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London County Council.
ENTERIC FEVER IN LONDON.
Report by the Medical Officer submitting a report by Dr. Hamer on certain localised
prevalences of Enteric Fever in London in September, 1900.
(Printed by order of the Public Health Committee, 6th December, 1900.)
Public Health Department,
8, St. Martin's-place, W.G.,
January, 1901.
1.—In presenting to the Public Health Committee Dr. Hamer's report on outbreaks of enteric
fever occurring in September, 1900, in Southwark, Lambeth and Kensal-town respectively, having
regard to the conclusion at which Dr. Hamer has arrived, that an article of food not hitherto suspected
of causing enteric fever has done so, I may refer to the method adopted in the inquiry into the circumstances
of these outbreaks.
2.—Dr. Hamer has in each case selected a defined area in which the persons attacked with
enteric fever resided, and has so far as practicable compared all the circumstances of those persons with
those of other people living in the same area, but not infected with this disease. As the result of this
comparison he has been able without any difficulty to negative the possibility that any of the agencies,
commonly accepted as producing enteric fever, were concerned in the first two of these outbreaks, and
the evidence he obtained has failed to show that any such agency was the cause of the third outbreak.
It became obvious quite early in his inquiries in Southwark and Lambeth that the behaviour of the
disease, its rapid appearance in a considerable number of persons, its multiple invasion of houses, and
the peculiarities of the age distribution of the cases, were probably explicable on the hypothesis that
infection had been received with a food supply. In his inquiry, one fact presented itself to him with
overwhelming evidence, viz., that fried fish purchased at particular shops, one in Southwark the other
in Lambeth, was the one and only article of food of common origin which had been partaken of by the
sufferers as a whole in these areas. In the absence of any other adequate explanation of the phenomena
he has intimately examined the possibility of this food being related to these outbreaks, and has come
to the conclusion that the evidence on this question is so strong that this relation must be accepted.
He has therefore stated all the circumstances bearing upon this hypothesis. In Lambeth, however,
the connection between this article of food and the cases of enteric fever is perhaps less obvious than
in Southwark, but there is much reason for thinking that this is due more to the smaller number of
cases occurring and to conditions special to this area and which relate to peculiarities of topography
and to distribution of persons of different social conditions and habits, than to any fundamental
difference in the value of the evidence which is adduced. In the case of Kensal-town, the evidence
which would tend to incriminate fish is in no way conclusive, but in the absence of other explanation
of the attack of a number of persons with enteric fever, and in view of the evidence obtained in the
investigation of the other outbreaks, it suggests the possibility that this food may have been the cause
of a number of cases of enteric fever in that district.
3.—It needs to be stated at the outset that Dr. Hamer's inquiries have related to areas in which
apart from the special cause under consideration, some amount of enteric fever may be expected, and
especially in the month of September, when the natural autumnal prevalence is established. He has,
therefore, in his examination of the circumstances of each case of this disease endeavoured to exclude
such cases as would, without any special superadded cause, have occurred in the defined areas, and
further, to separate from cases which he believes to have been directly due to the special cause those
which may be presumed to be due to personal infection received from an antecedent ca8e. The result
of so doing has left him with a large balance of cases which do not fall under either of the above
headings and which he has described as the cases constituting in each area the " special outbreak."
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