Dr. H. Timbrell Bulstrode’s Report to the Local Government
Board upon alleged Oyster-borne Enteric Fever and other
Illness following the Mayoral Banquets at Winchester
and Southampton, and upon Enteric Fever occurring
simultaneously elsewhere, and also ascribed to Oysters.
Ay. H. PoM^EK,
Medical Officer,
14th May, 1903.
On December 16th, 1902, a telegram was received from Dr, Lockhart
Stephens, Medical Officer of Health of the AAffirblingtoii Urban District in
Hampshire, stating that there were several cases of enteric fever at the town of
Emsworth, and that, from information derived from Winchester and Southampton,
Dr, Stephens had reason to believe that specifically infected 0}^sters were being
imported into these towns from Emsworth, and were causing enteric fever therein.
The Board also received about this time information from other sources to
the effect that cases of enteric fever had occurred among guests at the mayoral
banquets at the two towns here in question. It was stated, too, in the public
press that cases of enteric fever had occurred at Portsmouth which had been
attributed by the medical officer of health to the consumption of oysters, and
on December 17th a telegram was received from the Sanitary Committee of the
Portsmouth Corporation drawing the attention of the Board to the outbreak
referred to.
In consequence of this information I was instructed by the Board to
proceed to the several places mentioned to investigate the circumstances, and
to report thereon.
I now give an account of the facts which I elicited at each place, and of the
investigations subsequently made relative thereto.
THE MAYORAL BANQUET AT WINCHESTER.
On November 10th, 1902, there took place at the (Tiiildhall, Winchester,
a dinner to the ex-mayor, 134 guests being present.
Of these 134 guests, nine had, at the date of my visit on December 17th,
developed enteric fever, as also had one of the waiters who officiated at the
banquet, and who partook of a certain item in the menu. Of these 10 persons,
two,* including the waiter, were already dead. I gathered, too, from the
Mayor and from members and officials of the Corporation who were present
at the Guildhall at my preliminary conference, that, in addition to the
10 cases of enteric fever, there had been, among persons present at the banquet,
numerous cases of gastro-enteritis of varying degrees of severity.
The cause of these cases of illness had not then been definitely determined,
although suspicion had, it appears, fallen upon both the soup and the oysters
consumed at the banquet, while, by some, the mischief was ascribed to other
articles on the menu.
* Two more died subsequently, making four fatal cases in all. — H. T. B.
LONDON:
PRINTED FOR HIS MAJESTY’S STATIONERY OFFICE,
By darling & SON, Ltd., 34-40, Bacon Street, E.
And to be purchased, eithei' directly or through any Bookseller, from
EYRE SPOTTISWOODE, East Harding Street, Fleet Street, E.C.,
or OLIVER & BOY D, Edinburgh ;
or E. PONSONBY, 116, Graeton Street, Dublin.
r.H)3.
Price, One S/ti/linq.
No. 185.
1000 Wt 23606 6/03 D&S 19 13593
2
It appeared to me desirable that an exhaustive iuquhy should he made
with the object of ascertaining, if possible, what article or articles of diet might
have been responsible for the outbreak.
I therefore suggested to the mayor and the medical officer of health that
a copy of the menu in the form shown in the appendix (pages 20 and 21)
should be forwarded to each of the guests, and that they should be asked to
state of what articles of the menu they partook, whether they suffered any
indisposition or illness shortly after the banquet and, if so, the nature of such
attack ; and also whether they ascribed it to the banquet.
My suggestion was at once adopted, and after a considerable lapse of
time, caused mainly by the serious illness of several of the guests, the informa-
tion was procured, which is tabulated in Appendix No. 1 (pages 22-28).
I may add that I also visited, in company with the medical officer of
health of Winchester, several of the cases of illness other than enteric fever, and
that I called upon each of the medical practitioners who had been in attendance
upon the enteric fever cases.
In the table in the appendix the articles partaken of by each guest at
the banquet are tabulated, the cases of illness being printed in italic, and the
cases of enteric fever being differentiated by means of black type. An asterisk
is placed against the initials of those attacked with gastro- enteritis and a f against
the initials of those who suffered from enteric fever. I would draw special
attention to these tables as they serve to show at a glance the very considerable
amount of illness following the banquet.
I have made an analysis of this table, and I herewith arrange the results in
tabular form. In enumerating the cases, those articles against wdiich a ? was
placed by the guest have been omitted, such units having been reckoned neither
among the consumers or non-consumers of the articles in question. This
appeared to me, after consideration, to be the fairest manner of dealing with the
doubtful factors.
Out of the total 134 guests no less than 62, or 46'3 per cent., were
attacked with illness of some kind or other.
Of the 63 persons (inclusive of the waiter) who became ill —
2
did not
take
oysters.
At least
23
99
99
clear soup.
55
40
99
99
thick „
55
38
99
99
smelts.
23
99
99
turbot and lobster sauce.
5?
15
99
99
sweetbread and spinach.
??
51
99
99
kidneys and mushrooms.
??
50
99
99
boiled mutton.
45
99
9'
roast „
J?
50
99
99
roast beef.
37
99
99
venison.
44
99
99
red currant jelly.
??
56
99
99
capons.
n
50
99
99
ham.
95
54
99
99
tongue.
59
43
•9
99
turkey.
99
27
99
99
pheasant.
99
50
99
99
partridge.
99
48
99
99
Sir Watkin Wynn pudding
5 5
52
9^
99
Charlotte russe.
99
^6
99
99
liqueur jellies.
5^
54
99
99
caramel cream.
99
57
99
99
maraschino cream.
99
47
99
99
meringue.
99
19
99
99
ice.
59
32
99
99
cheese.
99
46
99
99
salad (celery).
99
45
99
99
aerated water.
The enteric fever cases considered
tever —
All the 10 took oy??ters.
least
.'i
did not
take
??
4
55
55
6
55
55
r
2
55
5'
)?
1
55
51
57
6
■5
55
r-
55
0
55
5'
55
ml
1 7
55
55
55
55
55
5
55
55
.0
55
55
^5
7
55
55
b
55
5'
7
55
5 5
5'
h
55
55
1
55
55
•5
5
55
55
55
•T)
55
55
55
5
/T
55
55
55
1
55
55
55
7
55
55
55
8
55
55
55
5
55
55
55
8
55
55
55
3
1 5
55
55
5
55
55
55
3
55
55
separately. — Of the 10 cases of enteric
clear soup,
thick ,,
smelts,
turbot,
svreetbread.
kidneys and mushrooms,
boiled mutton,
roast ,,
, , beef,
venison,
currant jelly.
cap(jns.
ham.
tongue,
turkey,
pheasant,
partridge.
Watkin Wynn pudding.
Charlotte russe.
liqueur jellies,
caramel cream,
maraschino cream,
meringue,
ice.
cheese.
salad.
aerated water.
The advantage of the scheme thus adopted is that, so far as enteric fever is
concerned, it is permissible to exclude every article on the menu with the
exception of oysters, so that from this point of view it is unnecessary to enter
at any length into the composition, or the source, of any other articles in
the menu.
It may, however, be stated that, with regard to illness generally, the
matter has been thoroughly gone into, and in the appendix (page 29) will be
found the precise composition and the source of each article which went to make
up the menu.
With respect to the turtle soup, which is one of the items to which suspi-
cion had locally attached as causative of indisposition if not of actual illness, it
is clear, seeing that at least 23 of those who were taken ill did not partake
thereof, that no reasonable suspicion can attach to it. It was alleged that the
“ stock ” from which the soup was made was prepared in copper vessels which
had not been recently tinned, and that directly after the banquet these same
vessels were sent by the caterer to be re-tinned. As the figures already given
will, I think, sutfice to show that neither of the soups was the source of
miscliief, I do not propose to discuss the matter further, nor do I propose to
deal with each article of the menu separately. Such a discussion, in face of the
evidence above set forth, is superfluous.
Additional data. — It occurred to me in the first instance that enquiries
relative to the waiters and other attendants who were present at the banquet
should furnish evidence which might be put to use in tracing out the cause
of illness, and, consequently, forms of enquiry were sent to each of the
attendants.
Forty-two returns were received in this connection, e.xclusive of the waiter
who contracted enteric fever and died, and who is included in the list published
in the appendix, but it has to be observed that the waiters partook of only a few
of the articles which formed part of the general menu.
i 2
13593
4
Among these 42 attendants only eight took oysters, and none of these
suffered from enteric fever. But if for the moment, the dead Avaiter be included,
it is found that there occurred one case of enteric fever among nine oyster
eaters, which is about tlie same percentage incidence as upon oyster-eating
guests, he., nine cases among 11 o oyster-eaters. In the matter of illness
other than enteric fever there was but one case of indisposition, and that was
a waiter who placed a ? against oysters, and tvho tvas “ taken A^ery sick Avith
dysentery for the next two days,” and who continued more or less unwell for
a wmek afteinvards. It is clear, therefore, seeing that among 43 waiters there
was but one case of enteric fever and one case of illness, that among these
attendants some factor was absent which was operative among the guests.
