View report page

London County Council.
Public Health Department,
8, St. Martin's-place, W.C.
April, 1904.
Report by the Medical Officer presenting report by Dr. Hamer on prevalences of
Enteric Fever in London at the close of 1903.
(Ordered to be printed by the Public Health Committee.)
Since the occurrence of the outbreaks of enteric fever in Southwark, Lambeth, and Kensal
Town,* which were investigated by Dr. Hamer, whose report I presented to the Committee in
January, 1901, the question has from time to time risen as to whether fish has again played a part
in spreading the disease in London.
In 1902 Dr. Allan, the medical officer of health of Westminster, called attention to a small
group of cases in which there was some ground for supposing fish had been at fault.t Another
case Dr. Allan reported was " believed to nave been contracted from eating fried fish while staying
at Old Ford." Dr. Newman, the medical officer of health of Finsbury, states that in that borough
in 1902 there were eight cases of enteric fever, concerning which there was some evidence that they
were caused by the consumption of fried fish.
Dr. Bulstrode, medical inspector of the Local Government Board, has called my attention to
references to the possible transmission of the infection of enteric fever by consumption of fried
fish contained in reports by Dr. Annis, formerly medical officer of health of Huddersfield, now
medical officer of health of Greenwich, and by Dr. A. S. Williamson, medical officer of health of
the Urban District of Sandal Magna.
The report of the third quarter of 1898 of the medical officer of health of Huddersfield contains
the statement that out of a total of 29 cases of enteric fever several " appear to have had a
common origin from a case occurring in the person of a fried fish shopkeeper, who, whilst suffering
from the earlier stages of the illness, still attended to his business without apparently having
a sufficient regard to cleanliness in all its details whilst conducting the same."
Dr. Williamson's annual report for 1899 describes how the occurrence of a case of enteric
fever in Heath-road, on June 17th, was followed from July 12th-14th by that of five other cases,
three in separate houses (one of the three being that of the keeper of a fried fish shop), and two
in the Heath-road house. Dr. Williamson writes: "At the house in Heath-road, of four children
who had been customers (the parents never ate fried fish) three contracted the disease; in another
house the patient was a lodger, and the only one in the house who had had fried fish; and in the
other case the patient was also the only one in the house who had."
The circumstances which led to Dr. Hamer's present inquiry were as follows—In
the week ending December 5th, 1903, Dr. Bond, the medical officer of health of Holborn,
raised question as to fish sold at two fried fish shops having caused enteric fever in his district, and
he later prepared a special report on the outbreak which he forwarded to the Council. I was from
the outset in communication with Dr. Bond and Dr. Allan (one of the shops held to be at fault
was situated in Westminster), and Dr. Hamer, at my request, conferred with them on December
14th and succeeding days, and made inquiries as to the source of the fish sold at the implicated
shops.
Examination of the notification figures directed attention to undue prevalences of enteric
fever in 1903 in other parts of London, and Dr. Hamer was afforded help by Dr. Millson, the
medical officer of health of Southwark, in making inquiries in that borough, and later extended
his investigations to other districts. It speedily became clear that a localised prevalence of enteric
fever in Southwark, occurring a few weeks before the Holborn and Westminster cases, was
in all probability due to consumption of fried fish, and it became necessary therefore to inquire as
to the possibility of mischief being thus caused in other parts of London during the closing
weeks of 1903. The localised outbreaks in Holborn and Southwark were on a smaller scale than
the prevalences in 1900 had been, but it was by no means clear that they represented the whole
of the cases due to distribution of infected fish in October, November and December, 1903. There
were, in fact, three periods subsequent to attainment of the autumnal maximum, when the number
of cases in some parts of London showed increase, one towards the end of October, another in the
51st and 52nd weeks, and an intermediate period. The tendency to grouping of cases in the
* In the Southwark and Lambeth outbreaks fried fish was incriminated. In Kensal Town fish sold in the uncooked condition (wet
fish) fell under suspicion.
† " One patient was a fishmonger and three others were regular customers buying fried 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 * * * to attribute his illness to oysters eaten off a barrow in the East-end."—Annual Report, Medical Officer
of Health of "Westminster, 1902.