View report page

9
it at the time of the prevalence of 1903 in areas iv., v. anil vi. It was found that this area showed
excessive incidence of enteric fever during the period 1896—1903, and the behaviour of the disease
in it in 1899 and at the close of 1900 and beginning of 1901 is noteworthy.
Charts xviii. (an area in llotherhithe) and xix. (an area in Bermondsey) furnish two further
examples of localities specially involved in 1899 and 1900. In both these instances the proportion
of black squares is much below the normal 50 per cent. and, further, examination of the charts
brings to light a very striking prevalence in area xviii. in the year 1901 and one in area xix.
(small in extent but with no black squares) in the following year.
Most of the areas examined are occupied in the main by poor people, the streets being, as
a rule, coloured light blue or purple on Mr. Charles Booth's poverty maps.* For purposes of comparison
two areas, altogether apart from any question as to enteric fever prevalence in them,
numbers xi. and xii., Lisson-grove and Somers-town, have been taken as presenting instances
of poverty-stricken localities. It will be seen that the charts for these areas exhibit from time
to time throughout the period 1896-1903 some suggestion of affinity to the charts already given,
the behaviour of the disease in Somers Town in 1900 being specially noteworthy in this connectiou.
In these two areas it will, however, be found that the percentages of cases at the ages 0-2
and 26 onwards to the remaining cases are above the normal, viz., 67 and 54 respectively.
All the areas hitherto examined, including xi. and xii., resemble one another not only in
comprising, in the main, light blue and purple streets, but also in forming centres in which fried
fish is largely consumed. It might at first sight be supposed that it would be possible to determine
to vmat extent the one, as opposed to the other condition, was associated with phenomena
such as those exhibited in the charts. The attempt has been made to find an area in London occupied
by the particular classes of the population in question and in which fried fish is not largely
eaten. This attempt has been quite unsuccessful. In Deptford some approximation to such an
area had, it was thought, been discovered, but there were fried fish shops immediately outside and
within easy reach of the locality, and the inhabitants were, no doubt, to some extent consumers of
fried fish.t
With a view to throwing light on the question how far poverty per se could be held
accountable for abnormal age-incidence of enteric fever, study has been made of the figures
furnished by five London boroughs, two rich and three poor, for the years 1898, 1900 and 1903.
In Kensington and Wandsworth, on the one hand, the higher ages (over 25) manifest a greater
tendency to be attacked than is, on the other hand, the case in Stepney, Southwark and Bethnal
Green. The fact is in part explained by differences of age distribution of the several populations,
but it is not thus wholly accounted for. The tendency for persons aged 3-25 to be affected in these
boroughs is not equally marked throughout the whole period under examination; indeed
—more particularly in the poorer boroughs—this tendency is evinced in notable degree at special
times; in fact, the abnormality of age-incidence is generally observed coincidently with the occurrence
of localised outbreaks of the disease. So far as the figures examined go, they do not suggest
that the phenomenon in question has any definite relation to a particular season of the year.
Inasmuch as Stepney and Bethnal Green yield the highest percentages among the boroughs
examined of cases at the ages 3-25, further study has been made of particular areas in these two
East-end boroughs, and charts xx-xxiv. have been prepared. These charts show that the
abnormality of age-incidence (high percentage of hatched squares) generally presents itself at
times when exceptional prevalence of the disease is manifested.
In area xx. (in Stepney) the outbreak in 1899 is noteworthy, and the area is one in which
four cases—account of which has been given in paragraph 4, p. 7—occurred at the close of 1903.
Area xxi. (in Stepney) furnishes appearances at the close of 1899, 1901, 1902 and 1903
strongly suggestive of an infected food supply being at fault.
Area xxii. (in Bethnal Green) presents features in 1899 which raise a similar suspicion.
Area xxiii. (Bethnal Green) is less striking, though here the high percentage of hatched
squares in the period 1896-1898 and in 1900 is noteworthy.
Area xxiv. (in Bethnal Green) yields notable outbreaks in 1897 and 1899.
In summary it may be stated, with regard to the areas i., ii., iii., iv., v. and vi., in which
outbreaks of enteric fever, presumably due to consumption of infected fish, occurred at the close
either of 1900 or 1903, that the disease has, throughout the period examined, been unduly
prevalent in them and that there is reason for suspecting that the cause of the 1900 and 1903
outbreaks came into operation at other times during the years 1896-1903.‡
Turning now to the areas which have been examined on account of the excessive prevalence
of enteric fever in tfiem—in the autumn of 1899 or of 1900, or at some other date within recent
years—the distribution in time of the cases, and the abnormal age-incidence, in all save viii., of the
disease, suggest that some food supply has been intermittently at fault throughout the period
named. The close association of the phenomena to which attention is specially directed with
poverty must, of course, be admitted, but it may be that an article of food consumed bv poor
persons is one of the connecting links between poverty and these exceptional outbreaks of disease.
Communication of the disease from person to person has no doubt to some extent been operative
in these areas, but the manner of occurrence of multiple attacks in houses is not such as to suggest
that this cause alone adequately explains the altogether abnormal incidences observed.
* Mr. Booth's scheme of classification, beginning from below, included— black, lowest class, vicious, semi-criminal; dark blue. very
poor, casual,chronic want; light blue, poor, 18. to 21s. a week for a moderate family; purple, mixed, some comfortable, others poor—
and so upwards. Black and dark blue are comparatively little represented in the 24 areas on the diagram; light blue aud purple
generally speaking dominate those areas.
†In this are a there was comparatively little enteric fever during the years 1896-1903, and the proportion of hatched to black
squares was. as a matter of fact nearly normal, London as a whole being taken as the standard.
‡ With regard to the two areas ix. and x., surrounding fried fish shops carried on under the same name as that of the owner
of the shop implicated in outbr ak ii., there is some slight ground for suspecting that these shops may have acted as sources of infection
at one time or another during the period reviewed.
[2]