The ladies in the gallery. — A few ladies Avere present towards the end of
the banquet, and they were furnished with light refreshments by the caterer.
These refreshments consisted of sandwiches, bread and butter, cakes,
coffee, and strawberry ice cream. The constitution of the ice cream was the
same as that of those used for the guests, and hence it seemed that the
information under this heading might proA^'e of use. These ladies AA^ere kind
enough to fill up the forms which were sent to them, and from these it appears
that none of them suffered any indisposition.
The observed nature of illness suffered by partakers of the banquet. — A study
■of the notes on the table in the appendix (pages 22-28) will shoAA^ that persons
who suffered from illness following the banquet may be divided into four
groups : —
(a) Those who suffered from gastric pain, Ammiting, and diarrhoea a few
hours after the banquet.
(h) Those who suffered from an attack of gastro- enteritis three or four
. days after the banquet.
(c) Those who suffered from enteric fever.
{d) Those who suffered from \mmiting and diarrhoea shortly after the
banquet, and also, later, from enteric fever.
How far was illness.^ enteric fever or other., occurring in Winchester at this
particular time referable directly or indirectly to the banquet I — Although it may
seem somewhat superfluous to discuss this question it is desirable that the
connection of the banquet with the illness shall be reasonably established before
proceeding further.
Now the banquet, or rather the presence of the guests at the Guildhall on
November 10th, was, as far as could be ascertained, the only factor common to
the lives of all those who were subsequently attacked. It was, however,
necessary before the connection of illness with the banquet could be logically
arriA^ed at to enquire whether there had been after the banquet any general
preA^alence of enteric fever and gastro-enteritis among persons who had not been
present at the dinner. But as far as could be ascertained all the cases of enteric
fever and gastro-enteritis which occurred in Winchester immediately subsequent
to the banquet were among persons who weie present at the banquet ; indeed
it will be seen by the next section that there were but A^ery few cases of
enteric fever in Winchester during the last six months of 1902.
The prevalence of enteric fever hi Winchester. — It is of particular importance
to ascertain how many persons there were suffering from enteric fcA^'er in
W^inchester at or about th'e time of the banquet, but Avho were not present at
such banquet.
Dr. Langdon has been good enough to furnish me Avith a list of the cases
notified in Winchester during the last six months of 1902. From this list it
appears that, excluding the ten cases among persons who attended the banquet,
there were only seven cases notified as enteric fever in Winchester since the end
of June, and that of these seven cases four were in all probability imported,
while one person was subsequently found not to have had enteric fever.
Of these seven persons, therefore, probably only two contracted their disease in
Winchester.
The cases of enteric fever notified in AVinchester during the last few ^^ears
have been as follows : —
1898
• • f
3 cases.
1899
• • •
3 „
1900
• • •
2 „
1901
• • •
1902
• . .
19 ,, (10 in connection with banquet)
The sanitary condition of the houses invaded by enteric fever. — As a matter
of routine the sanitary condition of the houses in which the enteric fever cases
occurred was examined by Mr. John Lord, the Winchester Inspector of
Nuisances. He reported that in seven of these houses the condition was “ satis-
factory.” In three there were sanitary defects, and tliere were also sanitary
defects in the business premises of one of the patients whose private house was
in a “satisfactory ” condition.
The milh supply in relation to the enteric fever cases. — The ten invaded
households were supplied with milk from six different sources so that there was
obviously no sufficient ground for attaching suspicion to the milk supply.
The sanitary condition of the Guildhall. — It might be contended that the
outbreak was due to defective drainage arrangements in the Guildhall itself.
I therefore examined the plans of the drainage, and, in company with
the Medical Officer of Health and Inspector of Nuisances, went over the
building. The drainage is not modern, and there were certain defects to which
I called attention and which will, I believe, be remedied. But these defects
would not be at all likely to have caused the remarkable and unique explosion
of illness with which I am now dealing.
Moreover, had the sanitary condition of the building been responsible for
the illness which is in question, there would be difficulty in explaining why
such defects exercised their influence almost without exception upon the
consumers of one article of diet, or why the ladies in the gallery, and the waiters,
were practically exempt from attack, and why, further, such an explosion should
not have taken place in connection with other aggregations of persons in the
same hall.
The oysters consumed at the banquet. — The caterer to the banquet informed
me that the oysters consumed were procured through a local fishmonger, and
that they were neither handled by him nor were they sent in transit to
his place of business. Intermediate handling of them by the caterer might, had
it occurred, possibly have been a point of considerable importance, as will be
seen later.
The fishmonger from whom the oysters were procured by the caterer stated
that he in turn obtained them from an oyster merchant at Emsworth on
November lOth, the day of the banquet. These oysters were delivered to the
fishmonger’s shop in Winchester, “given a drink” of salt and water, opened
at the shop,. brought down to the banquet on their flat shells on a tray, and
forthwith spread out by the waiters on the plates,, three oysters being placed
before each guest.
The oysters were what are known in the trade as “ Best French,” /.e., they
were oysters imported into this country from France, to be laid down or stored
in our waters. In this instance the oysters had, I ascertained subsequently,
come originally from a source other than Emsworth, and they had been stored
in the ponds at Emsworth for only a few days.
Although it appears from the returns sent in that one or two of the guests
did not altogether approve the oysters placed before them, a scrutiny of the
table in the appendix (pages 22-28) will serve to show that the oysters were
more generally patronised than any other article on the menu.
But certain of the guests only ate two oysters, and one of those who
subsequently developed a fatal attack of enteric fever only took one oyster.
Another enteric fever patient remarked at the time of the dinner that he did not
like the oysters, and yet another that “ one of the oysters was bad.”
6
A case of enteric fever in the caterer's family. — In order that all the
evidence bearing upon the case may be fairly set forth, it is necessary to refer
to the fact that a son of the caterer was attacked with illness about a week after
returning from Cowes on August 12th, and that he was found in the first week
in September to be suffering from enteric fever, which it is believed that he
contracted from eating oysters at Cowes.
The patient was isolated on the top floor of the caterer’s private residence,
a large modern house in the suburbs of Winchester. He was nursed by two
trained nurses, and after the termination of the illness his room, bedding, &c.,
were disinfected. Such disinfection was carried out on November 1st, and the
evidence points to the fact that his case had no causal relation to the
outbreak here under consideration. I make mention of it, however, to show
that the question of the possible infection of the oysters after they left the
ponds has not been lost sight of. As I have already pointed out, the oysters
were not handled by the caterer or by any of his family, nor did they even go
to the Guildhall via the caterer’s place of business.
Summary as regards Winchester. — The foregoing facts combine to form a
very strong presumption that the illness here in question was caused by the
banquet, and that the only item taken at the banquet capable of affording an
adequate explanation of the attacks of illness which followed was the oysters.
The fact that two* of the guests who did not take oysters were attacked
with illness after the Imnquet by no means suffices to negative the evidence
tending to incriminate the oysters. As regards any feast of the magnitude of
the Winchester banquet it might reasonably be expected that some of the guests
would suffer indisposition afterwards ; . indeed, it may be regarded as probable
that a few of those who were ill, but who also took oysters, may in point of fact
owe their illness to something other than the oysters.
f
THE MAYORAL BANQUET AT SOUTHAMTON.
/V.
The mayoral banquet at Southampton took place at the South Western
Hotel, Southampton, on Nov. 10th, 1902, and there were in all 132 guests.
Out of this number ten subsequently developed enteric fever, as also did one of
the attendants at the hotel who had partaken of certain articles on the menu.
In addition to these eleven cases of enteric fever there were a number of cases
of gastro-enteritis.
At the date of my visit to Southampton^ the enteric fever in question had
already been ascribed to the oysters : the evidence indeed accumulated by
Dr. Lauder, the medical officer of health, had appeared to him so strong that he
had reported the matter to the Local Government Board, and was about to
issue a notice warning persons against the danger of consuming oysters from
the locality where they had been derived.
I deemed it, however, expedient that the problem at Southampton should be
attacked on the same lines as that at Winchester, and Dr. Lauder was good
enough at once to fall in with my suggestion that a circular in the same sense
as that used at ATinchester should be forthwith despatched to each of the
guests. Although a large number of the returns were sent back to the medical
officer of health with promptitude, tabulated in his office, and forwarded , to me,
complete information was only in our hands at the end of January.
