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139
paddling at Southwick, and had assisted other boys in collecting mussels. From
enquiries I have made, there is no doubt that infection through the medium of
infected shellfish might be contracted at both the places mentioned. The cockles
sold in Southend came from Leigh, and I described in my Annual Report for
1901 the conditions under which this industry is conducted, and the Jenner
Institute was able to demonstrate in cockles brought from Leigh, the presence of
the bacillus which causes Typhoid Fever. Dr. Nash, the Medical Officer of Health
of Southend, attributes cases in that Borough to the same cause, and in a paper
read at the recent Congress at Manchester stated that he had ascertained that
several cases of typhoid fever had occurred in the district supplying the sewage
which falls into the creek on the banks of which the cockles are laid.
The Medical Officer of Health for Southend-on-Sea, Dr. J. T. C. Nash,
referred to the subject in a paper read before the Sanitary Institute Congress
at Manchester, 1902. He there states:—
In 1901, I found that in no less than twenty-one out of thirty-seven cases of
typhoid fever which occurred between August 15th and December 31st, there was a
history of the eating of shellfish (generally oysters and cockles) within a month of
the onset of illness.
The history of typhoid fever in the Borough of Southend-on-Sea indicates
that the more closely enquiries were made into the causative influence of shellfish
from doubtful layings, the larger became the proportion of cases in this connection.
From the internal evidence of the annual reports, it appears that the enquiries as
to shellfish for 1895-1897 were almost limited to the eating of oysters, and that
only within a limited period of from two to three weeks previous to onset. From
1898 onwards the figures generally show (with the exception of 1899) a larger
proportion each year of cases stated to have eaten shellfish. A legitimate inference
is that closer enquiries with respect to other shellfish, as well as oysters, in the
earlier years 1895-1897, would have revealed a larger proportion of cases of typhoid
fever attributable to infected shellfish than the figures given in the reports.
Moreover, the incubation period of typhoid fever is very variable, extending from
only one or two days to four or five weeks, and therefore enquiries as to shellfish
should cover at least a whole month prior to onset, instead of from two to three
weeks only.
Further, I have pointed out elsewhere* that enquiries should not be limited to
the eating of shellfish, but should extend to the handling of shellfish from suspicious
sources. It is easy to understand that germs can be carried to the mouth by the
unwashed hands after touching infective shellfish, as well as from clothing infected
with typhoid dejecta. This latter method of infection is the usual source of
secondary cases.
* Public Health, August, 1902.
Preparation.—Cockles are found in large quantities, mostly on sandy
shores around the coast, and are collected by hand at low water.
Dr. Bulstrode, in his report to the Local Government Board, 1896, "on
"Oyster Culture in relation to disease," states: "There are certain considera"tions
which serve to show that contractions of water-borne diseases by the
"ingestion of cockles is a somewhat remote contingency.