
PENNSYLVANIA. 
[Reprinted from the Proceedings of the Philadelphia County Medical Society, 
May 13,1885.] 
Dll. E. 0. Shakespeare gave a verbal report of the investiga- 
tions which Dr. M. S. French and himself, at the request of 
the Mayor, had made concerning the nature of the Plymouth 
epidemic. 
They had reached Plymouth on Saturday night, May 9, and on 
Sunday had an opportunity of making a post-mortem examination 
on one of the patients who had died from perforation. Well- 
marked evidences of peritonitis were found,the point of perforation 
being readily seen. On opening the intestine, the characteristic 
lesions of typhoid fever were well marked. The spleen and the liver 
were also enlarged and softened. Other post-mortems were made, 
showing the same condition. The clinical history of patients 
examined, also corresponded to typhoid fever. They had remained 
at Plymouth two days. 
He then gave the following descriptions of the conditions under 
which the epidemic arose :— 
The town of Plymouth nine months out of the twelve is sup- 
plied with water from a mountain stream, and during seasons of 
drought, occurring usually three months in the year, water from 
the Susquehanna River is pumped directly into the mains at the 
lower, portion of the town. 
In consequence of the frozen condition of all the streams in 
that portion of the country surroupding Pljunouth, about the 
20th of last March the usual mountain source of water supply 
became inadequate and, therefore, the water company began on 
that date to pump water from the Susquehanna directly into 
the mains in the lower streets of the town, while the upper 
streets on the hillside were still supplied from the reservoirs of 
the mountain stream. The pumping from the river continued 
until the evening of the 26th, when a sudden thaw, accompanied 
by slight rains, again filled the reservoirs. 2 
During the period of pumping from the Susquehanna, the 
water in that river was lower than it had been at any time for 
years, and the surface was frozen tight. The city of Wilkes- 
Barre, containing 30,000 inhabitants, delivers its sewage directly 
into the Susquehanna, the mouth of the lower sewer emptying 
only two miles above the Plymouth pumping-station, while the 
current is very rapid between the two towns. The water is 
further contaminated by refuse water from five or six mines, as 
well as by the garbage from the abattoirs at Wilkes-Barre. 
Notwithstanding this unusually filthy condition of the Susque- 
hanna water, it is beyond question entirely innocent of causing 
the epidemic, for the following and other reasons : 
There was less of typhoid fever in Wilkes-Barre at that time 
than usual. A section of Plymouth supplied exclusively by the 
Susquehanna water and by a few wells, containing a population 
of 800, is entirely free from the disease, except in the cases of 
eight persons, five of whom, previous to their attack, had been in 
the habit of going into the town and drinking the mountain 
water, while two were recent cases of secondary infection. In 
other portions of the town the extent of the disease was in direct 
ratio to the amount of mountain water used, and averaged 1-10 
of the population. 
The lower portion of the town was principally supplied with 
the river water during the time of the pumping, while the upper 
portion at the same time received the greatest supply of moun- 
tain water. The rate of sickness is two cases in' the upper por- 
tion to one in the lower, the latter also having been partly 
supplied from the reservoir. 
The mountain stream has four reservoirs, the lower one dis- 
tributing water throughout the town. The water in all the 
reservoirs was nearly exhausted at the time of the pumping, and 
they were also frozen. The mountain stream is a small one, 
running down over a rocky bed, and on a declivity not eighty 
feet from its bed a dwelling is situated, wherein, during January, 
February and March, was located a case of typhoid fever that is 
only now convalescent, the worst period of the case being about 
the 20th of March. The attending nurse was in the habit, during 
each night, of carrying the excreta from the patient and depositing 
it on the ground towards the stream. The ground during all this 
time was frozen and covered with snow, until the thaw and rain 3 
already alluded to occurred. The poisonous character of the 
dejecta is not destroyed by freezing, but is only kept in a 
state of hibernation. A great part of the three months’ accumu- 
lation of dejecta was suddenly swept into the rapidly running 
stream, and reached the lower reservoir as quickly as a man 
walking fast could have arrived there. 
In fifteen days from this time the epidemic began, fifty 
cases occurring daily between the 10th and 20th of April. Up to 
the present, twelve hundred have been sick and one hundred 
have died out of a population of eight thousand. For the 
first three weeks the few people in town who used well water 
exclusively escaped the disease. The period of incubation varies 
between ten and twenty days, or longer, and therefore no other 
conclusion can be arrived at than that the infective poison 
existed in the mountain water and originated from the one case 
of fever in the house on the side of the stream. 
The doctor went on to say, that although those people who used 
the water from the pumps in the town escaped at first, it was now 
found that the new cases developed in those who use well water. 
This was due to constant neglect to disinfect the excreta of the 
patients sick with the disease. In many cases they were thrown 
only a few feet from the well, and in this way the well water was 
now becoming contaminated. The people early became afraid of 
the hydrant water, and were now in great numbers resorting to 
the wells. Therein is the danger of a continuance and further 
spread of the epidemic. 
Notwithstanding the frightful lesson which the one case of 
the fever along the source of water supply had taught the doctors 
and the people, not one precaution against the possibility of 
secondary infection from the sick in Plymouth had been taken. 
Drs. French and Shakespeare were the first to inform the 
local Relief Committee and the people of their present danger, 
and to draft for them sanitary rules looking to disinfection of 
the excreta, and to rendering the drinking water, milk, and food 
harmless. They had occupied none of their limited time in 
looking into the milk or other food supply, for the reason that 
these could not possibty have been so universally contaminated 
as would have been required for them to have caused the sudden 
outbreak all over the town. 
They regarded this Plymouth epidemic of typhoid fever as 4 
unique in many respects. It is one more proof that there is 
required for the production of typhoid fever something more 
than the mere contamination of drinking water by common 
sewage or fecal matter; that, on the contrary, for the production 
of the specific, infectious, and altogether characteristic disease, 
known as typhoid fever, there must be introduced into the 
human organism a specific, infectious and characteristic cause, 
which is elaborated by and transmitted from a previous person 
sick with the disease. 
It is one more example of the great injury to the public which 
may follow neglect of the use of disinfectants in the handling of 
isolated cases of infectious disease, and it is one more rebuke to 
those who, in spite of our modern knowledge concerning the 
infectious nature of typhoid fever, constantly neglect the practice 
of systematic disinfection. 
1336 Spruce St., Philadelphia.