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14
A further point is made apparent on consideration of particular families in infected households.
In many instances it was found that the suiferer or sufferers from enteric fever in a
particular house were also eaters of fried fish obtained from Mr. X's shop, while other persons in
the house either ate fried fish from that source only quite exceptionally, if they ate it at all, or
were in the habit of procuring what they ate elsewhere.
As instances in which the sufferer or sufferers ate Mr. X's fried fish, and other members of
the same family did not, the following cases of which account is given in the appended notes may
be referred to—Nos. 6, 7, 8, 15, 21, 29, 36, 37, 45, 46, 47, 54, 57, 58, 65, 83 and 89, and 87. See
also in this connection Nos. 42, 49, 74, 85 and 110, 94 and 99 and 95.
In these instances the fact of purchase by the individual attacked of something not eaten
by the rest of the family was determined—
(а) By the fact that the sufferer went to work and was thus led to obtain certain
meals from sources not supplying the rest of the family.
(b) By the fact that it was a not uncommon practice in the area for children to be
given a penny or a halfpenny with which to purchase food for themselves, more
especially on washing days or under other circumstances in which cooking at home was
attended with difficulty.
(c) By the fact that the individual attacked was specially fond of eating fried fish
and usually devoted any pennies or halfpennies of which he or she became possessed to
purchasing it. Such expressions as " a craving for fish," " a dreadful child for fish and
taters," "terrible fond of fried fish," which I heard from mothers of patients attacked,
in the course of my inquiry, indicate the extent to which the growing, and in many cases
vigorous, hungry child appreciated its " halfpenny bit," and the extent to which
repeated requests for halfpennies to spend had led the mother to look upon fried fish
eating with concern and apprehension. I was told, moreover, that those children who
were sent away for a summer holiday specially manifested this craving on their return
from the country, and it was manifest that children described as particularly fond of
fried fish were the more vigorous specimens and presumably those with the best appetites.
In the affected area in Southwark it was not unusual to find' that it was considered
extravagant to spend money on watercress, lemonade, periwinkles, or ice-cream, but
the " bit of fish and taters " was looked to by children and young people themselves,,
and by their parents for them, as the most suitable and economical means of supplementing,
when the halfpenny or penny was available, such scant provision for satisfying
hunger as could be made at home.
The cases Nos. 40, 55 and 56, 59, 79, 103, 104 and 109 further illustrate some of the
points above referred to. In these cases other members of a family as well as the actual sufferer or
sufferers may have procured fried fish from the special source, but, inasmuch as the sufferer or
sufferers consumed fried fish independently, and in most instances to a larger extent than did the
other members, these cases may fittingly be referred to at this point.
The cases 9, 11, 12, 22, 28, 35, 44, 53 and 100 present instances of sufferers from enteric
fever obtaining their fried fish from the special source ,while other 'members of the same
family were in the habit of eating fried fish, but obtained it elsewhere. Finally certain cases, of
which the particulars are given in the appended notes, may be referred to as containing information
as to particular dates on which fried fish from the special shop was consumed. In the cases
numbered 27, 36, 38, 62 and 97 the consumption of fried fish from the particular source can be
fixed with high probability, in some instances with certainty, as having occurred either on August
31st or September 1st, and on no other day. The course of the outbreak is such as to suggest that
infection occurred at about that time, and that it was not in operation for more than one or two
days.
Lambeth.
The outbreak in Lambeth presents certain points of similarity, and, on the other hand, certain
contrasts as compared with the Southwark outbreak. In the former, as in the latter, there was no
reason for supposing that drainage defects, water, milk, shell fish or ice-cream were accountable for
the spread of infection, while there was strong reason for suspecting fried fish. Particulars as to
the four last-named articles are given in the appended notes. The age distribution of the Lambeth
cases was unusual, and its departure from the ordinary distribution in ages was to some extent in
the direction observed in the Southwark outbreak, though the abnormality of the distribution in
ages was much less marked in the case of Lambeth.
For convenience of comparison with Southwark, a circular area extending a quarter of a
mile in all directions from a particular fried-fish shop has been taken, and this area is indicated
on the accompanying map, on which are shown all the cases in which symptoms of enteric fever
commenced between August 26th and September 24th.
The dates of onset of the disease will be found indicated on the table facing page 8.
It will be seen that the special prevalence commenced about a week earlier than the outbreak
previously considered, and that it terminated at the same time. As in the case of Southwark,
the cases have been arranged in three columns. Column 1 includes cases regarded for one reason
or another as unconnected with the special outbreak; column 2 contains secondary cases, while
the third column contains the cases which remain, the cases that is which constitute the outbreak.
As regards column 1, which contains the sporadic cases probably unconnected with the
special outbreak, it appears that these were somewhat less numerous than in Southwark. In the
western portion of the Lambeth area was a considerable extent of ground unoccupied by houses, and,
partly on this account, the population at risk of contracting enteric fever in the Lambeth circle was
somewhat less than in the Southwark circle.
As regards column 2, there is in one or two instances more difficulty in Lambeth than