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Of the 1,600 cases of enteric fever notified during 1906, a proportion was found, after inquiry
by the Medical Officers of Health, to be incorrectly diagnosed. With respect to those which were
accepted as being actual cases of enteric fever, effort was made by Medical Officers of Health to discover
the cause of the illness. As might be expected, it was found that a considerable number received
their infection outside the district in which their illness was notified, some of them being infected on
the Continent, where they had gone for their summer holiday. The annual reports relating to Westminster
and Hampstead both mention cases which were infected abroad.
The reports continue to show the occurrence of attacks following the consumption of particular
articles of food—oysters, other shell fish, fried fish, and watercress. Cockles are still frequently mentioned
as a possible cause of infection, and Southend and Leigh-on-Sea are still referred to as the source of
some of these cockles. An outbreak of 52 cases of enteric fever occurred during the year in West Ham,
and a number of the persons attacked were found by Dr. Sanders, medical officer of health of that borough,
to have eaten cockles a short time before the onset of their disease. Dr. Sanders discusses in his annual
report the probability of the outbreak being due to this cause or to fried fish, which was also largely
consumed by the sufferers, deciding in favour of the former view.
In the majority of these cases the cockles were said to have been purchased in Billingsgate Market,
their original source being Leigh-on-Sea. Dr. Collingridge obtained a report from Dr. Klein concerning
cockles from this source. The concluding paragraph of this report is as follows : " From the above analyses
it follows that none of the six samples have been sufficiently heated, and are therefore unsafe, inasmuch
as the interior of the cockles contained abundance of microbes in a living state, which, like B. typhosus
are killed by temperatures far below the temperature of boiling water." Dr. Priestley alto
found Colon bacilli of intestinal type in cockles sold in Lambeth, his attention having been directed
to the matter by the occurrence of 19 cases of enteric fever in June and July apparently connected
with cockle consumption. Dr. Collingridge refers to the risk of laying cockles in the Leigh Creek,
and adds, " The Leigh fishermen are now fully aware that if they persist, as heretofore, in relaying cockles
in the Creek that receives the town sewage effluent, they will lose their means of livelihood. Provided
they entirely abandon this practice and cook the cockles properly there can be no objection to the
fish being sold. The Rector of the parish and one other resident having been appointed to exercise
supervision for ensuring that the directions and instructions of the Fishmongers Company were carried
out, no further action was taken."
Whatever view is taken as to the sufficiency of the evidence incriminating the cockles in these outbreaks,
the fact remains that the risk of consumption of cockles which have been laid in the Leigh Creek
is now well recognised and any further evidence of injury to London inhabitants from this source must
necessarily raise question as to the steps which should be taken in dealing with this matter, by public
authorities of the localities whose inhabitants suffer in this manner.
In the majority of the reports the number of cases is stated in which shell fish was eaten at a
time before the illness which suggests that this might have been the cause; in a few cases additional
evidence is supplied. Thus in Fulham a servant girl ate cockles at Deal and subsequently brought some
home; only one other member of the family ate them, a sister, who was afterwards attacked. In Finsbury
a group of 14 cases occurred in June. The dates of onset, Dr. Newman writes, indicate a common source
of infection; all had eaten fried fish, and 13 out of 14 had eaten cockles, at or about the critical period.
Dr. Newman adds that it is possible that this outbreak was part of the larger outbreak which occurred
at the same time in West Ham. In connection with the frequent statement that fried fish had been
1ee footnote (1), page 32.