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The City.—Dr. Collingridge states that five cases were brought to his knowledge in which
infection was attributed to oysters and four in which it was attributed to mussels. Samples
of oysters which had been laid down in South Deep and from the "Pollard" bed at Whitstable,
which thus came under suspicion, were reported by Dr. Klein to be sewage-polluted. Dr.
Collingridge reports that an undertaking was received from the chairman of the company supplying
the latter oysters to "discontinue the sale of any oysters (including 'natives') from the Pollard
layings at Whitstable during the remainder of the season, and sell only off the 'Ham' ground."
This latter is, Dr. Collingridge says, in deep water, some miles from the shore, and apparently
free from pollution. Mussels which came under suspicion came from Hadleigh Ray,
Leigh-on-Sea, and were sold in accordance with instructions received from the Fishmongers'
Company, viz., to caution purchasers to boil them for three and a-half minutes. Samples were
reported by Dr. Klein to be sewage-polluted. Dr. Collingridge states that he has received
written undertakings from the two proprietors of these layings, in the one case not to expose
Hadleigh mussels for sale without giving him due notice of their intention to do so, and in the
other not to have any more up until Dr. Collingridge considers them free from contamination.
The occurrence of cases of enteric fever which were attributed to the eating of cockles from
Leigh-on-Sea led to examination by Dr. Klein of cockles which had been cooked by the cocklers
with a view to sterilisation. The samples thus examined, Dr. Collingridge writes, "showed
evidence of sewage pollution, and that in the process of cooking the temperature had not been high
enough to ensure devitalisation of sewage bacilli, thus clearly showing the impossibility of relying
upon any arrangement with irresponsible fishermen to carry out precautions necessary to
protect the public health." The Fishmongers' Company had endeavoured to compel the discontinuance
of the practice of laying cockles in the Leigh-creek, and to ensure more complete
cooking, and now, in view of Dr. Klein's report, they excluded the Leigh cockles from the
London markets.
Shoreditch.—Five cases associated with the eating of shellfish occurred, one had eaten
cockles at Southend and another at Leigh-on-Sea.
Poplar.—Four cases occurred, two after eating oysters and one each after eating mussels
and cockles respectively.
Souihwark.—" In quite a fourth of the cases the evidence was so strong in favour of shellfish
being the cause that it could not be reasonably discarded. In one group of cases the shellfish
was purchased from a particular stall."
Bermondsey.—In three cases attack followed the eating of mussels, and in one case cockles.
Lambeth.—" There was a history in twenty cases (15 per cent.) of shellfish having been
eaten by the patients notified one to three weeks previous to the disease developing."
Wandsworth.—" Twelve cases were in all probability caused by eating infected oysters,
7 by mussels, 2 by cockles, 1 by winkles."
Deptford.—" Five of the cases reported were traced to the consumption of shellfish (oysters
and cockles)."
Greenwich.—The patient had eaten shellfish within the incubation period of the disease
in the following cases-—mussels 2, oysters 2, mussels and oysters 1, shell-fish 1.
Woolwich.—Two cases were attributed to eating oysters, 1 to periwinkles, 1 to crayfish
and crabs bought and cooked at Hull.
In one instance an outbreak of the disease is believed to have been due to local contamination
of a water supply. This outbreak occurred in Fulham, Dr. Jackson's report showing that
cases of enteric fever occurred in streets on each side of the portion of Greyhound-road, running
between Ancill-street and Field-road, comprising an area of about 20 acres, with an approximate
population of 4,000. In this area cases of enteric fever were reported as follows—6 in the week
ending June 27th, 16 in the week ending July 4th, and 4 in the week ending July 11th.
During the next six weeks 5 other cases occurred. Possible causes, such as milk, shellfish, icecreams,
fried-fish, etc., could be excluded. The water supply of this area, in which the cases of
enter fever occurred and of three other streets, was received from a particular water-main, the water
being on constant supply. Dr. Jackson states that "no information could be obtained from the company
respecting the supply having been intermitted at a time corresponding with the infection
of the patients, but I was positively assured by several residents in the district affected that the
water was shut off for a short time about Whitsuntide. If such were the case, it is quite conceivable
that some specifically infected sewage may have been sucked into a defective communication
pipe, and it may be noted that on the evening of Thursday, May 29th, we experienced
one of the heaviest of last year's storms by which the sewers were surcharged and the basements
in that locality flooded to a depth of two to three feet, so that the risk of sewage being drawn into
a defective empty pipe would be increased, as the subsoil would be soaked with it.''
Since Dr. Hamer found certain outbreaks of enteric fever in London in 1900 to be
associated with the consumption of fried-fish, attention has been directed to this subject,
and in December of 1903 groups of cases occurred for the most part in Holborn, Westminster and
Southwark, the persons attacked having eaten fried-fish obtained from local vendors at a period
before their attack which corresponded with the incubation period of the disease. The Holborn
and Westminster cases were investigated by Dr. Bond and Dr. Allan, the medical officers of health
of those districts. They were further inquired into by Dr. Hamer, who subsequently, by study
of the distribution of notified cases of enteric fever in London in certain selected areas during
a number of years, found that there was frequently a distinct tendency to the grouping of
cases, and that the localities in which the groups occurred were in the main occupied bv poor
persons by whom fried-fish was largely consumed. This behaviour of enteric fever appeared to be
of sufficient interest to put on record, and hence Dr. Hamer has discussed the subject in a report
which was presented to the Public Health Committee, and is appended to this report (see
appendix I.).