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

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London County Council 1900

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

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in school B who attended the baths on that day, of the girls from school J who went to the baths
on the 29th (Wednesday), and of boys from school J who went on the 31st, (Friday), and then
have ceased to operate after the next cleansing of the baths on September 1st (Saturday).
The escape, however, of scholars from other schools, who attended on the days in question,
and of persons other than scholars who attended on those days, is not explained on this assumption.
In the light of the fuller knowledge as to attendance at the baths which was ultimately obtained
it was clear, having regard to the large number of sufferers from enteric fever who had never
attended the baths at all, that the bath hypothesis was altogether untenable. The facts as to
attendance at the baths were seen to be very much what might have been predicted, given an
outbreak of enteric fever having an exceptional incidence upon young persons, in an area sending
children mainly to the two schools J and B.
Ice cream.—There were several premises in the area upon which ice-cream was manufactured.
At one of these all the ice-cream was sold by barrow-men who disposed of their wares
at a considerable distance from the area. At another several barrow-men were employed, most of
whom sold their ice-cream away from the area, but two, the C and E of the appended notes, had
as their standing places points in the area. At the establishment from which C and E came icecream
was retailed, but this establishment, though within the area, does not appear to have been
supplying directly any of the sufferers from enteric fever, though doing so intermediately through
the agency of C and E. Neither of these men supplied any considerable number of the, enteric
fever patients with ice-cream.
The vendor A (see appended notes) was concerned with two barrows standing within the
area; he took charge of one of these himself, while in connection with the other he employed an
Italian barrow-man (called in the notes " A's man "). These two men between them appear to
have supplied several of the enteric fever patients. The vendor B, it was found, had from time to
time supplied nearly one-third of the sufferers from enteric fever with ice-cream. His shop was
situated near the centre of the area, and his business was a large one, so that the incidence of
disease upon his customers was, having regard to the habits of the population in regard to icecream,
not greater than might have been expected. All the above vendors were Italians. One
English vendor, D, supplied, it will be seen, one or two infected households with ice-cream.
More than one-third of those attacked by enteric fever either denied having ever eaten
ice-cream, or said they had not partaken of it within at least a month of the onset of their illness.
It was clear from consideration of these circumstances that ice-cream was not the cause of the
Inquiry was made concerning many other articles of food and drink. The bread consumed
in infected households was obtained from very varied sources; watercress was rarely eaten in the
area, several persons whom I questioned intimated that it was a luxury quite beyond their means.
Fruit, lemonade, ginger-beer and other beverages sold on the area were found to be obtained from
a variety of sources, and these articles were not very generally consumed by the inhabitants, who,
indeed, could not, as a rule, afford to buy them. The question of possible influence of laundry
operations was also carefully considered, and, early 'in the course of the outbreak, many circumstances
were inquired into in connection with the schools already referred to as the J schools,
inasmuch as many children attacked had attended those schools. As the history of the outbreak
was more fully ascertained it became quite clear that these schools were not at fault, nor could any
connection be established between school operations and the disease.
Fish.—The only article of food or drink, emanating from one source, which had been
generally consumed by persons attacked during the outbreak was fried fish. The circle of a
quarter of a mile radius which has been already referred to as covering the area specially attacked
has at its centre a fried fish shop. Moreover, if the circle in question, of a quarter-mile or 440
yards radius, be subdivided into four by three circles, 110 yards, 220 yards and 330 yards
respectively in radius, and having the same centre, it will be found (limiting consideration to the
cases occurring between September 4 and September 24‡) that in the inner circle of 110 yards
radius, described about the fried fish shop, 47 cases (involving 38 houses) occurred; in the ring
outside this circle, between it and the circle of 220 yards radius, 39 cases (involving 33 houses)
occurred; in the next ring eight cases (involving eight houses) occurred, and in the outermost
ring ten cases (involving eight houses) occurred.
If the area of the innermost circle be taken as the unit, the areas of the three concentric
Tings outside it will be three, five and seven times this unit respectively. Hence, in order to
compare the intensity of incidence of enteric fever, upon equal elements of area, in the four
portions into which the affected area has been divided, the numbers 47, 39, 8 and 10, given above
as pertaining to these portions, must, taking the outer zone as a standard, be multiplied by
seven, 7-3rds, 7-5ths, and 7-7ths respectively, and there result the comparative numbers 329,
91, 11 and 10. These numbers give the relative intensity of incidence of enteric fever on
equal elements of area, for the areas within 110, between 220 and 110, between 330 and 220,
and between 440 and 330 yards from the fried fish shop. But another point must not be lost
sight of; in an area in London of the size of the affected area an appreciable number of
cases of enteric fever is likely to be met with, particularly at the time of year under consideration,
apart from the existence of any cause of special prevalence. Roughly speaking, the
affected area contains about 200 th of the total population of the County of London, and in
London during October the cases of enteric fever rose to nearly 200 per week; thus as a mere
matter of chance, cases at the rate, approximately speaking, of very nearly one a week might
be expected to occur in the affected area. As a matter of fact, during the period September
‡These cases correspond to the cases 6 to 110 of the appended notes, excluding case 22, and they occurred
in houses indicated on the accompanying map. On the map, however, the houses corresponding to cases 73 and
107, which were "secondary cases," are not represented, nor are the houses corresponding to case 90, which
proved not to be typhoid, nor to case 22, as this girl lived outside the affected area.