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OYSTERS AND TYPHOID FEVER

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307 the like. But, as he remarks, one cannot tell where the cost of an epidemic will end, the poor-rates often being saddled for years with the relief of the dependants of sufferers. Chesterfield with its ninety-six cases might have been freed from more than 80 per cent. of them had hospital accommodation been in actual readiness for the first cases. Other districts suffering heavy invasion were Newbold and Dnnston, 176 cases; Chesterfield rural, 178 cases; and Ecclesall Bierlow rural, 222 cases. On the matter of influence of vaccination on the outbreak, Dr. Barwise is able to give data of his own as regards Whittington with its 135 cases and thirteen deaths down to March, 1894. Of 159 vaccinated persons in infected dwellings, aged under ten years, 6 -9 per cent. were attacked and none died ; of twenty-one unvaccinated in the same case and of similar ages, 71’4 were attacked and 23-8 per cent. died. In the two classes in the same order at ages over ten years the attack-rates were 35 and 100 per cent. ; whilst the death-rates were 2’3 and 25 per cent. of the 300 and the four persons exposed to infection. True, the figures on which the resultg are based are small, but the rates are very startling, showing in an unmistakable manner the great need for vaccination, and equally for revaccination, looking to the almost complete immunity from attack of children once vaccinated and the complete immunity of those attacked from fatal illness. In the whole administrative county the deaths from small-pox were 8’9 per cent. of cases, and of 499 attacks concerning which the facts are known as to vaccination the per case mortality was 8’6 per cent., made up of 3 9 in the vaccinated and of 25 in the unvaccinated. Another point of interest is that 40 per cent. of the small-pox deaths were in children under five years of age, a figure which would seem to be taking us back to the early years of the century, when it was 90 per cent. of the total small-pox deaths. We must go back to a quinquennial period prior to the seventies for such a rate in England. The Derbyshire rate on children under five years of age in 1893 was twice that of England five years previously. Dr. Barwise sees in these data the result of the terrible laxity growing up over the county-and we may say country-in the matter of enforcement of the vaccination laws, and the figures certainly afford food for reflection on the part of professional agitators and of our legislators. We also commend them to the notice of the Vaccination Commission. Space does not enable us to dwell further on the point here, or to quote the interesting cases of malignancy of infection and of the protecting influence of vaccination to which Dr. Barwise refers. Such a report as this makes us wish that the printed reports of health officers were commonly available for the reading public, as by purchase or in other ways. OYSTERS AND TYPHOID FEVER. MUCH has appeared and is appearing in the daily press upon the subject of the possible communication of disease as a result of the consumption of oysters in a raw state. The President of the Local Government Board has instituted an inquiry into the circumstances under which the cultiva- tion and storage of the bivalvular mollusc and other shell- fish around the coast are carried out as the result of a ’, report from Dr. Thorne Thorne, the medical officer of the I, Board. The following is the report of a bacteriological ’, investigation of water from an oyster bed and of oysters I from the same source, made by Professor Crookshank, M.B., Director of the Bacteriological Laboratory, King’s College, ’, London :- "This investigation was made at the request of Dr. Fuller ’, of New Shoreham. The first sample of water, despatched by Dr. Fuller on Dec. 17th, consisted of sea water with a thick deposit of mud at the bottom of the vessel. The water and the deposit were separately examined. Experiments were made by special methods for detecting the presence of the bacillus of typhoid fever. The results were negative. Further experiments were made in order to isolate other bacteria present in the water and in the deposit, and to examine their exact nature. The colonies which developed in plate-cultivations were very numerous, and it was necessary to obtain a fresh sample of water and to repeat the experiments in order to obtain complete isolation of the individual colonies and to establish pure-cultivations of each species. The results obtained with the second sample will be referred to directly. There was no septic odour in the plate-cultivations obtained from the first sample- of water. The muddy sediment was examined by similar methods. There were no typhoid fever bacilli present, and the micro-organisms which were isolated and examined, both microscopically and in pure-cultures, were found to. be well-known harmless bacteria. The majority of these. colonies were the result of the multiplication of a harmless liquefying bacterium. On Dec. 20th three oysters were. despatched by Dr. Fuller. The liquid of the oyster was. mixed with liquefied gelatine and several plate-cultivations made. The number of colonies which developed was sur- prisingly small. The colonies were found to represent only five different species of bacteria. All of these were studied in the form of pure-cultivations, and were easily recognised as familiar and harmless species. The marked difference in the number of bacteria in the liquid of the oyster and in the water of the oyster bed suggests an interesting line of inquiry. The second sample of water, despatched on Jan. llth, was so treated that the individual colonies would be completely separated even if the bacteria were found to be present in very considerable numbers. Nine separate- experiments were made, and the average number of; colonies which developed amounted to 50,000 in a cubic centimetre. The colonies consisted very largely of a non-liquefying and a liquefying bacterium. Other species were similarly isolated and studied in their micro- scopical and