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Report of the Medical Officer of Health. 89
to the delivery in London of a consignment of infected fish on Thursday, August 17th, or Friday,
August 18th. The deliveries of fish in London on these dates were in some instances from unusual
sources, owing to the dislocation of traffic caused by the strike.
This outbreak adds yet another instance to the now growing list of outbreaks in which enquiry
failed to show any other explanation than the consumption of fried fish. The circumstances of the
outbreak afford further illustration of the peculiar features which have been described as typical of such
outbreaks. There is the attack of a particular social class, the peculiar age-incidence, the peculiar
distribution of the cases in family groups, the same frequency of the separate purchase of fish by
the sufferer himself or herself, in cases in which only one attack occurred in a house. But the present
outbreak is very instructive inasmuch as it was at first attributed to ice cream, and prima facie, there
was something to be said for an ice cream hypothesis. Analysis of the facts shows, however, that
at least half the sufferers in the outbreak had not eaten the suspected ice cream, and eight of the
ten persons over twenty years of age attacked had not partaken of this ice cream. Moreover, study
of the topographical distribution of the cases negatives an ice cream hypothesis.
The history of typhoid fever in London during the last twenty years shows that in numerous
instances explosive localised outbreaks of the disease have occurred and that suspicion has fallen
upon a food supply. In some instances question has been raised as to shell fish, in some as to ice cream,
in some as to watercress, and in some as to fried fish. It is noteworthy that difficulty has arisen in
some outbreaks as between cockles and fried fish, watercress and fried fish, mussels and fried fish
and ice cream and fried fish. The need for careful analysis of the facts in each instance is apparent,
and the present outbreak is deserving of study inasmuch as it strikingly illustrates difficulties which
may be encountered in discriminating between one and another suspected food supply.
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