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17
In water epidemics of cholera and typhoid fever the question of the escape of particular
communities has repeatedly been urged as a difficulty; it is only necessary to refer to the escape
of the East London Industrial School and other institutions in the cholera outbreak of 1866, and
to the escape of the village of California and certain groups of houses in the Tees Valley outbreak
of enteric fever. Having in view the smallness of the total number of cases in Lambeth, it might
be anticipated that in some streets three or four households would be attacked, while other streets
would altogether escape, even if the matter were one of pure chance; having regard to the certainty
that inhabitants of the streets specially affected purchased to a greater extent than inhabitants of
other streets, and to the possibility of their having purchased on a particular occasion or occasions
to an altogether disproportionate extent, the fact that in certain streets to the west of the shop
there were six, seven and eight infected households, while in other streets there was only one
infected household, or there were none at all, cannot be regarded as a serious difficulty.
In Lambeth, as in Southwark, it is noteworthy that in several instances there is a history
of the person attacked by enteric fever obtaining fried fish from the particular shop, while other
members of the household who escaped probably did not. Cases 7, 12, 14, 15, 19, 20, 45 and 45a
afford instances of this. In the family to which case 12 belonged the facts were particularly striking.
This child and her two sisters, cases 20 and 43, were stated to be the only customers of Y in the
family, which is a large one. Cases 12 and 20 were both attacked by enteric fever. Case 43 and
the baby of the family, case 44, did not sicken until quite towards the end of the outbreak,
and these cases may have been really secondary cases. As regards the baby she is not
definitely known to have eaten fried fish, but her three sisters, who were frequently left in charge
of her, all did so, and as it is a not uncommon practice of purchasers of fried fish in the neighbourhood,
if they take a baby into the shop, to give it a bite, it is probable that this particular
baby did have some. The evidence afforded by, the history of cases 12, 13, 19, 22 and 28 is of
interest, as showing that in all instances in which fried fish was definitely stated to have been consumed
on a particular day, that day was either Friday or Saturday. In case 41 the usual day for
purchasing fish was Friday, but just about the time when infection must have occurred there was
a birth in the family, and the children, cases 41, 42 and 51, were, by reason of this circumstance,
given money each day to buy their food out of doors, and the mother of case 41 stated that they
purchased fried fish from Y daily at that time.
Kensal Town.
The facts as to Kensal Town need be only very briefly referred to. In this locality there
was no marked incidence upon consumers of fried fish from any particular shop. There was, however,
a somewhat strinking incidence upon persons purchasing fish or shell fish at a general fishmonger's
shop, and also upon persons ultimately obtaining their milk from a milk company doing a very
large business. For purposes of comparison with the other areas, an area within a one-quarter
mile radius of the fishmonger's shop, referred to in the appended notes as the shop of Mr. Z, has been
taken. The distribution of the disease in point of time is indicated on the table facing page 8.*
The total number of cases occurring in the area was considerably smaller than 'in Lambeth
and much smaller than in Southwark. The cases in which no connection with Z's shop was
definitely traceable are indicated by the numbers in black in the first column of the table. In
some of these there was reason for concluding that infection had been contracted altogether away
from the district. The cases in the first column of the table are actually less numerous
in Kensal Town than in the other districts, but the proportion they bear to the total number of
cases is far greater, the outbreak in Kensal Town not attaining the magnitude reached in the
other districts. All the other cases, those numbered in red, had made purchases at Z's shop,
though, as regards the cases marked J, it should be noted that the fact of such purchase was only
stated by case 29, a secondary case; the member of the household first attacked, case 5, being a girl
who was unable to recollect from what source she had obtained fish or shell fish. Of the 21 cases
which occurred within a quarter of a mile radius of the shop between August 25th and September
17th, 16 (if case 5 just referred to be included) certainly obtained fish or shell fish at Z's shop.
There may be some question as to whether two of the remaining 5 cases did not also do so; one of
these two, and a third case, lived, at the extreme boundary of the quarter-mile circle; with' such
a small total number of cases the fact of the inclusion or exclusion of a case living at the
limits of the area considerably affects the numerical result. The incidence upon purchasers of fish
or shell fish from Z can, however, only be regarded as assuming some importance by reason of the
phenomena coincidently manifested in Southwark and Lambeth.
As regards milk, the supplies of the local vendors, A, B, C, H, I, and on occasion that of F,
were in part derived from one large company. It will be seen therefore that of the 21 cases
referred to above, and occurring between August 25th and September 17th, 14 almost certainly,
and possibly one other case, were obtaining milk supplied by this company. The incidence upon
persons supplied through one or another agency by the milk company was therefore nearly as
great as upon persons who purchased fish at Z's shop. Having regard to the extent to which milk
derived from this company was being distributed in the neighbourhood of the area affected in
Kensal Town, the former incidence cannot be regarded as specially remarkable.
It is interesting to note that a fried fish shop is situated close to the centre of the area of
one quarter-mile radius already defined, but in only one of the families affected by enteric fever was
fried fish from this shop consumed. On the other hand seven of the 21 cases mentioned above ate
* The facts ascertained concerning one of the cases indicate that in all probability in this case infection
occurred on August 23rd. The child (case 7 in appended notes) had been away from home for three months, and
returned to Kensal-town on the 23rd of August. She and other members of the same family (cases 3, 4, and 9)
were attacked between August 27th and August 31st. If the child who had been away was infected in Kensaltown,
it is probable she was infected immediately on her return.
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