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states that in a few cases in Battersea patients had consumed shell-fish, but that it could not
be proved that this had been the cause of the illness. Of cases occurring in Plumstead, Dr. Davies
writes that eleven cases had, within a few weeks of the illness, eaten shell-fish. Some of these
were in the habit of frequently partaking of molluscs, while others had taken some just about
two or three weeks before illness commenced. Five had taken celery shortly before the illness,
one was a greengrocer's boy, and one was a gardener who visited Stratford-market daily. Three
of the remaining patients were people of markedly dirty habits.
A localised outbreak of enteric fever of some magnitude occurred in St. George-the-Martyr
between the 4th and 24th September, upwards of one hundred persons being attacked. This
outbreak was investigated by Or. Waldo, the medical officer of health of the district, and
inasmuch as it raised question of more than local interest, and as a localised prevalence of the
disease appeared simultaneously in Lambeth, while increased prevalence was manifested in
Kensal-town, Dr. Hamer was instructed to enquire into the cause of the disease on behalf of
the London County Council, see Appendix I. Dr. Hamer's report is appended to this report and
it is, therefore, unnecessary here to discuss the subject in any detail, and it will suffice to say that
Dr. Hamer came to the conclusion that the outbreak in St. George-the-Martyr was due to the coasumption
of fish, in the main, fried fish, from a particular shop in the district. As to the outbreak
in Lambeth there was much evidence that a similar cause was operative, but this evidence was
perhaps less conclusive than in the case of St. George-the-Martyr, and in Kensal-town the
evidence did not justify any other conclusion than that, in the absence of any other explanation of
the illness of a number of persons, there was possibility that most of the cases might have arisen
from the consumption of fish. The localised outbreak in Lambeth was investigated by Dr.
Priestly, the medical officer of health, who presented to his authority a special report on its
circumstances. Dr. Priestley associated the occurrence of the cases of enteric fever with the use
of particular mangles, the inhabitants of the locality being in the habit of sending their clothes
to be mangled. He thus found that linen from three persons attacked in separate houses was
sent to one mangle. These three persons were attacked almost simultaneously, and there is no
evidence in his report that any person suffering from enteric fever had been resident in the house
in which the mangle was situated or that clothes from any previously infected house had been
sent there. He describes this mangle, however, as an infected mangle. A second group of six
cases occurred in five houses whose occupants sent their linen to another mangle, one of the cases
was that of a women who lived in the house in which the mangle was kept; as this case, however,
began about the same time as some of the others, the woman could not have acted as
the source of their infection. There was, as in the preceding group, no evidence that the mangle
had been infected by an antecedent case. In two other groups of cases the circumstances were
different, linen from a patient, regarded by Dr. Priestley as the source of infection, and in whose
house a second case occurred, had in one instance been sent to be mangled in a house to which
the linen from other invaded houses was sent; in the other instance an antecedent
case of enteric fever occurred on the premises on which was a mangle to which linen was sent
from houses subsequently invaded. It is, of course, matter of common experience that persons
engaged in the washing of linen infected by patients suffering from enteric fever frequently
contract the disease, but it has not hitherto been suggested that the use of mangles might lead to
the conveyance of infection from one person's linen to that of another. Even if the last two
groups of cases are accepted, as supporting this hypothesis of the origin of the disease, a considerable
balance of cases is left without explanation, and other cause of the prevalence of enteric
fever at this time in Lambeth is required to explain the observed phenomena. The circumstances
mentioned by Dr. Priestley do not, therefore, appear to me to deprive the Lambeth outbreak of
significance in connection with Dr. Hamer's observations.
Enteric fever—Age and sex distribution.
The following table shows the case-rates, death-rates and fatality of enteric fever during
the year 1900. The case rate at "all ages" was greater among males than among females, as
were also the death-rate and case mortality. In the age groups adopted for the purposes of this
table the greatest incidence of attack was upon both males and females aged 10-15 years. The
greatest incidence of death was upon males aged 20-35 and upon females aged 25-35. The
fatality was greatest among both males and females aged 55 and upwards.

3* See footnote (*), page 25.
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