Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
[Report of the Medical Officer of Health for London County Council]
fried fish obtained from a shop in the south-western quadrant of the circle of one-quarter-mile
radius. This shop is referred to in the appended notes as that of Mr. z.
The attempt was made in each instance to learn the source from which the fish sold by
Messrs. X, Y and Z was obtained. It was not, however, found possible to pursue this matter. The
three vendors obtained their fish from Billingsgate. Mr. X also obtained considerable quantities
of fish direct from Grimsby.† It was said to be impossible to trace for each day the source from
which the consignments purchased came; so many different middlemen were dealt with by
Messrs. X, Y, and Z, and complete records of purchases effected were not kept. Inquiry was,
moreover, made as to the existence of cases of illness, just before the time of the outbreak, among
the persons living at the fish shop premises, or employed by Mr. X, with a negative result.
The conclusion to which the facts which have been summarised appears to me to point is
that the local prevalence of enteric fever observed in Southwark during September, 1899, must
be attributed to the consumption by the sufferers of fish, purchased from a particular vendor,
and almost entirely in the form of fried fish. In the light of this conclusion the outbreaks of
enteric fever occurring at about the same time in Lambeth and in Kensal Town must, in the absence
of any adequate explanation of their cause, and in view of the fact that so considerable a percentage
of sufferers in the one case consumed fried fish from a particular fried fish shop, and in
the other were in the habit of making purchases at a general fishmonger's shop, be regarded as
possibly, and, in the case of Lambeth, probably admitting of similar explanation.
W. H. Hamer,
Assistant Medical Officer of Health.
Notes as to cases of Enteric Fever in Southwark, Lambeth and Kensal-town.
The inquiries as to milk, fish, &c.. were of course directed to ascertaining from what source
those articles of food were obtained, at a time which would correspond with the period when infection must
have oocurred. Local milk vendors are indicated by letters A, B, C, &c., and ice-cream vendors by the
same series of letters, but the two sets of letters must not be in any way connected with one another ;
again there is no connection between the letter3 A, B, &c., used to designate vendors in the three
districts Southwark, Lambeth and Kensal Town.
(The cases which may be regarded as constituting the special outbreak are those numbered 6 to 110.)
|No.||Date of onset of illness.||Date of notification.||Sex and age.||Milk supply.||Ice-cream.||As to consumption of fish, fried fish, shell fish, &c.||As to use of swimming baths.||Remarks.|
|1||Aug. 16||Sept. 22||M. 21||Head brand||Never||Obtained from three sources, which he names. Never from X||Never||...|
|2||Aug. 19||Sept. 6||F. 20||...||...||Was living away from the district at the time when her illness must have been contracted||...||...|
|3||Aug. 24||Sept. 7||F. 34||Condensed||Never||Sometimes buys winkles from X, but never obtains fish or fried fish there||Never||...|
|4||Sept. 1||Sept. 14||M. 3||A||Never||Obtained from a source named. Never from X||Never||Proved not to be enteric fever.|
|5||Sept. 3||Sept. 21||M. 35||B||Never||Never from X. Was much away from affected area.||Never||See case 73.|
|6||Sept. 4||Sept. 23||M. 11||Condensed||Never||Mother buys winkles, skate and plaice from X. The boy himself, just before his illness, was in the habit of buying fried fish there, but other members of the family do not have fried fish||Goes to the X baths||Eats watercress sometimes.|
|7||Sept. 5||Oct. 3||F. 18||Condensed||Yes, but source not ascertained||Fond of fried fish, which she obtains from X. Other members of family do not have it. She often purchases it for her mid-day meal, which she eats away from home Also obtains winkles from X||Never||...|
†The supply for Mr. Y's shop and for two other fried-fish shops at some distance from it but in the same
management was, according to the statement of the manager, purchased at Billingsgate-market by the same
individual, and as a rule came from market to the three shops in the same cart. There had been no marked
prevalence of enteric fever in the neighbourhood of these other shops.