These Southampton returns, which have been arranged in tabular form in
Appendix No. 2, suggest that the mischief which followed the Southampton
* Mr C was quite well after the dinner on November 10th, but on November 12th
and 13th he suffered from abdominal pain. He had no nausea. For a fortnight prior to
the banquet he had suffered from constipation, and shortly before the dinner he. had
taken an aperient. Mr. C would not have attributed his illness to^ the banquet had
there not been a rumour that several cases of illness had been caused by it.
Mr F was ) Those whose illness did not take place until three to five days after-
wards.
(c) Those who suffered from enteric fever.
{d) Those who suffered from illness a few hours after the banquet, and
who, in addition, developed enteric fever later on.
Alike, therefore, at Winchester and Southampton there appear to have been
poisons of an analogous nature at work ; and the results obtained may have
been brought about by —
(a) A toxin already formed in food, and capable of producing toxic
symptoms within a few hours, or, conceivably some rapidly
acting bacteria capable of producing the same manifestations.
(h) An infectioii of the food by bacteria requiring some three or four
days to produce in the human body sufficient bye-products to
bring about toxic symptoms.
(c) Presence in food of the specific bacteria of enteric fever requiring
one, two, or three weeks, or thereabouts, to give rise to symptoms
of enteric fever.
(6?) A mixed infection of the food by a ready-made toxin, or possibly
some rapidly acting bacteria, and by enteric fever bacteria, the
toxin or bacteria manifesting their effects on the consumer in
the one case in a few hours, in the other after a considerable
period of incubation had elapsed.
How jar teas the illness at Southampton referable to the banquet. — It is
possible on the facts recorded to eliminate from consideration the vast majority
of the articles consumed at the Southampton banquet, and reasonable suspicion
can alone attach to the oysters and the turtle soup. Before, however, discussing
these articles of diet, it may be mentioned that, locally, some suspicion was in
the first instance attached to the beans, which, it was alleged, were tinned.
But a reference to the table will show that at least 28 persons of the 55 who
were ill did not partake of beans. Moreover, the enquiries which were made
satisfied both Dr. Lauder and myself that the beans were not tinned, but that
they were, on the contrary, fresh hot-house beans, for which a high price had
been paid.
Passing now to the oysters and the turtle soup.
llie oysters. — It will be seen by this table that with one exception all those
who werd attacked with illness of one or another description took oysters, and
that the one guest wlio was ill, but who took no oysters, suffered from slight
abdominal pain.” It may, I suggest, be fairly said that all attacked with illness
took oysters, and this article of food was the only one common to all those so
attacked.
. The turtle soup. — Of the 55 persons who were taken ill at least six did not
partake of turtle souj), a fact which in itself goes far to negative belief that the
illness was in any degree due to this article. In the appendix will be found a
list of the articles out of which the “ stock,” which formed the basis of the turtle
soup, Avas made. The process of preparing the “ stock ” renders it necessary
that the compound shall be actually boiled on more than one occasion, and
this fact renders it improbable that the soup was the cause at any rate of the
enteric fever or other bacterial infection. As to illness of other sorts the tinned
turtle used in this instance was of West Indian origin and prepared by a French
firm, and the specimens of this which I was shown were quite “fresh ” and
the tins not “ blown.” The rhef io whom I spoke upon the subject seemed
fully alive to the danger of using a “ blown ” tin, i.e., a tin the ends of which are
distended by gas. There is e^mry probability that the turtle used had been
properly sterilised. Moreover, there was no complaint as to the quality of the
soup. Nevertheless, it is theoretically possible that one of the ingredients of the
soup may have contained ready-formed toxins which the boiling was insufficient
to destroy ; indeed, but little is known as to the effect of heat upon toxins.
But, even if this were so, a theory of this nature, improbable as it is, would not
account for the bacterial infection which, in my view, was responsible both for
the later developing gastro-enteritis and for the enteric fever.
The oysters supijlied to the Southampton hamjuet. — The oysters consumed at
this banquet were obtained by the caterer from a firm of local fishmongers who,
in turn, procured them from the same firm at Emsworth as that which supplied
the A¥inchester banquet.
On November 10th, 1,000 oysters were sent from Emsworth to the fish-
monger who supplied the Southampton banquet. These oysters, like those
consumed at Winchester, were of French origin, and they had, so I was informed,
been relaid on certain English gi'ounds. They had been sent from those
grounds to Emsworth, and stored in the ponds there until wanted. The oysters
in question are knowm in the trade as “ French, 1st quality,” and they were
described on the menu as Huitres de Whitstable.”
These oysters arrived at Southampton from Emsworth at about three o’clock
on the afternoon of Monday, November 10th, and they were sent in the same
package as that in which they arrived to the South Western Hotel, where
they were opened, the “ lift man ” who was subsequently attacked with enteric
fever assisting in the process. The oysters were opened in the basement of the
hotel, and they were sent up in the lift to the small kitchen which adjoins the
hall in which the banquet was held.
About 600 oysters were opened, and the remainder were returned to the
fishmonger who supplied them. It will thus be seen that the oysters which
were supplied to the Southampton guests were derived from practically the
same source as were those which were furnished to the guests at Winchester.
The enteric fever cases. — Of the eleven persons, including the “ lift-man,”
who attended the banquet and who were subsequently attacked with enteric fever,
eight were inhabitants of Southampton, and their illness was in due course
notified to the medical officer of health.
One of the three remaining cases lived at Cirencester, in Gloucestershire,
another at Woolston, and another at Swathling. In fact there was an approach
here to the phenomena observed in the well-known outbreak of enteric fever
which occurred at the Wesleyan College, Connecticut, of which a full account
is given in the supplement in continuation of the Report of the Medical Officer
of the Local Government Board.*
Other enteric fever cases which occurred in Southampton about the same
date among persons uTo icere not present at the banquet. — Besides the eleven
cases which attended the banquet, there were other cases which were notified to
the medical officer of health between December 8th and 15th, and the following
is a summary given me by Dr. Lauder of such cases : —
Date of
Notification.
Initials.
Age.
When taken
ill.
1
December
8
W. L. ...
20
December 1
Ate Emswoi’th oysters Novem-
ber 28th at a shop.
12
F. A. F. ...
23
„ 2
Fishmonger.
91
16
S. W. ...
44
7
Ate Emsworth oysters in a shop
November 17th.
99
9
M. B.
,8
November 28
Ate Emsworth oysters from time
to time.
91
9
A. W. ...
4
„ 29
99
9
G. C.
9 -
Admitted from outside borough.
99
9
K. G.
22
December 4
Nursing patients with enteric
fever for considerable time
before and up to her attack.
99
11
E. M. ...
19
November 27
Ate Emsworth oysters Novem-
ber 12th.
*“On Oyster Culture in Relation to Disease.” Supplement in continuation of the
Report of the Medical Officer for 1894-5. Twenty-fourth Annual Report of the Local
Government Board.
13593
B
10
Writing to me on December 2 4th, Dr. Lauder mentions that another case of
enteric fever had occurred in Southampton in a person who had eaten
Emsworth oysters.
Negative evidence as regards oysters f urnished hy the Southampton banquet. —
It will have been noticed that some 400 oysters were returned from the South
Western Hotel to the fishmongers who supplied them. An endeavour was
made by Dr. Lauder to ascertain what became of these oysters, but as it was
only after December 18th, i.e., live Aveeks subsequent to the banquet, that the
fact of the return of so many oysters became appreciated, there w^as difficulty in
following up the matter. Dr. Lauder was informed of six places to which
these oysters were said to have been sent, and enquiries were made wherever
possible. Ho information was, however, procurable, save in respect of a certain
banquet which took place at Southampton, on the loth of November, and
which was said to have been supplied with some of the oysters which were
left over from the mayoral banquet. Enquiries were made of the guests present,
and of the 32 who replied 18 had partaken of oysters. Of these —
One replied : —
In bed 15tli December. Pain in small of back, T. 102°, and shivering, but was
out next day. Illness not attributed to banquet.
Another replied ; —
Pain across shoulders, chest, and stomach ; lassitude. Illness not attributed to
banquet.
A third, who did not state whether he took oysters, replied : —
On 19th and 20th November had severe headache with feverish symptoms. Not
definitely ascribed to banquet.
No great importance is to be attached to this negative evidence, even
assuming that the oysters in question to have been part of the batch of 1 ,000
supplied to the mayor’s banquet (and it will be seen later how great was the
difficulty in obtaining reliable information). They had been kept for three
additional days, and possibly during that time the enteric fever bacillus,
assuming it to have been present in some of them, may have perished. As
regards other forms of illness such as gastro-enteritis, it is to be observed that
there are no means available for determining its prevalence ; in only a few
cases would medical assistance be sought, and it is improbable that such
attacks would be brought to the notice of the medical officer of health.
