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35
Report of the Medical Officer of Health.
"The prevalence of 1910 affected an area in Bethnal Green almost identical in extent with that
involved two years before. The outbreak was, moreover, of sufficient dimensions to enable the question
of shellfish, which had complicated the problem in 1908, to be eliminated, and an examination of the
sources of supply of fried fish, to the 49 sufferers from typhoid fever in the affected locality, showed
that they had in all probability obtained their fish from one or other of three shops, two of which had
a common source of fish supply. Analysis of the facts, indeed, showed that while there were 27
fried fish shops within the affected area, 24 had supplied none, or only one, or at most two, sufferers;
but in the case of the remaining three shops, 25, 12 and 12 sufferers respectively had been supplied.
Thus all 49 sufferers obtained fried fish from one or other of these three shops."
"Meantime it had become apparent that coincidentally with the outbreak in the specially affectcd
area in Bethnal Green, a number of other localised prevalences of typhoid fever had been developed
in other parts of Bethnal Green, in other parts of London generally, and in Tottenham and Edmonton.
Examination of the facts concerning these localised prevalences (33 in all) failed to show in each instance
that any ordinarily accepted cause of typhoid fever had been operative, but it was found that all
sufferers contributing to the excessive prevalences had partaken of fish (usually fried fish), and that
in all the instances in which information on this head could be obtained, small plaice belonging to
the category described by fried fish vendors as 'late steamer fish,' was in question. The chances
against such a combination of circumstances being the result of mere coincidence were, of course,
very great."
" Dr. Hamer draws attention to the interesting fact, established by the enquiries and reports
of officers of the Board of Trade, that much of the small plaice sold at Billingsgate comes from an
area in which are situated certain' nursery grounds/ not far from the mouth of the Elbe, and he
suggests as a possibility that estuary fish may be in question."
A full examination of the facts elicited with regard to the outbreak of 1910 was published in
Chapter XXXII. of last year's Annual Report. The accompanying diagram (v), which shows the
allocation of typhoid fever cases to the suspected shops, stalls, etc., in ten London boroughs, was not
then included, and is here reproduced for purposes of reference. The report of 1910 is summarised
and commented upon by Dr. Collingridge in his report for 1911. He says, "At the time that this
matter was under the consideration of your Committee and the Court of Common Council it was resolved
that your medical officer of health should arrange for the supervision of Billingsgate Market to be
carried out by the existing staff. It was at that time hoped that such arrangement could be carried
out, but it has, however, since been found that in consequence of the very large increase of work thrown
upon your meat inspectors, it is not possible to spare an officer for this purpose. It is important that
the supervision should be constant, and it is further necessary that such officer should have expert
knowledge of fish inspection, and the appointment of a special officer to act in regard to fish is now
under the consideration of the Sanitarv Committee."

Bacteriological
diagnosis.

Enteric
fever. Errors
of diagnosis.
12532
E2