biological characters, and all were recognised< as well known and harmless bacteria. There was no. septic odour from the cultivations, and, in fact, the com- plete absence of foul-smelling or saprogenic bacteria was very striking; and in none of these experiments was the- typhoid fever bacillus present. The number of bac- teria, however, calls for some comment. The colonies were far in excess of those found in pure sea water, and a similar number, if found in drinking water, would raise a suspicion of sewage contamination unless a very considerable interval had elapsed between the time of taking the sample and its subsequent examination. The question therefore arises whether the excessive number of colonies in this particular sample of sea water indicates sewage contamination or is due to a want of cleanliness in the oyster bed and the presence of organic matter- from other causes than sewage. The absence of septic and foul-smelling micro-organisms points to absence of sewage, unless sea water has a special action upon those micro-organisms which we expect to find wherever there is unquestionably mixture with sewage. The question of the presence or absence of such con-.. tamination can, however, be ascertained by further investigation and by local inquiry. The question which I have been asked is whether oysters from this particular bed are likely to be injurious to the consumer. From the bacteriological investigation of the samples of water and of oysters submitted for examination I am of opinion that there is no evidence, from the bacteriological examination, which would lead me to condemn the oysters as dangerous or unfit for food. I am led to this conclusion by the absence of typhoid fever bacilli and by the absence of any septic micro- organisms, and by the fact that all the micro-organisms which I succeeded in isolating were perfectly harmless species. I would venture to add, however, that more than a bacterio- logical investigation is required to relieve public anxiety upon the question of a possible danger arising from the con- sumption of uncooked oysters. The possibility of a constant or intermittent contamination of the oyster beds by sewage ought to be carefully inquired into. Any local evidence which justifies a suspicion of typhoid fever resulting from the consumption of oysters from a particular oyster bed ought to be carefully followed up. I am of opinion that the danger of the contamination of oysters with the specific cause of typhoid fever has been exaggerated, but I am equally convinced that it is quite possible that just as unboiled milk mixed with typhoid-infected water may dis- tribute typhoid fever among the consumers, so also the liquid of uncooked oysters may be the means of conveying typhoid fever if water infected with typhoid fever is imprisoned between the valves of the oyster. The oyster may thus be the means of mechanically transferring typhoid bacilli to the mouth of the consumer, and the question then arises whether the bacillus has been derived from the sewage-fed oyster bed or from typhoid-infected water in the establishments in which the oysters are retailed. Here there is need for further and careful inquiry. Have there been groups of cases of typhoid fever traced to oysters distributed from some,
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the like. But, as he remarks, one cannot tell where thecost of an epidemic will end, the poor-rates often beingsaddled for years with the relief of the dependants ofsufferers. Chesterfield with its ninety-six cases might havebeen freed from more than 80 per cent. of them had hospitalaccommodation been in actual readiness for the first cases.Other districts suffering heavy invasion were Newbold andDnnston, 176 cases; Chesterfield rural, 178 cases; and EcclesallBierlow rural, 222 cases. On the matter of influence ofvaccination on the outbreak, Dr. Barwise is able to give dataof his own as regards Whittington with its 135 cases andthirteen deaths down to March, 1894. Of 159 vaccinated personsin infected dwellings, aged under ten years, 6 -9 per cent. wereattacked and none died ; of twenty-one unvaccinated in thesame case and of similar ages, 71’4 were attacked and 23-8per cent. died. In the two classes in the same order at agesover ten years the attack-rates were 35 and 100 per cent. ;whilst the death-rates were 2’3 and 25 per cent. of the 300and the four persons exposed to infection. True, the figureson which the resultg are based are small, but the rates arevery startling, showing in an unmistakable manner the greatneed for vaccination, and equally for revaccination, looking tothe almost complete immunity from attack of children oncevaccinated and the complete immunity of those attacked fromfatal illness. In the whole administrative county the deathsfrom small-pox were 8’9 per cent. of cases, and of 499 attacksconcerning which the facts are known as to vaccination theper case mortality was 8’6 per cent., made up of 3 9 in thevaccinated and of 25 in the unvaccinated. Another pointof interest is that 40 per cent. of the small-pox deaths werein children under five years of age, a figure which would seemto be taking us back to the early years of the century, whenit was 90 per cent. of the total small-pox deaths. We mustgo back to a quinquennial period prior to the seventies forsuch a rate in England. The Derbyshire rate on childrenunder five years of age in 1893 was twice that of England fiveyears previously. Dr. Barwise sees in these data the resultof the terrible laxity growing up over the county-and wemay say country-in the matter of enforcement of thevaccination laws, and the figures certainly afford food forreflection on the part of professional agitators and of ourlegislators. We also commend them to the notice of theVaccination Commission. Space does not enable us to dwellfurther on the point here, or to quote the interesting cases ofmalignancy of infection and of the protecting influence ofvaccination to which Dr. Barwise refers. Such a report asthis makes us wish that the printed reports of health officerswere commonly available for the reading public, as bypurchase or in other ways.

