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62
adopted at. Leigh. Dr. Klein infers from further investigations that
these bacilli undergo multiplication within the body of the cockle.
"At Southwick and Shoreham a very imperfect effluent is turned into
the estuary at a point near to which mussels are to lie found in quantity
(see Oyster Report by Dr. Timbrell Bulstrode). I learn that many cases
of typhoid fever in neighbouring towns have been traced to shellfish
from this source.
"It has been found that persons handling infected shellfish mayconvey
the typhoid bacillus accidentally to their mouths, and so infect
themselves, and it is therefore probable that children bathing or paddling
in polluted water, or playing on a polluted foreshore, may similarly
become infected.
"It is somewhat difficult to determine at which place each of the
present group of patients became infected, as the period which elapses
between receiving infection and the appearance of illness varies from a
few days to several weeks—perhaps as many as live weeks—and the
preliminary sympton being often merely a feeling of malaise, it is not
easy to fix the date of its appearance. However, 6 of the children who
had been to Southend only, took ill, so far as can be ascertained, within
18 days of their visit, 3 being at that limit, 2 at 13 days, and 1 at 10.
In the case of the seventh patient in this group, 36 days elapsed, but I
found that his mother had been to Southend on a later date, and brought
back a quantityper cent. of cockles with her, and he partook of them freely7, and
dating from that day would give 18 days as the incubation period. As
none of these 7 children had been to Southwick, they could not have
been infected there. Of those who went to both places there are two
divisions, as 4 of the 10 were at Southwick for a fortnight ending three
days before going to Southend for the dayper cent., and 6 went to Southwick two
days after the Southend excursion. The length of the incubation period
for the first four would be, dating from Southend, 9, 15, 18 and 18 days
respectively, dating from Southwick, 12, 18, 21 and 21 at the earliest,
26, 32, 35, 35 days at the latest. They may thus have been infected at
either place, and in support of the possibility of infection at Southwick
at this period, viz., from the 2nd to the 16th August, is the case of the
girl R. D., who did not go to Southend, as she was not feeling well on
her return from Southwick, and the incubation period in her case was
therefore less than 16 days. The second division were at Southwick
from the 21st August to 4th September. Two of this party took ill
before their return, and 2 two days after. The incubation periods of
the 6 cases were, after Southend 14, 16, 18, 18, 27 and 31 days
respectively; dating from 21st August, the first day at Southwick, 12,
14, 16, 16, 25 and 29 days, dating from the 4th September, 2, 2, 11 and
15 days for the last 4 of the group. It is therefore possible for the