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105
the rest, an analysis of the enquiry cards used in the investigation
of the cases excluded milk and most of the usual sources of
infection, but showed that many of the patients had eaten ice
cream and fried fish during the presumed period of infection.
Attention was, therefore, chiefly directed to these two articles of
food.
All the cases, omitting those such as late family cases, almost
certainly due to contact, cannot even now be satisfactorily explained
011 the basis of one or other of these two impugned food
substances.
In another report, the epidemic has, on statistical grounds,
been attributed to fried fish.
In the Finsbury Public Health Department the early cases were
attributed to ice crCam. In the house of one ice cream vendor
there was an early concealed case. The daughter of another ice
cream vendor contracted the disease early in September. Some
of the early cases were missed. The diarrhoea of which they
complained was considered to be summer diarrhoea, at that time
very prevalent, or an attack of " liver and headache."
Some of these missed and early cases fed and ate in the neighbouring
ice cream shops and fried fish and other restaurants and
possibly infected the feeding utensils.
The method of cleansing these utensils is very unsatisfactory.
In ice cream shops the glasses are momentarily dipped into a
bucket of water, swabbed out with a wet cloth used for hours at
a time, and then inverted on the ice erean. cart.
In August and September, 1911, the weather was extremely
hot. The bucket of water for cleansing ice cream glasses would
form an excellent medium for the growth of the typhoid germs
left on the edge of the glass by infected purchasers, and by the
end of the day might contain very large numbers.
Each time the glass was washed it would carry with it numbers
of the typhoid germ ready for the next purchaser.