OYSTERS AND TYPHOID FEVER.

MUCH has appeared and is appearing in the daily pressupon the subject of the possible communication of diseaseas a result of the consumption of oysters in a raw state.The President of the Local Government Board has instituted an inquiry into the circumstances under which the cultiva- tion and storage of the bivalvular mollusc and other shell-fish around the coast are carried out as the result of a ’,report from Dr. Thorne Thorne, the medical officer of the I,Board. The following is the report of a bacteriological ’,investigation of water from an oyster bed and of oysters Ifrom the same source, made by Professor Crookshank, M.B.,Director of the Bacteriological Laboratory, King’s College, ’,London :- ’

"This investigation was made at the request of Dr. Fuller ’,of New Shoreham. The first sample of water, despatchedby Dr. Fuller on Dec. 17th, consisted of sea waterwith a thick deposit of mud at the bottom of the vessel.The water and the deposit were separately examined.Experiments were made by special methods for detecting thepresence of the bacillus of typhoid fever. The results werenegative. Further experiments were made in order to isolateother bacteria present in the water and in the deposit, andto examine their exact nature. The colonies which developedin plate-cultivations were very numerous, and it was

necessary to obtain a fresh sample of water and to repeatthe experiments in order to obtain complete isolation ofthe individual colonies and to establish pure-cultivationsof each species. The results obtained with the secondsample will be referred to directly. There was no septic

odour in the plate-cultivations obtained from the first sample-of water. The muddy sediment was examined by similarmethods. There were no typhoid fever bacilli present, andthe micro-organisms which were isolated and examined,both microscopically and in pure-cultures, were found to.be well-known harmless bacteria. The majority of these.colonies were the result of the multiplication of a harmlessliquefying bacterium. On Dec. 20th three oysters were.

despatched by Dr. Fuller. The liquid of the oyster was.mixed with liquefied gelatine and several plate-cultivationsmade. The number of colonies which developed was sur-prisingly small. The colonies were found to represent onlyfive different species of bacteria. All of these were studiedin the form of pure-cultivations, and were easily recognisedas familiar and harmless species. The marked difference inthe number of bacteria in the liquid of the oyster and in thewater of the oyster bed suggests an interesting line ofinquiry. The second sample of water, despatched on

Jan. llth, was so treated that the individual colonies wouldbe completely separated even if the bacteria were foundto be present in very considerable numbers. Nine separate-experiments were made, and the average number of;colonies which developed amounted to 50,000 in a

cubic centimetre. The colonies consisted very largely ofa non-liquefying and a liquefying bacterium. Otherspecies were similarly isolated and studied in their micro-scopical and biological characters, and all were recognised<as well known and harmless bacteria. There was no.

septic odour from the cultivations, and, in fact, the com-plete absence of foul-smelling or saprogenic bacteria was

very striking; and in none of these experiments was the-typhoid fever bacillus present. The number of bac-teria, however, calls for some comment. The colonieswere far in excess of those found in pure sea water,and a similar number, if found in drinking water,would raise a suspicion of sewage contamination unless avery considerable interval had elapsed between the timeof taking the sample and its subsequent examination. The

question therefore arises whether the excessive numberof colonies in this particular sample of sea water indicatessewage contamination or is due to a want of cleanlinessin the oyster bed and the presence of organic matter-from other causes than sewage. The absence of septicand foul-smelling micro-organisms points to absence of

sewage, unless sea water has a special action uponthose micro-organisms which we expect to find whereverthere is unquestionably mixture with sewage. Thequestion of the presence or absence of such con-..

