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60
cockles brought from Southend. Another had eaten oysters while
yachting off Poole, the oysters having been gathered by himself. Six
others had eaten shellfish from stalls in London or on day trips to seaside
places, on dates which would correspond with the periods of
infection. In some instances the patients themselves attributed the
attack to such cause, as they had had some stomach or bowel trouble
soon after eating the shellfish.
Fish. — It is now known that infection may sometimes be
communicated through fish where not thoroughly cooked, and in this
connection a small group of cases which occurred is interesting. One
patient w-as a fishmonger, and three others were regular customers
buying fresh fish; the fishmonger and two of the customers were
probably infected about the same date, but in the fourth case symptoms
did not appear till a month later and the patient is inclined, for reasons
mentioned above, to attribute his illness to oysters eaten off a barrow in
the East End. The drainage of the fishmongerper cent.s house was bad.
Another case is believed to have been contracted from eating fried fish
while staying at Old Ford.
In addition to the above, two persons contracted the disease through
polluted water—one in England and one in the United States; fourteen
persons came to Westminster ill, five from other parts of London, three
from Brighton, one from Margate, one from Worthing, one each from
Germany, Holland, France and Italy. It is quite likely that some
of these acquired the complaint from one of the causes already
specified.
I find that there were six cooks among the patients, all of them in
connection with hotels, clubs, or eating-houses; nine other persons lived
or worked in the same kind of house.
Tn connection with the outbreak of typhoid fever from shellfish
it may be interesting to quote what I wrote in my Report for
September:—
"The marked decline which took place in enteric fever cases in
London in August was not maintained, the cases rising from 287 to 473,
a figure in excess of that recorded last year. In Westminster there
have been no less than 26 cases, and the manner in which a number of
these contracted the disease suggests a possible explanation of the
increase in London generally. It will be observed that 14 of the cases
were notified in the Wards of Covent Garden and Strand. Two other
cases were notified at the end of the month subsequent to the date of
this Report, and 1 am informed that a case lias also occurred in the
Borough of Holborn, and is connected with this group ; a fourth case of
bowel complaint in a brother of one of the above patients came to my