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another house, the patient having eaten cockles purchased from the same dealer. In the reports
relating to the following districts cases of enteric fever occurred which followed the eating
of shellfish. In Paddingtou, the eating of oysters in four cases and of cockles in one case
was followed within the period of incubation by attack by enteric fever. In Kensington there
was ground for suspicion in twelve cases that enteric fever had been caused by eating oysters.
In Fulham there were five cases in which shellfish had been eaten at a time which corresponded
with the period of incubation, viz., at Ramsgate (oysters), at Brighton and Southend (oysters
and cockles), at Littlehampton (oysters), at Dublin (cockles), in London (oysters). In Chelsea
there was one case in which cockles and oysters had been eaten at Southend. In St. Pancras
eleven cases occurred in July, September and October, cockles, or oysters, or other shellfish
having been eaten in each case at Southend. In Islington there were three cases after eating
oysters. In Stoke Newington, one case occurred after eating oysters, and two cases after eating
cockles. In Hackney, nine cases were attributed by the relations to the eating of shellfish. In
Finsbury, ten cases occurred after the eating of shellfish, in five shellfish had been purchased at a
stall (in one case, oysters), in one case oysters had been eaten at Jersey, in one case oysters and
other shellfish at Margate, in two cases shellfish had been eaten at Southend, and in another case
the shellfish had come from Southend. In Shoreditch, in twelve cases occurring in July, August,
and September, the attack followed the eating of cockles at Southend. The interval between the
visit to Southend and the subsequent attack in eleven cases ranged between seven and sixteen
days, and in one case was twenty-six days. In Poplar, in July, August, and September, in seven
cases cockles had been eaten at Southend, in four cases cockles which came from Southend, and in
one case cockles which came from Margate had been eaten. In two cases oysters had been eaten, in
one case three weeks and in the other a month before attack. In Soutliwark, in seven cases cockles
had been eaten at Southend, in one cockles from an unknown source, in seven cases mussels, in
seven cases oysters, in four whelks, and in two crabs, all from unknown sources. In Battersea, at
a time corresponding with the date of infection, cockles had been eaten in five cases, mussels in
five, and oysters in two cases. In two of these cases the cockles came from Leigh-on-Sea. Dr.
Smith is of opinion that 22 cases in the borough of Wandsworth were due to the consumption of
shellfish two or three weeks before this attack, viz., mussels in one case, winkles in one case, cockles
in six cases, and oysters in fourteen cases. In only one of the last cases was the source of the
oysters definitely traced, viz., Emsworth. This case occurred about the same time as an outbreak
of enteric fever at Southampton, due to eating oysters from this source. In Camberwell, in
two cases oysters had been eaten at Southend, in one case oysters had been eaten at Brixton, and in
a fourth case winkles had been eaten at Southend some four weeks before attack; in other cases
the patients occasionally partook of shellfish. In Greenwich, in seventeen cases shellfish had
been eaten within three weeks of attack; in two of these cases cockles had been eaten at Leigh;
in five cases cockles, in one case oysters at Southend, and in nine cases shellfish had been eaten at
home. The Southend and Leigh cases occurred in September and October. In Woolwich, in
twelve cases shellfish had been eaten within three weeks of attack, and one of these was a case
in which cockles had been eaten at Southend.
How many of the cases mentioned above were actually due to the eating of shellfish
cannot be stated, but the fact that in numerous instances the shellfish was known to come from
polluted sources, and that in respect of some of these, notably Southend and Leigh, cases of
enteric fever had occurred locally, apparently from the eating of shellfish, creates a strong
presumption that in 1902 many cases of this disease were caused in London in this manner.
On the occurrence of the four cases of enteric fever in Wandsworth, mentioned above,
Dr. Caldwell Smith communicated with Dr. Collingridge, who found that the cockles in question
had come from Leigh-on-Sea. Samples of cockles taken at Leigh—some boiled, some unboiled—
were submitted by Dr. Collingridge to Dr. Klein for bacteriological examination, with the result
that Dr. Klein reported that they showed evidence of sewage pollution. Dr. Collingridge reports
that the Fishmongers' Company at once put their powers into force, and prohibited the Leigh
cocklers from sending to the London market any more cockles which had been relaid in the Leigh
estuary other than those which were actually ready for market and had been boiled, but that
cockles taken from the parent beds on the Maplins and elsewhere and boiled directly they were
landed, without allowing them to be contaminated with sewage, might be sold in London. Later,
however, after examination by Dr. Klein, Dr. Collingridge reported that samples of cockles taken
from the Maplins and Blyth were also contaminated with sewage. The occurrence of numerous
cases of enteric fever among the guests at a mayoral banquet at Winchester in November, due to
the consumption of oysters taken from the Emsworth pits, led the Fishmongers' Company to
prohibit the sale in London of oysters from this source. Dr. Collingridge gives the results of
Dr. Klein's examination of oysters from five places, and he states that the conclusions arrived
at were that one Emsworth sample examined was contaminated, that of two Bosham samples both
were contaminated, that of five Mumbles samples four were contaminated, that of two Southwick
samples both were contaminated, and that of eight Whitstable samples two were contaminated.
It is important to observe that evidence of the contamination of particular shellfish layings appears
in some instances to include that of a clinical and topographical nature, while in other cases the
evidence appears to have been of a bacteriological nature only.
In 1898, the County Council joined in a deputation from the authorities of 27 large towns
to the President of the Local Government Board, which urged the necessity of legislation in order
to minimise the dangers to which the public are exposed through the consumption of sewage contaminated
ovsters and other shellfish. A Bill for the purpose of dealing with oysters was in 1899
introduced into Parliament, and submitted to a select committee of the House of Lords. This