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experience in Southwark seemed to point, and he later, as the result of further inquiry which
he caused to be made, came to the conclusion that an average of 80 per cent. of the houses in a
non-infected street were supplied with fried fish from Y's, whereas only 33 per cent. of the 24
infected houses were so supplied. From investigation which I had already personally made, and
which included inquiry addressed to the patients themselvesi while in hospital, it was clear that
the large majority, if not all the infected persons, were supplied from Y s. In order to obtain
further material on which to base an opinion as to the extent to which different parts of the area
were supplied from the fried fish shop, house to house inquiry was again made by the Council's
inspectors. The result of this inquiry was to show that—
In the three streets mainly affected in the western half of the area 31 out of 36
families, or 161 out of 212 persons—i.e., 76 per cent. of the population—had been in the
habit of obtaining fried fish from Y's.
In four other streets in the western half of the area, adjoining the three streets
already mentioned, 28 out of 46 families, or 99 out of 175 persons—i.e., 57 per cent. of the
population—had been in this habit; and in three streets close to Y's shop, but situated in
the eastern half of the area, only 38 out of 98 families, or 160 out of 390 persons—i.e., 41
per cent.—had been in this habit.
This house to house inquiry showed a considerably larger percentage of purchasers of Y's fish
among the persons living in the streets mainly affected than in those living in the other streets.
But the amount of fish consumed by inhabitants of a particular street depends not only upon the
number of purchasers, but also upon the frequency and extent of their purchases. Inquiry in the
streets mainly affected showed that many of the inhabitants were in the habit of buying fried fish
very frequently, while, on the other hand, one of the Council's inspectors who made inquiry in two
streets in the eastern half of the area, but quite close to the fried fish shop, reports " if the statements
of the occupiers are to be believed, they all partake very sparingly of fish."
In this connection it is deserving of note that while the streets mainly affected to the west
of the fish shop are occupied by a very poor class of persons, the corresponding streets just to the
east of the shop appear to be occupied by a class a little less poor. Another point which must be
borne in mind is that two of the affected streets form practically a cul de sac, and people who live
in them and in two adjoining affected streets are from the topography of the locality necessarily
compelled to go eastwards to do their shopping. To the west are extensive premises occupied by a
railway company; to the north and south houses are occupied as residences and not for bus:ness
purposes, so that the only available shops are in the main road to the east of the specially-affected
streets. In this road, close to the opening of the cul de sac already referred to, and immediately
opposite one of the streets mainly affected, is the fried fish shop.
On the other hand, inhabitants of the streets in the eastern half of the area, while they no
doubt largely make use of the shops in the main road, in which the fried fish shop is situated, are
not necessarily constrained to go westwards; there are shops on all sides of them, and that they go
to the shops on their east and north and south, as well as to those on their west, is shown by the
results of the house to house inquiry made by the Council's inspectors.
The attempt was made to gauge the extent to which the inhabitants of different streets
frequented the fried fish shop, by keeping observation on the shop, and noting the streets to which
purchasers of fried fish returned. It was found, however, that purchasers of fish, after leaving
the shop, did not, in a large number of instances, go straight home, but that they either proceeded
to make other purchases, or in some instances went into a place of entertainment situated near
the shop, and in one way or another many persons were lost sight of and could not be traced.
As the outcome of the observations made, it transpired that 101 persons out of a total of
481 who came out of the fish shop returned to the three streets mainly affected in the outbreak.
While it may be inferred that most of the 101 persons lived in the three streets to which they
returned, it is probable that a number of the other persons making up the total of 481 also did
so. Apart, however, from the difficulty of allocating persons leaving the shop to the houses in
which they lived, it became clear in the course of the inquiry that no estimate based upon observations
made subsequent to the outbreak could be precisely accurate, as several of the families,
particularly those living in the streets mainly affected, were found to have then ceased to purchase
fried fish at Y's shop.
A fact of some interest in connection with the observations made with regard to persons
leaving the fish shop was that the proportion of persons returning to the three mainly affected
streets showed considerable variation at different times : thus, on a particular Tuesday morning,
it was only 13 per cent. of the total number leaving the shop, while on the following
Friday morning it was 30 per cent. On Saturday evening it was 19 per cent., but
at this time in particular it was clear that only a comparatively small number of
those visiting the shop returned, on leaving it, straight to their homes. Having regard to the
facts ascertained in Southwark as to the connection between fish eating and modifications of
ordinary domestic routine (occasioned, for instance, by washing days), it may well have happened,
in view of what has just been said, that on a particular day or days a very considerable percentage
of the persons visiting the shop came from the three streets mainly affected. The marked
incidence on these three streets is none the less in contrast with the greater uniformity of
distribution of cases around the Southwark fried fish shop, and the facts stated in the latter
instance as to marked diminution of intensity of incidence, on proceeding outwards from the
particular shop, have not a parallel in Lambeth. In connection with these circumstances
the smaller magnitude of the Lambeth outbreak must not be lost sight of as being likely to yield
a less symmetrical distribution of cases, and the peculiar topography of the area taken in conjunction
with differences in the character of the populations to the east and west of the fried fish shop
are certainly considerations to which weight may be attached, as possibly affording explanation
of the greater incidence of disease upon the streets which were mainly affected.