The efforts therefore, which were made after December 18th to determine
wdiether or not harm had resulted from the consumption of the 400 oysters
remaining over from the mayoral banquet on November 10th w^ere unsuccessful.
The sanitary condition of the South Western Hotel. — Shortly after the
banquet Dr. Lauder turned his attention to this matter, and as a result of his
investigations he reported to the sanitary committee that there was nothing in
the sanitary condition of^ the hotel which would be likely to account for the
outbreak. I subsequently inspected the drainage myself, and I am quite in
accord with Dr. Lauder on this point.
The sanitary condition of the invaded houses. — The sanitary condition of
these premises has been carefully gone into by Dr. Lauder, and he has kindly
furnished me with the following facts : —
Initials.
Premises.
Remarks.
G. H
Carlton Crescent
Drains tested ;
no defects found.
T. J
Bargate Street ...
Do.
do.
W. H. R
Westwood Road
Do.
do.
J. F
Polygon
Drains tested ;
found.
no internal defects
G. F
Belmont Road
Drains tested ;
no defects found.
J. H
“ Holly holm ”
Do.
do.
J. M
Belmont Road
Do.
do.
11
The milk supjjly of the invaded houses. — The source from which the milk
wiis supplied was in eadi case investig'ated, and the results showed that there
was no common source of supply ; indeed nearly every house vras supplied from
a different source.
The behaviour of enteric fever in Southampton apart from the particular
series of cases. — As a general rule enteric fever in Southampton is confiiied to
the poorer portions of the town, but in the series of cases here under considera-
tion the incidence has been on portions of the borough in whiclTj^ases of enteric
fever are of rare occurrence.
As affording some indication of the prevalence of enteric fever in
Southampton, I submit herewith the notification figures for that disease for each
of the five last years, as also the figures for the month of December in the same
years.
Enteric Fever.
Year.
Total
Notifications.
Notifications for
December.
1898
154
10
1899
173
3
1900
73
4
1901
106
3
1902
123
18
Summary of the Southampton outbreak. — After the banquet on November 10th
there occurred 11 cases of enteric fever and 44 cases of gastro -enteritis. The
only circumstances common to the lives of those thus attacked was the mayoral
banquet f on November 10th, a date which would be consistent with enteric
fever infection having been contracted at such banquet. On this occasion the
only article of diet common to the sufferers — apart from a single and doubtful
case which may be disregarded in this connection — was oysters which had
been procured from the same sources and at the same date as those that were
consumed at the Winchester banquet.
PORTSMOUTH.
Cases of enteric fever in Portsmouth ascribed by the medical ofirer of
health to the consiirnpjtion of oysters from Emsworth. — In consequence of a
telegram which had been received by the Local Government Board from the
Town Council of Portsmouth relative to an outbreak of oyster-borne enteric
fever in that town, 1 visited Portsmouth on December 18th, and conferred
with Alderman Emanuel, the Chairman of the Sanitary Committee, and with
Dr. Mearns Fraser, the Medical Officer of Health. I then learned that there had
been 22* cases of enteric fever notified in the liorough between November 5th
and December 16th, and that all these cases had been attributed by Dr. Fraser
to the consumption of oysters procured from Emsworth.
The cases, generally speaking, belonged to a class of persons in comfortable
circumstances, although some of the patients were described as “ poor.”
Dr. Fi •aser informed me that he had excluded other likely causes of enteric
fever, and that oysters appeared to him to be the most |>robable source of
infection. There had, it appears, been no cases of illness following the mayoral
banquet on November 10th, although oysters had formed part of the menu.
*
B 2
13593
Three other cases occurred subsequently, making 25 in all.
V2
As it was a matter of interest to determine the source of the oysters in
this instance, the oyster merchant who supplied the oysters was sent for to
the town hall. He stated that the oysters in question were procured direct
from Whitstable. According to the fishmonger, the oysters came down from
London on November Stir and were taken unopened to the banquet. There
were 120 guests present at this mayoral banquet, and at a more recent banquet
to Lord Roberts there were 280 guests present. He supplied the oysters on
eacli occasion, and in each instance the oysters were supplied direct from
Whitstable.
I have, however, reason to believe that, although the oysters referred to
above were procured from Whitstable, they were in each instance stored for
a short period in the Emswortli ponds. I have had considerable difficulty in
ascertaining the facts in this case, but I eventually saw the entries in the
books of the Emsworth oyster merchant who supplied the oysters, and he
informed me that, as a matter of fact, the oysters in each instance had been
deposited in the Emsworth ponds. This illustrates the manner in which a grave
injustice may be done to certain oyster layings and beds, and it accentuates the
importance of the greatest care being exercised in working out outbreaks of this
nature.
My other public duties have not allowed me to enquire personally into the
outbreak of oyster-borne enteric fever in Portsmouth, bu,t Dr. Fraser has
furnished me with the interesting report which he made uj)on the subject to the
Sanitary Committee of the Portsmouth Corporation, which report is repro-
duced in Appendix No. 3. Briefly it is to the following effect : —
Between December fth and 14th the medical officer of health had his
attention arrested by the unusual number of notifications of enteric fever, and
by the fact that the cases in question inhabited a portion of the borough as a
rule but slightly invaded by the disease. Upon detailed empiiry the medical
officer of health found that the only factor common to all the cases was the
consum|)tion of oysters, and it further transpired that these oysters w^ere taken
at a date which was consistent with their having been the cause of the illness.
These oysters were procured from Emsworth, a place at which. Dr. Fraser had
reason to know, the o}^sters were liable to be polluted by sewage.
None of the usual vehicles of infection, such as water, milk or other articles
of food, were competent to explain the outbreak, nor Avere there such general
drainage defects in conneation with the invaded houses that the prevalence of
the disease could be reasonably attributed to this cause. Moreover, personal
infection was apparently almost imperative in the series under consideration.
Finally, Dr. Fraser was able to ascertain that 18 out of the 25 cases which
were notified betAveen December 4th and '21st had consumed oysters between
November 10th and 2bth, i.e., at a date Avhen, as Avill be seen shortly, the oysters
had opportunity of becoming specifically })olluted in the Emsworth ponds.
PLACES OTHER THAN WINCHESTER, SOUTHAMPTON, AND
PORTSMOUTH, AT WHICH OCCURRED CASES OF ENTERIC
FEVER IN NOVEMBER AND DECEMBER, AND SOME OF
WHIICH WERE ATTRIBUTED TO THE CONSUMPTION OF
OYSTERS FROM EMSWORTH.
Seeing that EmsAvorth is an important centre for the distribution of oysters
to many parts of England, it seemed not improbable that an inquiry at some
of the places to which oysters had been sent on or abput the date at Avhich the
oysters \\'ere furnished to the Wincliester and Southampton banquets might
Yfford some interesting information. i, therefore, abstracted from tlie books
of the oyster mercliants who supplied the oysters to the banquets in question
the names of certain of ihe places to Avhich oysters had been sent on or about
' NoA^ember 10 th, and I caused to be sent to the medical officer of health of
each place a letter inquiring into ])re\valence of fever and other gastro-enteric
illness subsequent to that date.
13
I furnish in Appendix No. 3 my letter and a1:>stracts of the answers, in a
positive sense, arranging these replies in the order in which they reached me,
and I would here express my thanks to Dr. Arthur Mitchell, Dr. Caldwell
Smith, Dr. W. G. Willoughby, Dr. Arthur Newsholme, and Dr. A. Grilfiths,
for their kind co-operation. I have omitted from these replies any matter ol a
confidential nature.
The majority of the replies 'which I received Avere of a negative character.
No cases of enteric fever had in the localities in rpiestion been either traced to
or been surmised to have been caused by oysters at or about the date referred
to in my circular letter. The fact as it stands calls for some comment. It
is in accordance witli the experience of epidemiology that usually only a
relatively small percentage of those who are exj)Osed to any given infection
contract the disease in question. In this connection it has to be noted, that,
as will presently appear, the EmsAVorth oysters, although they haA^e for very
many years been exposed to the liability of pollution, are only actually
thus polluted at uncertain, probably widely separated, intervals. It is not
unlikely indeed that the majority of the oysters taken on any given date
from the Emsworth grounds Avould prove incapable of conveying dehuite
infection.
I have had no personal opportunity of investigating' the cases referred to in
the correspondence in Appendix No. 3, and I therefore refrain from any
comments thereon. I may, however, add that it is not improbable, had my
circular letter asked for information as to oyster-borne enteric fever generally,
and hafl no specific dates been mentioned, the positiAm replies might have been
more numerous. But my instructions did not cover so Avide a field.
