The following report is transcribed from the Evening Express dated 24 September 1903, 120 years today…..
COCKLES & MUSSELS
Cause Enteric Fever at Merthyr
REPORT BY THE MEDICAL OFFICER.
At a meeting of the health committee of the Merthyr Urban District Council yesterday, Mr. T. E. Morgan presiding, Dr. D. J. Thomas submitted a preliminary report upon an outbreak of enteric fever in the district. Up to the end of August the number of cases notified had been 40. During the week ended September 5 fourteen cases were notified. Eighteen cases were notified during the week ended September 12, and 56 during the week ended September 19. The number of houses affected was 75. Between September 1 and September 19 no deaths occurred from the disease. Of the total number notified between these dates, 48 were removed to hospital.
The cases were too evenly distributed between the two sexes for the outbreak to bear any relation to occupation. Visits of inspection to the premises affected had disclosed no gross sanitary defects. All the houses concerned were supplied with water from the council’s supply. This water was above suspicion.
There remained two other sources of infection-milk or some other article of food. The houses involved were supplied with milk from 40 different sources, and it might be concluded that the outbreak could not be traced to milk. With one exception, the milk was obtained in the immediate neighbourhood. The premises of all the milk vendors had been visited and inquiries made as to any cases of illness, etc., on the premises or amongst the employees.
The other food supply to which attention would naturally be directed was shell-fish. This kind of food had been proved on many occasions to be the cause of outbreaks of enteric fever. Of the total number notified five were secondary cases. In three instances the disease had been imported into the district. One of these had been at Llanstephan from August 5 to August 22, and was taken ill on September 6. The second hall been at Goodwick from August 8 to August 29, and was taken ill on August 30, It was more than probable that both these cases had contracted the disease away from this district. The third case came from Aberdare on September 5, and was suffering from the disease when he arrived here. There remained 83 cases. It had been found that 64 of these bad partaken of shell-fish about a fortnight previous to the outset of symptoms.
In an industrial district like this, these figures would not in themselves be conclusive, as a large majority of the population were partakers of this form of food. But when the replies were analysed it was found that no less than 54 of the persons attacked had obtained their shell-fish from one source. Taking first of all the history of these 54 persons, it was ascertained that with three exceptions they first exhibited symptoms of the disease between August 28 and September 1. Two were taken ill on September 6, and one on September 4. As the incubation period of enteric fever was usually about fourteen days, the contamination occurred about the middle of August. A sample of the shell-fish was taken for bacteriological examination on September 12, but the result would not materially assist them, as the conditions existing in the middle of September might be very different from those that prevailed in the middle of August.
As the analyses were not considered satisfactory inquiries were made at the viilages where the shell-fish had been gathered. It was found that no case of enteric fever had occurred there recently. It must, therefore, be concluded that the contamination took place after arrival in the district.
Mrs. ———- had one consignment of cockles and mussels a week. The cockles were shelled at the seaside, and in that form they were popularly called “rhython.” They arrived in sacks on a Thursday evening or Friday morning, were washed and cleaned so as to get rid of the brine on a Friday, and taken in baskets to the market on a Saturday.
On September 4 Mr. ———- was suffering from enteric fever. The history he gave of his illness was fairly definite. He had been confined to his bed since August 21, but had been ill suffering from diarrhoea for eight or nine days previous to that date, so that his illness really dated from August 12 or 13. On August 13 a consignment of cockles and mussels arrived at the house. On the following day they underwent the usual process of washing and cleaning, and on August 15 they were sold in the market. The cleaning was mostly done by the wife, but the husband also assisted. To what extent and the nature of assistance rendered by him on August 14 could not be precisely ascertained.
All the persons referred to above bought the cockles on August 15. In some instances it was the only occasion upon which they had eaten shellfish for months. It was difficult to ascertain the true history in many instances, and the figures given above referred only to those persons who distinctly recollected to have bought the cockles on the 15th of August. There remained 29 cases whose infection could not be traced to this source, but it was a general experience for cases to arise during the epidemic where the source of infection remained obscure, and was, probably, independent of the epidemic cause.
Moreover, then there was the possibility that an error in diagnosis might have been made in some of these cases, as four of the persons admitted into the hospital were found not to be suffering from the disease. At any rate, the source of the infection of those remaining cases had not yet been definitely traced.
The Chairman said that the matter had been taken up by the medical officer and himself very seriously, and he thought they had now got the upper hand of the outbreak.—In reply to Mr. G. C. James, Dr. Thomas said there had been only one death, and the disease was of a very mild form. Nothing could be done to stop the sale of cockles unless they were found to be contaminated, but in that case it could be done. The Chairman said the cockles were presumed to be all right when they came to Merthyr.—A copy of the report was ordered to be sent to the Local Government Board.