tamination can, however, be ascertained by further

investigation and by local inquiry. The question whichI have been asked is whether oysters from this particularbed are likely to be injurious to the consumer. From thebacteriological investigation of the samples of water andof oysters submitted for examination I am of opinion thatthere is no evidence, from the bacteriological examination,which would lead me to condemn the oysters as dangerous orunfit for food. I am led to this conclusion by the absence oftyphoid fever bacilli and by the absence of any septic micro-organisms, and by the fact that all the micro-organisms whichI succeeded in isolating were perfectly harmless species. Iwould venture to add, however, that more than a bacterio-logical investigation is required to relieve public anxietyupon the question of a possible danger arising from the con-sumption of uncooked oysters. The possibility of a constantor intermittent contamination of the oyster beds by sewageought to be carefully inquired into. Any local evidencewhich justifies a suspicion of typhoid fever resultingfrom the consumption of oysters from a particular oysterbed ought to be carefully followed up. I am of opinionthat the danger of the contamination of oysters with thespecific cause of typhoid fever has been exaggerated, butI am equally convinced that it is quite possible that just asunboiled milk mixed with typhoid-infected water may dis-tribute typhoid fever among the consumers, so also the liquidof uncooked oysters may be the means of conveying typhoidfever if water infected with typhoid fever is imprisonedbetween the valves of the oyster. The oyster may thus bethe means of mechanically transferring typhoid bacilli to themouth of the consumer, and the question then arises whetherthe bacillus has been derived from the sewage-fed oyster bedor from typhoid-infected water in the establishments inwhich the oysters are retailed. Here there is need for furtherand careful inquiry. Have there been groups of cases oftyphoid fever traced to oysters distributed from some,

308

particular oyster bed, or have the cases been traced to anyparticular establishment or retail shop, so that suspicion mayrest equally upon the water at the place of distribution tothe consumer and upon the water of the oyster bed I donot believe that either the cow or the oyster can elaboratetyphoid fever from sewage, but it is quite possible thatoysters may mechanically convey typhoid fever, just as milkmixed with infected water may be the medium for distributingthis disease. In both cases it is more than probable that thelarger is much exaggerated."

DINNER TO DR. JAMESON, C.B.

IT was a happy thought which impelled some of the fellow-students of Dr. Leander Starr Jameson at University Collegeto arrange for a dinner to him at which he would meet those

amongst whom he worked in college and hospital, where for,two years he held the position of resident medical officer.The dinner took place at the Whitehall Rooms on Thursday,Jan. 24th, and passed off with great eclat. The chair was

- occupied by Mr. Christopher Heath, senior surgeon to Uni-versity College Hospital, having on his right the guest of theevening. Upwards of 120 sat down, many having come fromlong distances to be present on the occasion. Amongst thosepresent were Sir J. Russell Reynolds, F.R.S., Sir J. E.Erichsen, F.R.S., Sir John Williams, Dr. Bastian, F.R S.,Dr. Gowers, F.R.S., Dr. F. T. Roberts, Dr. Poore, Mr.Tweedy, Mr. Bilton Pollard, Mr. S. J. Hutchinson,Dr. Bradford, F.R.S., Dr. Sidney Martin, Dr. RadcliffeCrocker, Dr. Corfield, Mr. Meredith, Mr. Quarry Silcock,Mr. A. J. Pepper, Dr. Dawson Williams, Dr. Sidney<Coupland, Mr. Pearce Gould, Mr. Stanley Boyd, Mr. Buckston’Browne, Dr. Campbell Pope, Dr. B. H. Allen (Hastings),Dr. Colgate (Eastbourne), and Mr. Farrell (Eastbourne).After the toast of the Queen had been duly honoured theChairman in a brief speech proposed the health of Dr. Jameson,which was enthusiastically received.Dr. JAMESON : Mr. Chairman and Gentlemen,-I thank

;:you most heartily for this more than kind reception to-

.night. I need not say how gratifying it is to me that anywork of mine should be considered worthy of such recogni-tion from you, many of whom have been intimately asso-ciated with me during my early career. I need not say howhonoured I feel at the presence here to-night, on my righthand and on my left, of those professors and teachers who,in my time as a student, more than twenty years ago, wereeven then the leading men at University College, then, andIbelieve still, one of the leading schools of medicinein the kingdom. It is a special gratification to me tohave the honour of the presence of two of my old teacherswho have been lately recognised by the Queen as leaders.of the profession by special distinction of title. Gentlemen,’it is more than seven years ago since I practically left theprofession. I assure you it has often been to me, for manyreasons, a regret that I have done so. and I shall always con-tinue to feel a sense of regret. Yet it seems to me that Ihave rather drifted out of it than that I have deliberatelyleft it. During the first year of the new work to which Iturned I sometimes thought of going back to medical prac-tice, but I soon found that the profession had also driftedaway from me. Indeed, I began to wonder whether, in the’first instance, it had not drifted away from me rather than Ifrom it. I soon saw, from the rapid manner in which medicalscience was advancing, that if I attempted to resume it Ishould have to go to school again to become competent totreat patients. I felt that I should not have energy enoughfor that. Hence, by a natural consequence, as my work in-creased and my sphere became larger and of greaterimportance, my own interest in it increased also. So my oldprofession and I got further apart. I have gradually drifted’from the medical man into the administrator, and yet,perhaps, after all it is more correct to say that the onehas become merged into the other. I have always recognisedthat any capability I may have shown for my present work’has been due in great measure to the experience I gained inthe several resident posts I held in University College Hos-pital, and especially to the influence of the last two years,when in the time of some of the professors here to-night Iheld the much-coveted post of Resident Medical Officer. Inthose two years I learnt what I consider are the main

