London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1896

[Report of the Medical Officer of Health for London County Council]

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46
would appear to be as follows—First, the cholera vibrio, and still more the typhoid bacillus, are difficult
of demonstration in sewage known to have received them ; second, both these organisms may persist in
sea-water tanks for two or more weeks, the typhoid bacillus retaining its characteristics unimpaired,
whilst the cholera vibrio tends to lose them ; third, oysters from sources which appeared to be free from
risk of sewage contamination exhibited none of the bacteria, specific or otherwise, which are commonly
regarded as being concerned with sewage; fourth, oysters, from a few out of numerous batches derived
from sources where they did appear to be exposed to risk of sewage contamination, were found to exhibit
colon bacilli, a circumstance which, notwithstanding the comparative universality of this intestinal
organism, may be regarded as having some significance by reason of the absence of this bacillus from
oysters which appeared to have been exposed to no such risk; fifth, in one case where the circumstances
were especially suspicious Eberth's typhoid bacillus was found in the mingled body and liquor of the
oyster.
In my report for the year 1894, I referred to an outbreak of enteric fever in Wesleyan College,
Connecticut, in which a number of persons were attacked undoubtedly through eating specifically
contaminated oysters, and in the report of that year and of 1895, I cited various instances in which
London medical officers of health had directed attention to the fact that enteric fever had followed upon
the eating of oysters. This year again, reference is made to the subject in the reports relating to the
following districts—
Marylebone.—" A few [of the cases of enteric fever] had some connection with sewage-polluted
oysters." Stoke Newington.—" Seven of the cases were doubtless imported and three were ascribed by
the sufferers themselves to the eating of oysters." Hackney.—" For some years I have had cases
brought to my notice in Hackney where the disease had undoubtedly been contracted out of London
during the summer holidays, mostly during visits to places on the coast; during 1896 no less than eight
such cases were brought to light .... The interest of all this so far as Hackney is concerned
lies in the fact that oyster eaters are as numerous in this district as in many others; and there is
reasonable ground for suspicion that some of the cases of the past year have been due to this cause. I
have notes that several of those who had suffered from typhoid fever had eaten freely of this mollusc
at a period on or about the time when the disease must have been contracted. Two of the cases which
I mentioned above as having been introduced into Hackney were certainly infected during a holiday
at Southend, one of the places mentioned by Dr. Bulstrode where the oysters were exposed to pollution.
I must add, however, that I am unable to prove these persons had eaten specifically polluted oysters."
Wandsworth (Putney and Roehampton).—" The eating of contaminated oysters was again believed to
be the cause of the disease in several cases." Lee (Eltham).—" Ten cases were reported but fortunately
no deaths, nearly half of them were attributed by the medical attendants to eating oysters."
Plumstead.—" In one case the patient was in the habit of eating oysters freely, in another case the
disease was evidently contracted at the seaside."
The report of medical officer of health of Shoreditch gives account, as follows, of a localized
outbreak of enteric fever possibly due to insuction of sewage matter into a defective water main.
Thirteen cases of enteric fever were notified between August 6th and November 4th in a small
area comprising the west end of Watson's-place and the adjacent north end of Louisa-street.
The persons attacked had an average age of 15 years, the average age of other cases in Shoreditch
occurring at the same time being 22.2 years. They lived in ten houses, five on the south
side of Watson's-place, one on the north side and the remainder in Louisa-street. "The drainage of
the houses on the south side of Watson's-place was extremely defective, but that of the houses in
Louisa-street and on the north side of Watson's-place was satisfactory. The invaded houses on the
south side of Watson's-place were found to be drained by a common drain which was in a very defective
condition throughout the whole of its extent to the sewer in Watson's-place, being broken in several
places and leaking freely at every joint." In point of time there was some grouping of the cases of
enteric fever, the illness of some not being notified until some three weeks after the commencement of
their illness. Inquiry as to milk supply showed that this was from various sources. The following
paragraphs in the report of the medical officer of health shows the probable cause of this outbreak—
The defective drain was re-laid throughout the whole of its course, and intercepted from the vestry's
sewer, the work being finished in October. Where it passed under the roadway to join the sewer in
Watson's-place, the depth was iound to be between 9 and 10 feet below the crown of the road.
I am informed that the water main supplying the houses passes down Watson's-place from east to
west and then turns round to supply the houses in Louisa-street. It is about two feet below the crown
of the road and where it crosses the defective drain there is a distance of about eight feet between
them. The water main is a 4-inch iron pipe. It was found to be broken, and was repaired in September,
1896. As to the length of time the fracture had existed before it was discovered I have no knowledge.
The distance of the fracture in the water main from the defective drain passing under the roadway was
about 23 feet. Although the evidence as to the implication of the water supply through the defective
drain is not conclusive, it is quite within the bounds of possibility that such was the case, and that this
is the other factor in connection with the occurrences of these cases of typhoid fever.
Enteric fever—Age and sex distribution.
As in preceding years, males in London in 1896 had a greater attack rate and death rate from
this disease than females, and this greater incidence upon males of attack and death is manifested at
each age period. The case mortality of males at all ages was greater than that of females. This is
due to the higher case mortality of males above five years of age, females below five years of age
having a higher case mortality than males of like age.