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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appears to be conducted, but it is of a different character from that at Mr. X's shop. It was
explained by more than one inhabitant of the area that at the latter " a halfpenny bit" could
be procured, and it will be seen from the notes that it was common for children (presumably
because they had no more than a halfpenny to spend) to patronise Mr. X's shop, when other
members of the family were in the habit of going elsewhere.
With a view to ascertaining what percentage of the inhabitants of the area purchased fish,
fried fish, shell fish, etc., from Mr. X, a house to house inquiry was conducted in two portions of
it by the Council's inspectors. The portions of the area dealt with are indicated by cross
hatching on the map. Inquiry concerning persons attacked had shown that it was a not
uncommon thing for the habits of different members of the same family to vary in respect of the
articles purchased from a fish shop, and particularly in respect of fried fish eating. Hence the
inspectors did not limit their inquiry to asking questions of the head of the family, but ascertained
concerning each individual, making, if necessary, a second visit for the purpose, whether
he or she was in the habit of obtaining fried fish, etc., and if so, whence it was obtained. It
was of not infrequent occurrence to find, for example, that the elder members of a family did
not consume fried fish, while the younger ones did so. In such cases the whole family has
been classed as fried fish eating. In a very limited number of instances fried fish, shell fish, etc.,
were stated to have been procured from more than one source; in such instances, if one of the sources
was Mr. X's shop, the case has been classed accordingly, the fact of there being an alternative
source being neglected. In making their inquiry the inspectors were careful to ascertain the
facts as to fish eating shortly before the outbreak of fever, that is at a time which must be regarded
as the date of infection.

The following results were obtained in the areas in which house to house inquiry was made—

Number of families.Wet fish.Shell fish.Shrimps.Fried fish.Dry fish.
From X.From other sources.None.From X.From other sources.None.From X.From other sources.None.From X.From other sources.None.From X.From other sources.None.
Area A77419273593332936371723411917
Area B10060251540654371053492229572617
Xnot XXnot XXnot XXnot XXnot X

It will be seen that the results in the two areas closely correspond; so far as fried fish is
concerned the percentages will be found to be identical. It thus appears that 49 per cent., or just
about half the families, contained one or more members who ate fried fish from Mr. X's shop.*
If, instead of dealing with families, the facts relating to individuals be considered, it
transpires from the inspectors' inquiry that—
42 per cent. of the population did not eat fried fish.
16 per cent. ate fried fish not obtained from X's shop.
42 per cent. ate fried fish obtained from X's shop.†
The areas A and B are of somewhat different character. Area B includes some of the
blocks of tenement buildings already described. Area A consists of some houses, tenemented for
the most part, fronting upon a main street, and a number of cottages in two alleys at the rear.‡
The facts as to fried fish are identical for the two small areas, and may, I think, be regarded as
fairly typical of those of houses situated from 100 to 200 yards from the shop.
The percentage of persons obtaining fried fish from Mr. X would probably somewhat
exceed 42 per cent. in two of the streets close to the shop, which consist of the poorer class of
tenement houses; on the other hand it would probably fall considerably short of 42 per cent. in
the more outlying portions of the area. It may doubtless be stated with certainty that Mr. X's
percentage for the area considered as a whole lies somewhere between 25 and 40 per cent.
If the facts as to fried fish, shell fish, etc., for the entire area be compared with those
ascertained for persons (Nos. 6-110 in the notes appended) attacked by enteric fever between
September 4th and 24th, the contrasts are striking. Thus, while less than 40 per cent, of the in-
* For the most part persons who obtained one of the five commodities referred to in the above table from
X, obtained the others, if they purchased them at all, from the same source, Thus the 101 purchasers of wet fish
from X in the above table include almost all the 75 purchasers of shell fish and the 69 purchasers of shrimps;
they include, too, the majority of the 86 purchasers of fried fish and of the 98 purchasers of dry fish. If- the
families be grouped into those in which one or more members obtained food of any sort from X, and those in
which no member did so, the former group contains about 70 per cent, of the whole number of families.
†The number of persons not eating fried fish at all was 381, the number eating fried fish not obtained
from X's shop 149, and the number obtaining fried fish from X 370; the total number thus amounts to 900. In
the case of 12 of the 177 families, while it was ascertained that fried fish was consumed, particulars as to which
members of the family were in the habit of consuming it were not recorded ; in tabulating these persons, it has
been assumed that all the members, save those under 4 and over 60, were fried-fish eaters. As regards one other
family, there is some doubt as to the way in which the particulars recorded should be tabulated. If all cases
in which any kind of question arises were relegated to X, the number would only just exceed 42 per cent. of the total.
‡This area has at its southern boundary a fried-fish shop already referred to as being a shop at which a
similar class of business to that of Mr. X, but one on a considerably smaller scale, is carried on.