The negative replies AATich I receiA^ed were from the following places,
and I take this opportunity of thanking the Medical Officers of Health
of these localities for their kind assistance: — Tunbridge Wells, Newcastle-on-
Tyne, Addlestone, Salisbury, Newport (Mon.), Torquay (reply received from
Dr. M^inter, Chairman of Sanitary Committee), Southend, City of London,
Bournemouth, Worthing, Ringwood, Bognor, Fareham, Devonport, Chichester,
Lewes, Cheltenham, M^orcester, Gosport, and the Croydon Rural District.
VENTNOR.
Dr. Robertson, of Ventnor, has been good enough to furnish me vAuth the
particulars of a case of enteric fever under his care, in regard of wdiicli the evidence
points strongly to Emsworth oysters as having been the source of the infection.
The case is of particular interest, owing to the fact that the patient had been
under Dr. Robertson’s care for chronic bronchitis and emphysema since
October 9th ; that all she ate and drank had been duly recorded since October 9th ;
and that she had only been outside the house in Avhich she Avas lodging on. one
or two occasions, and then only in an iiiAmlid chair.
On October loth, 16th, 21st, 24th and 27th, and on NoAmraber 4th, Gth,
10th, 11th, and 14th, this patient partook of oysters which had been procured
from Emsworth by the occupier of the house in Avhich she was lodging, no
oy sters having been consumed either before or after these dates.
This patient of Dr. Robertson fell ill with what proved to be a mild but
typical attack of enteric fever on December 3rd. On page 47 Avill be found the
temperature chart of this case.
1 am informed by Dr. Woodford, the medical officer of health of Ventnor,
that there was no doubt whatever as to the oysters having come frA)m
Emsworth, and I was able to ascertain myself at EmsAvorth that this AA^as the
fact. The oysters were not procured from the same merchant who supplied
the Winchester and Southampton banquets, but from the merchant who
supplied the Portsmouth banquet. In the first instance this merchant asserted
14
emphatically that the oysters supplied to Yentnor, and which were probably
the source of one case of enteric fever, came direct from Whitstable, and had
not been stored in the Emsworth ponds ; but on being pressed upon this
point he admitted that the oysters had been so stored.
THE EMSWORTH OYSTER PONDS.
Reference to the accompanying map will serve to show the position of the
Emsworth oyster ponds, and the relation thereof to the Emsworth sewers.
The Emsworth ponds are mainly the property of two oyster merchants,
but certain of the ponds belong to the local fishermen, and are used by them
solely for storing oysters.
The oysters stored in these ponds are of different kinds ; they include
French, American, Portuguese, and Deep Sea oysters. These are brought
from abroad, or from the sea, and stored in these ponds until they are required
for market. In a word, Emsworth is an important distributing centre for
oysters of nearly all varieties.
The ponds have been known to me since 1895. I pointed out at that
date the dangerous position which they occupied in relation to the Emsworth
sewer outfalls. The report which 1 then made was instrumental in bringing
about a small improvement in the condition of affairs. Certain drains which in
1895 discharged directly among the ponds were intercepted and led to the main
outfall.
On the map now submitted the ponds from which the oysters for the
Winchester and Southampton banquets were said to have been taken are
coloured red, as also are those in which the Whitstable oysters which were
supplied to the Portsmouth banquet and to the banquet to Lord Roberts are
said to have been deposited pending their despatch to Portsmouth. Two ponds
are marked red in each instance, because it is not quite clear which ponds
actually represent those in which the oysters were deposited.
The drainage of Emsworth.— 'i\\e house drainage of Emsworth is disposed
of partly into privy-middens and partly into catchpits, which communicate in
most instances by an overflow with the sewers in the neighbouring streets.
The slop-water — including the sink-water, &c. — passes, generally speaking,
wheilier there arc privy-middens or catchpits, directly into the sewers. These
sewers have been constructed at different dates, and they consist partly of brick
culverts, and partly of stoneware pipes. For the most part they are leaky,
and their fall, in places, is deficient. They are neither properly flushed nor
adequately ventilated.
These sewers now discharge mainly by means of one outfall, which is
situated in the channel of the estuary, near to the oyster ponds {see map),
and which consists of an iron pipe, the end of which is covered with an
iron flap.
In addition to this main outfall there are others, some discharging into the
river Ems under and near to the bridge crossing the river at the end of Queen
Street, and another into the same river at the lower end of King Street
{see map). As I stated as far back as 1895,* “ Af ivould hardly seem necessary.,
in view (f the relations between the sewer outlets and the storage pits depicted
on the accompanying map, to diced upon the gross contaminations to which oysters
here stored must he liable."
The behaviour, pjast and piresent, of enteric fever in the town of Emsworth. —
From a rej.ort drawn up by Dr. Lockhart Stephens, the medical officer of
health of the Warblington tJrban District, it appears that enteric fever has
* ‘‘ On Oyster Culture in Relation to Disease.”
15
been unduly prevalent in the town of Emsworth for many years. But I do
not in this report propose to trace the behaviour of the disease further back
than 1895, at which time Emsworth became administratively part of the
Warblington Urban District, an area previously within the limits of the Havant
Rural Sanitary District,
The number of cases of enteric fever notified annually in Emsworth
(population in 1901, 3,037) since 1895 has been as follows : —
Years.
Cases of Enteric
Fever.
1895
20
1896
5
1897
7
1898
10
1899
10
1900
12
1901
17
1902
21
The cases occurring during 1902 were notified month by month as
follows : —
Month. ■
Cases of Enteric
Fever.
January ...
2
February ...
—
March
1
April
—
May ... ... ...
—
June
2
July
2
August
1
September
—
October
3
November
9
December...
1
In view of the suspicion which has attached to Emsworth oysters, it will
be well to ascertain the position of the houses invaded in the place during
October and November, and to enquire as to the destination of the drainage
from such houses.
Between October 22nd and December 8th, 1902, there were in all nine
Emsworth houses (comprising 13 cases) invaded by enteric fever, and six of
such houses were invaded before November 10th. The position of each of these
nine houses will be found indicated by a red dot on the accompanying map.
16
The slop water of infected dwellings, which would be apt to contain the
washings from bed linen, etc., as also probably some of the urine, passed in
every instance but one into the , sewer, and in each case the catch-pit which
received the excreta overflowed into the sewer. It may, in fact, be said that
every house, save one, communicated in some measure with the sewer, and that
specifically infected material from eight out of the nine houses had opportunit}^
^of entering the outfall sewer which discharges near to the oyster ponds.
llie source of the Emsicorth cases of Enteric Fever. — It was not until
attention had been drawn to the Winchester and Southampton outbreaks
that enquiry was made in Emsworth as to the part which Emsworth oysters
may have had in disease causation in Emsworth itself, and at this comparatively
late date there was the greatest difficulty in ascertaining the facts owing in no
small degree to a disinclination on the part of the people of Emsworth to incri-
minate the Emsworth oyster ponds. In many of the invaded houses there were
it seems, sanitary defects ; but subsequent inquiries tended to show that
Emsworth oysters were not improbably operative in causing fever in Emsworth
to a greater extent than was originally believed. As I had no opportunity of
personally investigating the Emsworth cases I do not propose to give a detailed
account of them, but I have little doubt from the evidence which I have
obtained, but of which I am not able to make public use, that oysters played a
not altogether unimportant pait in the causation of enteric fever in Emsworth
during October and November, 1902.
When Dr. Lockhart Stephens was informed by the Medical Officers of
Health of Southampton, Portsmouth and AVinchester, of the suspicions which
they had formed with regard to the Emsworth oysters, he at once drew the
attention of the Warblington District Council to the matter, and urged that a
notice warning the public against the danger of eating shellfish from Emsworth
should be published. This advice was, however, rejected by the District
Council.
Summary of facts brought out by this Inquiry.
It may be useful at this stage to briefly summarise what are the alleged
facts in connection with this altogether unique explosion of illness.
1. Two Mayoral banquets occur on the same day in separate towns several
miles apart.
0
2. In connection with each banquet there occurs illness of anakigous nature,
attacking, approximately speaking, the same percentage of guests and at
corresponding intervals.
3. At both banquets not every guest partook of oysters, but all those
guests who suffered enteric fever, and approximately all those who suffered
other illness did partake of oysters. The exceptions to this rule appear
insiirnificant when all the facts are marshalled.
o
4. Oysters derived directly from the same source constituted the only
article of food "which was common to the guests attacked.
5. Oysters from this source were at the same time and in other places
proving themselves competent causes of enteric fever.
