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41
Enteric fever in London manifested increase in the 31st, 32nd and 33rd weeks, decrease
in the 34th, and then rose in the 35th week, after which the usual autumnal increase was
maintained. A comparison of the mean weekly cases of enteric fever notified in the years 18901901,
see diagram XVII., shows a slight and gradual increase from the 30th week, the cases being
below the average until the 34th week. In 1901 the average was exceeded in the 31st week. The
increase in the 31st, 32nd and 33rd weeks of 1901 upon preceding weeks was most conspicuous in
the West Middlesex area, but the increase in that area is in great part due to the increase in
Fulham, of which Mr. Jackson gives account.
In 14 cases among those occurring in Fulham Mr. Jackson found the disease was apparently
communicated by personal infection from a previous case in the same house. In Westminster, Dr.
Allan states that of 102 actual cases of the disease it was found that 24 persons "came into
the city suffering from the complaint which they had contracted, some in South Africa, some
in France, and a number at other places in this country." Of the 78 remaining cases 7 were
due to infection from a previous case, and 5 to eating shellfish. Of five cases treated in King's
College Hospital, it had been observed that "four of the patients had some slight gastric ailment
before the proper symptoms appeared, which might probably suggest infection through food;
three of these suffered from extremely toxic symptoms." He thus reports concerning another
case, that of a girl, aged 12 years, living in a block of buildings in which there were no sanitary
defects—
She was very fond of cockles, and frequently bought some at a certain shop on Saturdays, on which
day they arrived from Leigh-on-Sea. On 11th May she ate some; she felt ill the next day, and was
seen by a medical man on the 15th, who treated her for congestion of the bowels. From this attack
she recovered, but a week afterwards again became ill, and on the 26th May the doctor certified that
she had typhoid fever. The fishmonger who sold the cockles gave all the information he had with
reference to the source; in order to obtain the best quality he paid a little more than the market price
for the cockles. The Public Health Committee, deeming the matter one of peculiar importance, gave
instructions that a bacteriological examination be made of some cockles as supplied by this fish
merchant (which was done), and that a special report be made on the subject, which is incorporated
herewith. The Jenner Institute subsequently reported that "the cockles were examined by culture
methods; the typical bacillus, coli communis, was isolated. A bacillus was isolated, which in all its
characters resembled the typhoid bacillus. It was an actively motile, non-liquefying bacillus, producing
no gas, and growing on culture media like the typhoid bacillus. Its colonies in the Eisner
medium were typical typhoid-like. It was agglutinated by typhoid blood, whereas normal blood did
not produce agglutination."
Dr. Allan quotes a report to the Local Government Board in 189G, in which Dr. H. Timbrell
Bulstrode wrote "that the cockles laid down to 'clean' in the bed of Leigh Creek are
liable to pollution, must, I think, be admitted, since they are often placed near one or other of
the Leigh sewage outfalls," and Dr. Allan states that Dr. Bulstrode's description still applies,
though some improvements have been made, and that there is no doubt as to the possibility
of sewage obtaining access to the cockles, as they lie on the side of the creek. He mentions,
moreover, that the cooking process to which the cockles are submitted can scarcely be called
'"boiling" them; "it consists rather of dipping a cage containing the cockles into a copper of
boiling water, the process only taking 1 or 1½ minutes, the object being to kill the 'fish,' and
enable it to be separated from the shell." Dr. Allan points out that this process cannot be
relied upon to kill the typhoid bacillus if it be inside the cockle, as was the case in those
examined by the Jenner Institute.
Experiments by Dr. Klein, of which account is given in the report of the Medical Officer
of the Local Government Board, 1900-01, tend to confirm this view and further show that "mussels
and cockles that have sojourned for 24 hours in typhoid-infected sea water, did not, after a further
sojourn for 48 hours in clean sea water, become free of the typhoid bacilli they had taken up," and
indeed the bacilli appear to have "actually increased in number within the bodies of the cockles."
In a special report on the outbreak of typhoid fever in Southend during June and July, 1902,
which has just been published, Dr. Nash, the medical officer of health, found, as a result of inquiry,
that 54 per cent. of the cases of typhoid fever occurred among the 5 per cent. of the population
which, he estimated, eat cockles.
In Stoke Newington 20 cases were notified, in 5 of which the disease was contracted outside
London during the summer and autumn holiday. "The evidence pointed strongly to the
infection having been derived from the eating of mussels in one instance and to the consumption
of tinned salmon in another instance." In Hackney, 8 cases of 183 cases of actual enteric fever
had been infected outside the borough. In Finsbury, Dr. Newman says, there is some evidence
to show that enteric fever was caused in 3 instances by drain nuisances in the house, in 8 instances
by eating shellfish, in 4 instances by personal contact with previous cases, in 2 instances by
personal contact with unrecognised cases, in 5 instances by eating ice-cream, in 4 instances by
eating watercress. In the remainder of 65 cases notified it had not been possible, even approximately,
to discover the source of infection. One, however, appeared to be connected with a ragshop
anil another with a visit to the hop-gardens in Kent, while another was that of an ambulance
porter, and may have contracted the disease in the discharge of his duties. In Southwark, the
cause of one case is attributed by Dr. Millson to contact with clothes which two years before
had been worn by a man who had died of enteric fever. In Bermondsey a group of 14 cases
occurred in Irwell-place between the 23rd September and the 28th October. Inquiry by Dr.
Brown, as to milk and food supply, threw no light on the occurrence, but defective water service
pipes were found in connection with the invaded houses. In Lambeth, Dr. Priestley states, no
rase could be traced to infected water, milk, oysters or other shellfish, or to ice-creams. In
Battersea Dr. McCleary found reason to suspect shellfish in two cases, while in the remaining
cases, "where a history of infection was obtained, the source was to be found in personal infection."
In 8 cases the disease was imported from outside the borough. In Wandsworth, Dr.
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