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In four cases there was strong evidence that the disease was caused by eating shell-fish, and in
several others there was a great probability that shell-fish was the cause of the disease.
Many outbreaks of enteric fever have been proved to be due to sewage-contaminated shell-fish.
In many cases oysters and other shell-fish which have been laying in beds where there was a
probability of sewage contamination have been proved on bacteriological examination to have been so
contaminated. During December, 1902, and January 1903, oysters from various sources were submitted
by the Worshipful Company of Fishmongers for bacteriological examination, and the majority
of them were found to have sewage-contamination.
In order to prevent outbreaks of this disease due to the eating of contaminated shell-fish, it
is desirable that an Act should be passed prohibiting the use for food of any shell-fish that have been
laid or stored in places liable to sewage-contamination.
Of the 24 cases notified in the month of December, 19 occurred in the vicinity of the Seven
Dials, one of which I was of opinion was not a case of enteric fever, and the Widal re-action was not
obtained. 15 of the 18 genuine cases were notified in the first fortnight of the month, and there
were only two houses in which there was more than one case. Each of these having two cases. In
one of these two houses the two cases were probably contracted from the same source of infection, and
in the other house the second case was probably contracted from the first.
I made very careful enquiry in each case and was able to exclude shell-fish, watercress, celery,
milk and ice-cream as a common source of infection. On the other hand in twelve of the fifteen
primary cases there was a history of the consumption of fried fish at a time corresponding to the
period of infection. In one of the remaining three cases the patient (male 26) was very ill after
eating fried fish seven weeks previously, and on account of that had not eaten any fried fish since.
It is therefore probable that he may have been suffering from a mild attack of enteric fever for five
weeks and that at the time of notification he was having a relapse.
In the second of these three cases it is very probable that the woman had had fried fish as well
as whelks, and in the other, although the patient had not had any fried fish, she very frequently had
boiled fish, and it is possible that she may have contaminated her hands with the infected fish as she
was in the habit of preparing and cooking it herself.
I also had information of another case in the same neighbourhood, in which the Widal reaction
was obtained, but the case was not notified as it bad been a mild case, and the patient was then
convalescent. This patient had also often eaten fried fish from one of the two suspected shops.
The only two cases which had been notified in the neighbourhood, in the City of Westminster,
I was informed by the Medical Officer of Health of that City, had also eaten fried fish from one of
these two sheps.
I made enquiries respecting fried fish because I had read the detailed reports by Dr. Hamer,
Assistant Medical Officer of Health, London County Council, of the outbreaks in Southwark, Lambeth
and Kensal Town of enteric fever in September, 1900, which after a most careful enquiry he attributed
to the consumption of fried fish. The Southwark outbreak consisted of more than 100 cases, and the
evidence pointing to fried fish as the cause was exceedingly strong. I therefore had a consultation
with Dr. Hamer and he made a large number of inspections with me, and also visited the fish shops at
Billingsgate Market, and the South Western and North Western Fever Hospitals, to which the
patients had been removed.
INFECTED BLANKETS FROM SOUTH AFRICA.
On the 21st May, I received information from the Medical Officer of Health of the City of
London that a number of disused army blankets had been supplied to a large firm in this Borough.
He informed me that blankets from the same source had been found to be soiled and infected with
typhoid fever germs, and had given rise to an outbreak of typhoid fever. I at once proceeded to
the factory, and with the manager inspected the premises, and saw that many of the blankets were
already in use; I also saw the unused ones which were stored away. I was informed that no stains
of any kind had been seen on the blankets, and that they had been sold to the firm as unused army