Conclusion. \
The foreffoingf narrative of facts would seem to establish the strongest
possible presumption that oysters which had been deposited for a time at
Emsworth have caused the outbreaks of enteric fever and other illness
which followed the Mayoral banquets on November 10th at AVinchester and
Southampton.
A
17
It would seem, too, that the series of cases at Portsmouth referred to by
Dr. Fraser in his report also contracted their enteric fever through oysters
procured from Ems worth ; and, from further evidence supplied in this report it
would appear that Emsworth oysters may also have been operative in the pro-
duction of fever in places other than Winchester, Southampton and Portsmouth.
It will, necessarily, be asked : why, if the Emsworth oysters were respon-
sible for the illness following the Winchester and Southampton banquets, no
conspicuous illness followed the two banquets at Portsmouth, seeing that the
oysters supplied to those other banquets had also been deposited in the
Emsworth ponds. It may further be asked why, in view of the long time
which the Emsworth oyster ponds have been exposed to sewage pollution, no
such occurrences as those here under consideration have been previously brought
to light.
The answer is, I think, this. It is only occasionally that enteric fever has
been prevalent in Emsworth. On such occasions the specific bacilli in the
excreta may not always have escaped the disinfecting process to which the
stools are usually subjected, or, if they did thus escape, they failed to maiiuain
their potency for harm in face of the antagonistic influence of other bacteria in
the sewer. Or, again, if they survived they may have rapidly perished on
reaching the outfall. Laboratory experiments tend to show that the Eberth-
Oaftlky bacillus has no great expectation of life in sewage, and. furthermore, that
it does not, again under laboratory conditions, survive indefinitely in sea water.
Nevertheless, laboratory experiments do tend to show that the bacilli in question
may survive long enough to reach the Emsworth outfall, as well as, under the
topographical circumstances of the Emsworth ponds, long enough to reach these
ponds. Laboratory experiments also show that the enteric fever bacillus having
once reached the oysters may survive therein sufficiently long to enable the
bacillus to pass to the consumer with the oysters.
It is obviously an assumption without sufficient warrant to infer that what
takes place in a tank of sea water procured from a certain source will of
necessity also take place in an estuar}' consisting partly of fresh and partly
of salt water, which estuary may contain other lower forms of life, animal and
vegetable, capable of influencing favourably or adversely the vitality of the
enteric fever bacillus. Few competent bacteriologists would, I think, make any
such claim, and there is obviously need for further investigation into the fauna
and flora of sea and brackish water before we can forecast what, under any
given circumstances, will be the behaviour therein of the enteric fever bacillus.
However this may be, looking at the outbreaks here, under consideration from
the epidemiological standpoint, it seems to me to be a matter of practical
certainty that some of the enteric fever dejecta which found its way into the
Emsworth sewer from one or other of the cases of enteric fever which occurred
antecedent to November 1 0th, did as a matter of fact carry living enteric fever
bacteria into the Emsworth channel, which bacteria, on the rising tides, found
their way into the ponds from which the oysters supplied to the banquets were
taken. What were the circumstances which enabled this infectious material to
resist adverse influences until it was carried into the pond or ponds from which
the oysters for the Winchester and Southampton banquets were taken, aud
what the conditions which seemingly safeguarded these ponds during the shorr
time during which the oysters for the Portsmouth bampuet were deposited in
them, I am unable to say.
Bacterioloiiical examination of the ivater and oysters from the Emsworth
'ponds. — When I visited Emsworth in connection with the enquir}' now in
question I was pressed by the oyster merchants (and I see by Dr. Fraser’s
report that similar pressure was brought to bear upon him) to take samples of
the water and oysters in the ponds and to submit them to the bacteriologist for
examination. My rej)ly was that 1 had been familiar with these ponds since
1895 ; that I had at that date expressed my opinion as to the dangers to which
oysters deposited therein were liable ; and that no negative testimony, either
chemical ot* bacteriological, would undo the fact that the oysters were laid
down within a few yards of the main sewer. Moreover, a positive result
13593 0
18
in either case Avould be superfluous. This attitude I adopted because I
considered that if this outbreak of enteric fever had been caused by the
Emsworth oysters, the science of epidemiology should be competent to demon-
strate the fact. How far I have — with the hearty co-operation and assistance
of Dr. Fraser, Dr. Langdon, Dr. Lauder, Dr. Lockhart Stephens, and others —
been able to afEord such demonstration may be judged of from this report.
Moreover, I had recently seen a bacteriological analysis of alleged Emsworth
oysters in which it was stated that such oysters were free from sewage con-
tamination, and the experience which I gained in my enquiry in 1895 had gone
far to show me that, at any rate at that date, negative results might be yielded
by particular samples taken from situations obviously liable to contamination
by sewage.
It is, moreover, not unusual for a sample of water to be taken at the mouth
of an estuary, on the top of the flood, and, if this sample is regarded as satis-
factory by the bacteriologist, the certificate relating thereto is utilised to cover
all parts of the fishery. Clearly, regard should be had to the state of tide, as
also to other parts of the fishery from v^hich no samples have been taken. In
a word, negative bacteriological evidence may be highly misleading, and, as
regards positive evidence, it is desirable that there should be some agreement
among bacteriologists as to the precise significance, both as regards presence
and number, of B. coli communis and B. enteritidis sporogenes before a bacterial
standard can be applied either with safety to the consumer or justice to the oyster
industry.
It may, however, be added that, as a matter of fact, specimens of water
and oysters from -the Emsworth ponds were examined by Dr. Klein, which,
in December, 1902, were found to contain bacteria of sewage origin in
abundance, albeit the enteric fever bacillus was not discovered by him in these
oysters.
In concluding this report I wish to place on record my indebtedness to a
number of persons who have afforded me assistance in connection with this
enquiry.
In connection with Winchester, my thanks are due to the Mayor (J. A.
Fort, Esq.), the Town Clerk, and Dr. Langdon (the Medical f'fficer of Health),
for their cordial co-operation during the enquiry, as also to all those medical
s^entlemen who were yood enouo-h to afford me information as to cases under
their care.
As regards Southampton, I have received very great assistance from
Dr. Lauder, the Medical Officer of Health, who took especial ]>ains to furnish
me v.dth the numerous details necessary for this report, and I have also to thank
the Town Clerk for his co-operation, as well as all those medical practitioners
who gave me information as to their cases.
With respect to Portsmouth and Emsworth I have to acknowledge with
gratitude the assistance of Dr. Mearns Fraser and Dr. Lockhart !Stei)hens, as
also, at the former place, that of Alderman Emanuel, J.P.
I also received assistance from the oyster merchants at Emsworth, and
from others whose names space will not allow me to mention; but who will,
I trust, accept this acknoAvledgment of the help they rendered me.
H. TIMBRELL BULSTRODE.
Note on the Storage of Oysters in Shoes.
I think that it may not be altogether out of place if I here draw attention
to the imjiortance, from the point of view of the public health, of greater care
being exercised in the storage of oysters. Although it is unlikely that oysters
stored in shops should become specifically polluted by the excreta of enteric
fever it is in my view probable — -albeit I am satisfied that no such influence
has been operative in the series of cases under consideration in this report —
that at least some of the acute diarrhoea and vomiting, which is by no means
rarely observed after the ingestion of oysters, may be caused by oysters kept
so long in the shops that when sold they are practically moribund.
I do not propose to mention the towns where instances of oysters exposed
for sale in a moribund state have come beneath my notice, but I may add that
in the course of my experience I have seen multiple examples of this. I can
recall an instance in which having examined certain oyster layings, and being
satisfied that they were free from sewage |X)llution, I entered a shop in a
neighbouring town to procure some oysters for consumption. Before purchasing
the oysters 1 asked to see them, and I found so many in a moribnnd condition
that I deemed it unsafe to partake of any.
I have recently had a very similar experience, and I am far from satisfied
with the manner in which oysters are stored. It is not nncommon to find
several dead or dying oysters among those exposed for sale, and it is not
improbable that the toxic symptoms oljserved after the consumption of
oysters may, in some cases, be due to this cause. The frequency of these
attacks of gastro-enteritis after the consumption of o}"sters and other molluscs
is not, I think, adequately appreciated, a fact which is probably due to the
circumstance that such attacks are rarely fatal. Several attacks of this nature
have been recorded in this country, and, as regards France, Dr. Mosny has
brought together a mass of information in a valnable report which he made
on the subject to the French Government.
The shells of all oysters should be thoroughly cleansed by scrubbing before
the oysters are placed in a common receptacle, and such receptacle should
be constructed of white impervious material, and not used for other purposes.
Weak oysters should be at once removed. It is, however, desirable that oysters
should be procured daily from the “ beds,” “ layings,” or “ ponds,” and that the
shells should be thoroughly cleansed before being despatched therefrom.
