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5
The Records of Ice-borne Disease.
The literature of "impure ice" is a fairly extensive one, and numerous references are given
in the Index Catalogue of the Washington Library; the number of instances in which there has
been evidence that actual disease has been caused by the consumption of ice is, however, small.1
Heyroth2 refers to five papers in American journals giving account of outbreaks of illness
traced to eating impure ice. I have been unable to follow up two of these references; two others
which I have traced merely refer to the occurrence of ice-borne-disease in a general way, one
of them quotes one of the two reports just mentioned which I have been unable to obtain (Second
Annual Report of the State Board of Health of Connecticut, 1879, p. 90). There remains the
fifth paper, a "Report on an Outbreak of Intestinal Disorder Attributal to the Contamination
of Drinking Water by Means of Impure Ice," by A. H. Nichols, M.D., of Boston (State Board of
Health of Massachusetts, January, 1876, p, 467), which gives an account of an outbreak of illness
in July, 1875, among the guests in one of the large hotels at Rye Beach, a popular seaside
resort upon the coast of New Hampshire. The chief symptoms manifested by the sufferers were
giddiness, nausea, vomiting, diarrhoea, abdominal pain, fever, loss of appetite, and mental depression
; in most instances the illness was not sufficiently severe to necessitate the aid of a
physician, but twenty-six adults presented "grave symptoms" the attacks were limited to the
inmates of a single hotel accommodating about three hundred guests. Examination of the
water-supply, drainage, cooking-utensils, and milk-supply yielded negative results, but the ice used
was found to be "rather impure and opaque" and it "contained numerous foreign substances
varying in size and apparently of vegetable origin." Further inquiry elicited the fact that a
resident of the place who had consumed ice from the pond whence the ice-supply of the hotel was
obtained, had experienced nausea and distress for the remainder of the day, and two gentlemen
who had taken a quantity of the iee with them on an excursion had also been attacked. Moreover,
there was a distinct odour given off by the melted ice, and the atmosphere of the ice-house was
offensive. The ice was found to be derived from the practically stagnant water of a flooded marsh,
which contained a putrescent mass of marsh mud and decomposing sawdust; it is noted, too, that
there were several large houses at no great distance. Finally, coincidently with the disuse of the
ice there was amelioration of the symptoms of those hitherto ill, and no fresh cases occurred
during the season.
In a somewhat similar outbreak, affecting persons who dined at the table-d'hote of a London
hotel, in 1898, some suspicion fell upon the ice, but in London, as at Rye Beach, no precise
statement was obtained from each sufferer as to the various foods, etc., consumed, and in the
absence of an exact analysis of this kind no inference could be drawn. In neither of these cases
can the connection of the gastro-intestinal disturbance with ice be regarded, therefore, as
conclusively demonstrated, though having in view the occasional spread of illness of the kind in
question by contaminated water, it is possible that dirty ice may have been the source of trouble
in these and similar instances, since, as will be seen, freezing affords no guarantee of freedom from
disease germs.
Interest, however, especially attaches to a class of cases which remains to be considered—
instances in which enteric fever is believed to have been spread by contaminated ice. Reference is
made to such a case by Dunbar (Boston Medical and Surgical Journal, 1894, p. 261). "Careful
search of the records," he says, resulted in the discovery of "but one presumably authentic case of
transmission of typhoid fever through ice"; he adds "this occurred in France, and resulted from
the use in wine of ice taken from a river below the sewage outlet of a town."3 An outbreak of
enteric fever referred to by Osier ("The Principles and Practice of Medicine ") may be here
mentioned, though the medium of infection in this case was not, strictly speaking, ice. Plymouth,
Pennsylvania, a town of 8,000 inhabitants, in part supplied by reservoirs fed by a mountain
stream, suffered severely in 1885 from enteric fever. In January, February and March, a man
living in a cottage by the side of, and some 60 to 80 ft. distant from, the mountain stream suffered
from that disease. The ground was then frozen and covered with snow, and the patient's evacuations
were thrown upon it on the side of the cottage next to the stream. Late in March and in early
April, there was considerable rainfall and a thaw, during which "a large part of the three weeks'
accumulation of discharges was washed into the brook." About the 10th April, cases of typhoid
fever broke out in the town, appearing for a time at the rate of fifty in a day until some 1,200
persons in all had been attacked, and "an immense majority of all the cases were in a part of the
town which received water from the infected reservoirs."
In the American Journal of the Medical Sciences (October, 1903), there appeared a paper by
R. H. Hutchings, M.D., and A. W. Wheeler, M.D., on "An Epidemic of Typhoid Fever due to
Impure Ice." The outbreak occurred in the St. Lawrence State Hospital, situated on the St.
Lawrence River three miles below the city of Ogdensburg. Between 2nd and 5th October, 1903,
eight attacks of illness, which proved to be enteric fever, occurred. The ordinary sources of
infection, water, milk, vegetables, oysters, could be excluded, and "there remained only the ice to
be considered." This ice, which had been taken from the river and had been stored more than
seven months, had, it appeared, come into use about six days before the cases of illness developed;
furthermore, during January and February, 1902, when the ice was forming, there were three or
four attacks of typhoid in the city of Ogdensburg, the sewers of which discharged into the river,
1 Excluding from consideration, of course, outbreaks of ice-cream poisoning—i.e., cases in which the source of
infection was presumably the cream or custard rather than the ice. Some instances of this kind have been
referred to in my report on food, published as an Appendix to the Annual Repor^ of the Medic al Officer of Health of
the County of London, 1898.
3 Arbelten aus dem Kaiserlichen Qesundhoitsamte, 1888, p. 23.
I have not been able to trace this case.