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"If the consumption of shellfish in any given locality is a more or less routine
"custom, indulged in at times by a large percentage of the population, it will,
"of course, be probable that in some instances there will be an association in point
"of time between the shellfish eating and the onset of enteric fever, without there
"being necessary causal relationship between the two events; in fact, were the
"consumption of shellfish as common as the consumption of milk, the value of the
"statement that a patient had eaten shellfish within a short period prior to attack,
"would, having regard to the relatively small number of cases of enteric fever,
"have no more etiological significance considered alone than the statement that the
"patient had consumed milk, both of which articles are liable to be contamined by
"polluted water."
It is pointed out that the proportion of persons consuming mussels and cockles,
though variable, is probably small.
Reference is made to well attested shellfish-borne outbreaks of enteric fever and
gastro-enteritis, as also to cases of mussel poisoning.
Dr. Bulstrode then discusses the question of the influence of polluted shellfish in
maintaining enteric fever prevalence, and states that:—
"In addition to shellfish borne outbreaks there is evidence of a somewhat
"different, but cumulative very strong character which goes to show that in some
"towns at least shellfish have had an important share in producing and main"tabling
the prevalence of enteric fever, and although there are difficulties in
"dealing with some of the evidence adduced, owing to the paucity and relative
"unreliability of the data available, it may be said generally that the amount of
"enteric fever attributed to shellfish by medical officers of health is increasing in
"direct proportion to the amount of attention devoted to the subject, and the care
"which is exercised in the detailed investigation of individual cases or groups of
"cases. It is well to bear this fact prominently in mind."
But the report carefully points out that the danger is not entirely confined to
shellfish, presumably contaminated on the beds or layings, or in storage, but they may
also be polluted in the wholesale or retail premises, in which they are kept.
"In so far as the retailers are concerned it is important to remember that
"much shellfish is sold by hawkers with fish barrows, and that such persons are
"not unlikely to inhabit districts and localities where sanitary imperfections are
"common, and where medical advice is only sought when disease is well
"developed.
"The occurrence of a recognised or unrecognised case of enteric fever in the
"house of one of these shellfish hawkers might therefore not improbably result in
"the specific contamination of the shellfish, with consequences similar to those
"which are believed to have ensued in Merthyr Tydvil in 1903."
On the question of infected shellfish in the production of enteric fever amongst
visitors at seaside resorts, it is stated that
"There can be little question that occasionally infected shellfish consumed by
"visitors at holiday resorts is responsible for some of the enteric fever occurring
"in our large towns and in other inland places,"
and numerous instances are quoted.