The shells of a healthy oyster should be either tightly closed, or, if apart,
they should, when the oyster is held flat between the fingers and thumb, be felt
to be gripped together by means of the powerful adductor muscle with which the
oyster is provided. If the shells gape, and do not at once, and vigorously, close
on handling, the oyster should be rejected.
H. T. B.
C 2
1359S
20
APPENDIX No. 1.
Contents.
(a.) Copy of communication sent to each guest.
(&.) A table showing the articles consumed at the Winchester banquet, and the returns of
the illness from which certain guests suffered.
(c.) A list of the articles used in the preparation of the banquet, and the sources from
which they were procured.
(d.) Notes on the enteric fever cases.
(a.)
Dear Sir,
Guildhall, Winchester,
December 20th, 1902.
The Sanitary Committee of the Corporation, acting on the advice of their Medical
Officer of Health, are anxious to ascertain certain additional facts with regard to the
illness which followed the recent public banquet of November 10th, and they will be
much obliged if you will be good enough to supply them with some special information.
There is furnished herewith a form containing a list of the articles of food consumed
at the banquet.
You are requested —
(1.) To place a ( + ) opposite the articles of which you partook, a query (?) against
those concerning which you are not in a position to make a positive
statement ; no mark against those articles which you did not consume.
(2.) To answer the questions printed on the form.
(3.) To return the form filled up, if possible, by return of post, to
T. C. Langdon, F.R.C.S.,
Medical Officer of Health,
Guildhall, Winchester.
I am, dear Sir,
Yours faithfully,
J. A. FORT, Maj'or.
Did you suffer any illness or serious inconvenience after the banquet ?
If so, do you attribute such illness to the banquet ?
If so, how long after the banquet did such illness commence ?
If so, what was the nature of such illness ?
Please return to
T. C. Langdon, F.R.C.S.,
Medical Officer of Health,
Guildhall, Winchester.
21
Oysters
Clear Soup ...
Thick Soup
Smelts
Turbot and Lobster Sauce
Sweetbread and Spinach ...
Kidneys and Mushrooms...
Boiled Mutton
Boast Mutton
Boast Beef ...
Venison
Bed Currant Jelly
^Capons
Ham ...
Tongue
Turkey
Pheasant
Partridge
Sir Watkin Wynn Pudding
Charlotte Busse
Liqueur Jellies
Caramel Cream
Maraschino Cream...
Meringues ...
Ice
Cheese
Salad
Aerated Water, which ? ...
Column for Marks.
Bemarks.
The Winchester Mayorar Banquet.
cc
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No diarrhoea or vomiting after banquet,
but attacked by enteric fever about
November 20th.
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Names of Guests
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W. L
C. R
M. W
H. J. A. K
fr. s. M.
T. F. K
N. C. H. N
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Articles consumed, s= Articles not consnnied, * s; Illness, | = Enteric fever,
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Mrs. B.. Commercial Road, Landport. Oysters on November 11th ; taken ill on December 1st. Notified
on December 8th.
4. — Mr. P. B., Commercial Road, Landport. Oysters on November 12th; taken ill on November 25th. Notified
on December 8th.
5. — Mr. S. B., Commercial Road, Landport. Oysters on November 12th; taken ill on November 28th. Notified
on December 8th.
6. — Miss C. B.. Commercial Road, Landport. Oysters on November 12th ; taken ill December 5th. Notified
on December 8th.
{The above four were members of the same family.')
7. — Mr. W; S., North End Grove, North End. Oysters on November 11th; taken ill on November 21st.
Notified on December 7th.
8. — Mr. C. W.. Union Street, Portsea. Oysters on November 8th ; taken ill on November 29th. Notified on
December 9th.
9. — Mrs. F. G.. Shaftesbury Road, Southsea. Oysters on November 13th ; taken ill on November 22nd.
Notified on December 9th.
10. — Mrs. P. W., Gains Road, Southsea. Oysters on November 22nd and 24th ; taken ill on December 3rd.
Notified on December 10th.
11. — Miss F. A.. Lake Road, Landport. Oysters on November 12th ; taken ill on November 20th. Notified on
December 10th.
12. — Miss E. A.. Lake Road, Landport. Oysters on November 12th ; taken ill on December 5th. Notified on
December 10th.
{The above two are members of the same' family; and as the second ease E. A. was tahen ill fifteen days
after the first, it is possible the second case was caused by personal infection, and therefore only ind'irectly
due to oysters.)
13. — Mrs. K., Shaftesbury Road. Southsea. Oysters several times from November 1st to the 10th ; taken ill on
November 27th. Notified on December 11th.
14. — Mr. J. H., Nelson Road, Southsea. Oysters on November 10th and 18th ; taken ill November 29th.
Notified on December 12th.
15. — Miss. L. B., Commfercial Road, Landport. Oysters on November 21st and 29th ; taken ill December 2nd.
Notified on December 12th.
16. — Mr. W. L., Osborne Road. Southsea. Oysters taken on numerous occasions during November; taken ill
November 27th. Notified on December 14th.
17. — Mr. E. B. A., Nightingale Road, Southsea. Oysters on November 26th, 30th, and December 7th; taken ill
December 9th. Notified on December 4th.
18. — Mrs. E. H., Somers Road, Southsea. Oysters on November 21st ; taken ill December 7th. Notified on
December 16th.
19. — A. H., Somers Road, Southsea. Oysters on November 21st ; taken ill December 12th. Notified on
December 16th.
20. — Mrs. C. T., St. Ronan’s Avenue, Southsea. Oysters on November 14th ; taken ill on Decembf r 2nd. Notified
on December 18th.
21. — K. B., Derby Road, North End. Oysters on November 16th; taken ill on December 8th. Notified on
December 20th.
22. — Miss H. W., Osborne Road, Southsea. Oysters November 14th ; taken ill December 6th. Notified on
December 18th.
23. — Mr. S. W., Osborne Road, Southsea. Oysters three times a week during November; taken ill on
November 30th. Notified on December 16th.
24. — Mr. 0. P., Hampshire Terrace, Southsea. Oysters on December 6th and 13th ; taken ill on December 20th.
Notified on December 21st.
25. — Mrs. F. A., King Street, Portsea. Oysters nearly every day from November 17th to 27th ; taken ill
December 7th. Notified on December 19th. \
F 2
13593
44
Confidential.
Local Government Board,
Whitehall, S.W.,
December, 1902.
Dear Sir,
I AM investigating, under the instructions of the Local Government Board, an
outbreak of enteric fever in Hampshire Avhich is alleged to have been caused by the
consumption of oysters eaten raw.
I have reason to believe that oysters from the suspected sources were introduced into
your district during the second week in November, and I should be extremely obliged if
you could kindly inform me if any cases of enteric fever or gastro-enteritis have occurred
in your district at a date which would suggest infection at or about November 10th. If so,
might 1 ask whether oysters had been taken at or about the date in question, and, if so,
what is the name of the fishmonger from whom the oysters were procured.
To Dr.
Medical Officer of Health.
I am , dear Sir,
Yours faithfully,
H. TIMBRELL BULSTRODE.
GUILDFORD URBAN SANITARY AUTHORITY.
Medical Officer’s Department.
Guildford,
December 28th, 1902.
Dear Sir,
In reply to your letter of the 27th inst., I am glad to say that the only two
recent cases of enteric in this district were undoubtedly due to direct infection, as these
patients contracted the disease whilst nursing an enteric case at Woking.
In September I had a case, and the only possible cause that I could discover was that
the boy had eaten shell-fish at Portsmouth a fortnight previously.
Dr. Bulstrode.
Believe me, dear Sir, *
Yours faithfully,
ARTHUR M. MITCHELL.
METROPOLITAN BOROUGH OF WANDSWORTH.
Dear Dr. Bulstrode,
Public Health Department,
1, Huguenot Place, East Hill,
Wandsworth, S.W.,
31st December, 1902.
I enclose list of enteric fever cases which have occurred since the 1st December
in this district, attributable to shellfish. The cases infected by cockles were perfectly
clear, and both Dr. Watson, of Leigh-on-Sea, and Dr. Thresh, Medical Officer of Health
for the County of Essex, have been informed. The case occurring at No. — , M Road
Clapham, notified on the 8th December, was, as you will see from the letters enclosed,
almost certainly due to Emsworth oysters, but in the case at No. — , Old Town, I could
not ascertain from what part the oysters had come. Any further cases I shall report to
you immediately on notification. I may say that Dr. Klein has been investigating the
cockles, and I have no doubt he will send you a copy of his report shortly.
Dr. Bulstrode,
Local Government Board.
