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Bill authorised county councils to enter upon any oyster laying and take samples, and to prohibit
the sale of oysters from polluted layings, unless the oysters were before sale laid down for a
specified period in a laying free from contamination. The select committee, however, substituted
the sea fishery boards for county councils, and the President of the Local Government Board in
consequence withdrew the Bill.
In view of the occurrences of enteric fever due to contaminated shellfish, the County Council
on the 3rd February, 1903, on the recommendation of the Public Health Committee, adopted the
following resolution : " That a letter be addressed to the Local Government Board expressing the
Council'8 hope that, in the interests of the public health, the Board will, as soon as possible, take
steps to obtain an amendment of the law so as to prohibit under heavy penalties the laying down of
all edible forms of shellfish in sewage-polluted creeks or other dangerous localities, and the sale
of such shellfish for human consumption; and that all unpolluted layings, fattening beds and
storage ponds at present in use may be protected from pollution by sewage by any person or sanitary
authority." The subject is now being considered by the Royal Commission on Sewage Disposal.
It will be recollected that in the year 1900 Dr. Hamer, as the result of an inquiry on
behalf of the Council into certain local prevalences of enteric fever in London, came to the
conclusion that a localised outbreak of some magnitude in the parish of St. George-the-Martyr was
due to the consumption of fish from a particular fried fish shop. During 1902 Dr. Allan observed
in Westminster the occurrence of certain cases which appeared to be attributable to a similar
cause. He writes:44 It is now known that infection may sometimes be communicated through,
fish where not thoroughly cooked, and in this connection a small group of cases which occurred
is interesting. One patient was a fishmonger, and three others were regular customers buying
fresh fish; the fishmonger and two of his customers were probably infected about the same date,
but in the fourth case symptoms did not appear till a month later, and the patient is inclined, for
reasons mentioned above, to attribute his illness to oysters eaten off a barrow in the East End.
The drainage of the fishmonger's house was bad. Another case is believed to have been contracted
from eating fried fish while staying at Old Ford." Dr. Newman also states that in Finsbury there
were eight cases of enteric fever, concerning which there was some evidence that they were caused
by the consumption of fried fish. In Woolwich, in two instances infection had been preceded by
the eating of fried fish, and in Greenwich in three instances.
The consumption of ice-creams was probably responsible for the attack by enteric fever of
twelve boys in June in the Borough of Finsbury. I)r. Newman states that they had all had icecream
about the same time, and as far as could be gathered from the same source, namely, hawkers
in the street. In six other cases in Finsbury, in which no other cause of infection, the patients
attributed their illness to ice-creams. In Paddington, a case of enteric fever occurred, the
person attacked having eaten ice-cream at a period before the illness which was consistent with it
being the cause of the illness. In Woolwich the attack of three persons had been preceded by
the eating of ice-creams.
Watercress as a possible means of infection is mentioned in two reports. In Camberwell
one or more of the persons attacked attributed their illness to the eating of watercress, and in
Woolwich in two cases attack had been preceded by the eating of watercress.
In several reports mention is made of the occurrence of cases due to infection from person to
person, and Dr. Bryett records the occurrence in Shoreditch of series of cases probably caused in
this way. In one of these series the first case was a girl aged 15 years who died, but the nature
of whose illness had not been recognised ; her illness was followed by the attack of a young sister,
a young brother and her mother, who became ill within a few days of each other. A few days later
an adult relative living in another house, but who had helped in the nursing, and also the father of
the family were attacked. Two younger children of the family were sent to Croydon, but were
ailing at the time, and later an inmate of the house in which they were staying was attacked by
enteric fever. In a second series the attack of a brother, sister and father followed that of the
first case, a child aged five years. In Woolwich five cases were due to direct infection, three living
in the same dirty house as the primary case, and the other two being employed in nursing the
primary case. In Lambeth five cases were infected by preceding cases in the borough. In Wandsworth
in eight cases out of 139 the disease was known to have been contracted in this way. In
Battersea 10 such cases occurred. In Paddington two persons contracted the disease from nursing
others. In Hacknev there were four secondary cases and in Finsbury seven.
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The Widal test was more largely used ill 1902 than before for the diagnosis of enteric
fever. In Fulham 54 such examinations were made, the result being positive in_20. In Westminster
a positive result was obtained in 25 examinations, in St. Pancras 34 in 77 examinations,
in Islington 45 in 114, in Finsbury 7 in 18, in Shoreditch 3 in 7, in Poplar 60 in 115, in
Bermondsey 17 in 38, in Lambeth 34 in 91, in Wandsworth 2 in 6, in Camberwell 13 in 3G, and
in Woolwich in 13 of 30 examinations.
Enteric fever—Age and sex distribution.
The following table shows the cases, deaths, case-rates, death-rates and fatality of
enteric fever during the year 1902 in London. The case-rate at " all ages" was greater among
males than among females, as were also the death-rate and fatality. In the age-groups adopted
for the purposes of this table the greatest incidence of attack was upon males aged 10-15 and also
upon females of the same age-period. The greatest incidence of death was upon males age 20-25,
and upon females aged 25-35. The fatality was greatest among both males and females aged
55 and upwards.