elements of success for anyone who attempts to govern or toadminister. They are these two principles-first, never

;0 promise anything you cannot undertake; secondly, tobelieve that one’s own opinion is not the only opinionin the world, but that other people are worth listeningto, and other opinions are worth considering. If thesetwo principles are recognised in action, if they are

thoroughly acted up to, I believe it will be found to begood for those who govern, good for the man who governs,and good for those to whom the administrator is responsible.I have thus to thank University College and UniversityCollege Hospital for the groundwork of any success I mayhave had in my different sphere of work. I have also tothank University College Hospital for the memory ofwhat I may truly say were the best years of my life. Iremember the days when I secured a dressership underMr. Erichsen, and only two days ago I met in the train myformer house surgeon, Mr. Buckston Browne. I wish,gentlemen, that I could go through those days again. Lateron I was fortunate enough to secure the post of house phy-sician in the hospital to Dr. Russell Reynolds, and still latera house surgeoncy to Mr. Marshall, when I had the supremepleasure of beating my friend, Mr. Pepper. I can assure youthat when I obtained this post I felt more gratification andwas more proud of myself than I was last year when I arrivedat Buluwayo. Although I had gone through a considerableamount of disagreeable work, and although the anxiety whichpreceded the success was very great, I think the examinationfor that house surgeoncy, and especially the horrible zzva.zocepart of it, gave me more anxiety than I experienced in allthat campaign. Now, gentlemen, I will not trouble you witha digest of the downfall of Buluwayo or even of an outline ofour Company’s proceedings ; but our Chairman mentionedthe subject of what he was kind enough to call the libel" "on myself during our operations. If you will allow me, Ishould like to say a few words for myself on that subject.Our Chairman also said that this was not a political meeting;I hope sincerely that it is not. But when a friend of mine-one of our secretaries-this evening told me that yonintended to give me a dinner, I felt that I did wish onething. Whatever the country may think of the methods ofour procedure in Matabeleland, I am anxious that themembers of the profession to which I have the honour tobelong should understand the origin of what took place.I myself, previous to our troubles last year, alwayshoped that the Matabele question would be settledwithout having recourse to force. I knew that Lobengnlahad always said he would never fight with the "whitemen," and I believed that he had absolute control over hisIndunas. I, therefore, believed that we should come throughall our difficulties without any conflict. I was egotisticalenough to think that had I been at Pretoria when the troublebegan I should have been able to stave off any conflict; butI was 200 miles away, and I will give you as short an accountas I can of what happened. When I arrived I found on bothsides of the road the Matabeles carrying off their goods inpreparation for a fight ; but a year before the same thing hadhappened, and I then took up a firm position and settledmatters. I thought I might do the same thing again. Itturned out that I was wrong. Only two things were pos-sible-either 2000 people, including every white man, would .

have lost their all, and there would have been such abutchery of Mashonas as had never been heard of before,or we must use force-we must go to Buluwayo. Whenthe war was over, after the settlement, I went over thewhole of the facts, and heard the same account fromeveryone. I found I was right in regard to the king-he never wanted to fight ; but I was wrong with regardto the natives. They had entirely the upper hand of-the king. There were only two people who did not wantto fight-one was the king, the other was one of theIndunas who had been over here. I wish you to know to-night that we adopted the only possible method we couldadopt. We were driven into the campaign, and during the

three preceding years we had done everything we possiblycould to avoid such a thing as a conflict. No one could bemore ready than I am to condemn any attempt to bring on awar with these unfortunate races. I have troubled yonenough. I can only thank you most heartily for the ex-tremely kind welcome you have given me.

Dr. Jameson concluded by proposing the health of the .Chairman, which was most cordially received.The toast of the Secretaries, Dr. Radcliffe Crocker and Mr.

Quarry Silcock, to whom the success of the gathering was


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