Yours faithfully,
CALDWELL SMITH,
Medical Officer of Health.
45
Enteric Fever prom Shellfish.
Date of
Notifica-
tion.
Name of Patient.
Age.
Address. j
Date of
First
Symptoms.
Suspected Source of Infection.
1902.
/
Dec. 1 ...
T. D.
20
Chip Street, Clap-
ham.
Nov. 15 ...
Patient had some cooked cookies
on the 1st November. The
cockles were purchased from a
man named G., who bought
them from a man P. at Billings-
gate market. P. came from
Leigh-on-Sea, near Southend,
and brought the cockles from
there.
„ 1...
A. D
16
Chip Street, Clap-
ham.
„ 22...
Patient had some cockles on the
8th November, obtained from
same source as her brother
above.
„ 1...
N. D
18
Chip Street, Clap-
ham.
„ 15 ..
Patient had some cooked cockles
on 1st November. Particulars
as above.
„ 4...
J. 0
31
Baker’s Cottages,
Prescott Place,
Clapham.
„ 19 ...
Patient had some cooked cockles
purchased off the man G. men-
tioned above on 8th November.
„ 6...
E. 0.
32
Hazelbourne Road,
Streatham.
„ 29 ...
Patient had some oysters two
weeks previously, also on 27th
November.
„ 12...
,W. K
50
Old Town, Clapham
About two
weeks ago.
Patient had some raw oysters pur-
chased by a Mr. S., probably
purchased from Mr. R., Billings-
gate Market.
„ 8...
0. Y
28
Macaulay Road,
Clapham.
Nov. 29 ...
Patient had some oysters bought
at a shop near London Bridge
Station. QSee copy of letters.)
„ 22...
H. C.
2
Lyddon Road,
Wandsworth.
Dec. 9 ...
Patient had some boiled mussels
eight weeks previous.
„ 26...
D. U
14
Gartmoor Gardens,
Wandsworth.
„ 20 ...
Patient had some raw oysters on
19th December.
1903.
Jan. 7 ...
A. C
40
Bedford Hill,
Balham.
„ 26 ..
Patient had some raw oysters on
7th or 8th December.
„ 9...
G. R
21
Fircroft, King’s
Road, Clapham
Park.
„ 30...
Patient had some raw oysters on
7th or 8th December, purchased
from a Mr. M., who obtained
them from Mr. D., of Lower
Thames Street.
„ 12...
M. A. C
53
Lebanon Gardens,
Wandsworth.
„ 27...
Patient had some raw oysters
about six weeks previous.
METROPOLITAN BOROUGH OF BERMONDSEY.
Public Health Department.
Dear Sir,
Town Hall, Lower Road, S.E.,
20th December, 1902.
Assuming that the incubation period of your case was 14 days, and the first
symptoms came on on November 29th, the disease might possibly be acquired about the
15th or before. I find that on November 10th, 14th, and December 3rd this man got
consignments of oysters from Emsworth as follows : —
November 10th
14th
December 3rd
1,300.
1,000.
1,000.
It is therefore quite possible that the source of infection may be Emsworth oysters.
Dr. P. Caldwell Smith,
Medioel Officer of Health,
Wandsworth.
Yours faithfully,
R. K. BROWN,
Medical Officer of Health.
1
46
Town Hall, Eastbource,
Sanitary Offices,
December 30th, 1902.
SIR,
In reply to your letter of the 27th December, I beg to inform you that on November
25th a case of enteric fever was notified to me in Eastbourne about which there was some
doubt as to the possibility of oyster infection. The case was a very bad one and quickly
fatal, and as he was a soldier of 23 I have been unable to get definite information about
oysters as his friends did not know what he might have been doing.
On December 22nd a case of enteric fever was notified to me of a man who had been
already ill about a fortnight and ivho had partaken largely of oysters about the date you
mention. He obtained these oysters, as I am inf ormed, from a fishmonger named X.
There have been but three cases (although six notifications) of enteric fever in
Eastbourne this year.
I am. Sir,
Yours faithfully,
W. G. WILLOUGHBY,
H. T. Bulstrode, Esq.,
Local Government Board,
Whitehall, London, S.W.
Medical Officer of Health.
N.B. — I have not been able to trace the oysters referred to above to Emsworth.
H. T. B.
BRIGHTON.
Information furnished by Dr. Arthur Newsholme, Medical Officer
OF Health.
January 19, 1903,
List of cases of Typhoid Fever occurring in Brighton during 1902, m which oysters
from Emsworth had been partaken of within three weeks of the onset of the atta(^.
(1.) Mrs. F., aged 27, wife of a cabinet maker of No. 29, G. Street, failed with typhoid
fever about the lOtli July, and kept her bed from the 19th. On or about June 26th she
ate 10 oysters, the last of which she states was “ bad.” On July 4th, she and her mother
ate four oysters each. The mother has remained well. The oysters were obtained from
No. 82, C. Street. The proprietor of this shop obtains a portion of his oysters from South-
wick and a portion from Emsworth. No other cases of typhoid fever occurred at this
house, and the total number of such cases notified in Brighton during the months of June
and July was only 10. No other cases occurred in connection with the same milk supply.
The house was in a completely sanitary condition.
(2.) Mrs. S., aged 55, of No. 14, B. Place, failed with typhoid fever about October
12th. On October 5th she went to Emsworth, returning to Brighton on the 12th. While
at- Emsworth she had oysters several times. She stayed in Emsworth during the whole
six days she was away from Brighton, On October 12th before returning to Brighton sho
had oysters for lunch. During the rest of the day she felt well, but next morning on
getting out of bed she vomited and had severe diarrhoea. The diarrhoea lasted for several
days. She was then better for a week, but after that was under a doctor’s care for about
a week before her admission to the Borough Sanatorium on November 16th. The sanitary
condition of the house in which she lived in Brighton is good. There was no special
prevalence of typhoid fever in Brighton at that time ; the total number of cases notified
during the month of October being only eight. There were no other cases in connection
with the same milk supply.
(3.) Alice B., aged il8, of No. 12, B. Street, a barmaid failed with typhoid fever on
November 24th. This patient and her sweetheart had oysters about three times weekly
for three weeks during the weeks beginning at the end of October. She usually ate seven
to 14 oysters on each occasion. Her sweetheart has remained well. The oysters were
bought at No. 82, 0. Street, the same shop as above, and are obtained from Southwick and
Emsworth. The proprietor of the inn where this patient was barmaid, failed with typhoid
fever on October 4th, the attack being traceable to oysters derived from Grimsby. The
]>atient was nursed by a trained nurse and every precaution taken, but as Alice B. did not
leave the inn for 10 days after the onset of the proprietor’s attack of typhoid rever it is
conceivable that her attack was caused by personal infection, though more likely that it.
was due to the oysters which she partook of at No. 82, C. Street.
47
(4.) George G„ aged 40, of No. 77, S. Street, a detective at race meetings, failed with
typhoid fever on December 1st. He had been living at the above address or one
before the onset of his illness. Early in the third week of November he bought and ate
six oysters at No. 28, N. Eoad. At No. 77, S. Street, there are living six other persons,
who have remained well. The oysters at No. 28, N. Road, are obtained from Emsworth
and the Whitstable Company.
(S.) John B., age 34, of No. 71, B. Road, a grocer, failed with typhoid fever on
December 19tb. On or about the first week in December he ate a few oysters at the above
shop in N. Road. There are living in the same house with the patient, his wife, two
children, and two servants, all of whom have remained well. The patient does not a e
milk except in puddings. The sanitary condition of the house is good, and no o er
source of infection can be discovered.
The total number of notifications of typhoid fever in each month of 1902 has been as
follows : —
January
February
March
April ...
May ...
June ...
July ...
August
September
October
November
December
7
3
2
3
3
3
7
5
5
8
8
11
Total 65
BOROUGH OF HOVE.
Town Hall,
Hove, Sussex,
t January 30th, 1903.
Dear Dr. Bulstrodb,
The case of enteric fever associated with oysters which I mentioned’ was as
follows : —
C. R. S. ate oysters on October 12th, obtained direct from Emsworth.
The history of the case is as follows : October J3th, violent diarrhoea till 16th when he
took castor oil which stopped diarrhoea. October 20th, began to have headache and felt
shivering, after which illness followed usual course of mild enteric fever
I am.
Yours faithfully,
A. GRIFFITH.
TEMPERATURE CHART OF Dr. ROBERTSON’S CaSE.
LONDON :
PRINTED FOR HIS MAJESTY’S STATIONERY OFFICE,
By darling. & SON, Ltd., 34-40, Bacon Steeet, E.
- 1903.
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if, vade^f' iy JEjif^erCo JFc^'er, the coti/^e^ of
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