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44
three cases the patients had been in the habit of eating mussels and in two cases cockles and whelks.
In Lambeth, of 72 cases, in 28 there was a history of the patient having eaten shell-fish from one to
three weeks before attack. In Battersea, of 27 cases, in five, it is thought, there was probability that
the eating of shell-fish was responsible for the illness. In Wandsworth, where 82 cases occurred, in 12
the suggested cause was the consumption of shell-fish, viz., oysters in two cases, mussels in three,
winkles in three, cockles in one, whelks in one and shrimps in two cases. In Greenwich, of 28 cases,
six may have been due to eating fried fish or oysters. In Woolwich, of 2? cases, in one case oysters
from Emsworth had been eaten, in one case cockles from Southend, in one periwinkles, and in one
case lobster, which it is suggested may have been contaminated after boiling.
Watercress, as a possible cause of the cases of enteric fever which occurred, is mentioned in four
reports. In Bethnal Green, watercress had been eaten in seven cases, in Wandsworth in five, and in
Woolwich in one case. In Bethnal Green, the seven persons attacked were reported to be in the
habit of eating watercress. Dr. Caldwell Smith states in reference to the five cases occurring in
Wandsworth: " In all the five cases where watercress was suspected it was purchased from itinerant
vendors and further enquiry showed that it had, in two cases, been grown at watercress beds just
outside the borough. The water from this bed had been examined by the officials of the London
County Council and unfavourably reported on."
Of other suggested causes it may be mentioned that ice cream in connection with the cases
which occurred is less frequently referred to than formerly. In the case of a boy who was attacked
in Greenwich, bathing in the Thames is mentioned as a possible cause.

No accurate comparison of the deaths from epidemic diarrhoea for a long series of years in London
can be made; diagram XIX., however, shows the death-rate from cholera, dysentery, and diarrhoea
combined, in relation to the mean death-rate of the period 1841-1905 in each year since 1840.
The following table shows that the London diarrhoea death-rate was in the decennium 1895-1904,
lower than the death-rate of any of the undermentioned large English towns except Bristol and Newcastleupon-Tyne,
and in the year 1905 was lower than that of any except Bristol, Bradford and Newcastleupon-Tyne.

1. See footnote (2) page 9.