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3
Dr. Hamer's Report.
During the first two weeks of December, 1903, Dr. Bond, the medical officer of health of
Holborn, made inquiry concerning a group of cases of enteric fever in that borough, and found
"the only article of food that had been eaten in common was fried fish obtained from two
shops." One of these shops was in Westminster, and Dr. Bond communicated the facts observed
by him to Dr. Allan, the medical officer of health of that city, who ascertained there was reason
for concluding that fish purchased at the shop in question had been consumed by one or more
persons recently attacked by enteric fever in Westminster, and he subsequently mentioned the
suspicion entertained to the Council's medical officer. At Mr. Shirley Murphy's request I conferred
witu Dr. Bond on December 14th, and was then informed by him that in most of the cases notified
during the preceding fortnight he had elicited the history that shortly prior to attack the patient
had consumed fried fish from one of two shops.* I conferred with Dr. Allan later in the day, and we
visited the fried fish shop in Westminster. On succeeding days further inquiries were prosecuted,
and with a view to learning whether the two shops received fish from a common source, I called
upon Dr. Collingridge, the medical officer of health of the City of London, who gave me facilities
for ascertaining the facts as to those portions of the two fish vendors' supplies which were obtained
from Billingsgate.
Meantime, it was found that in other parts of London there had recently been small exacerbations
of prevalence of enteric fever, and these were made the subject of further investigation.
Special attention was devoted to areas in Southwark, Camberwell, Battersea, Lambeth and Stepney,
in which during the closing weeks of the year the behaviour of the disease presented unusual
features. In Camberwell Dr. Stevens, the medical officer of health, had noted that almost all the
invaded houses were supplied by the Southwark and Vauxhall Water Company. For the most part
the houses involved in Camberwell were situated in portions of the borough in which water was
supplied exclusively by that company, hence the incidence of enteric fever upon houses so supplied
was possibly explicable as resulting from the fact that the disease happened to affect a Southwark
and Vauxhall supplied area.
In Southwark, just over the borders of Camberwell, both the Southwark and Vauxhall
and the Lambeth companies were supplying water; there were still, in fact, in parts of this
district, as was the case nearly half a century ago, in the time of cholera prevalence in 1854, two
" mutually interfused" populations living in the same streets having other circumstances in
common, but one obtaining water from the Lambeth and the other from the Southwark and Vauxhall
Company. The investigation of the Southwark cases was therefore undertaken in the
first instance with a view to throwing light upon the question of water supply. I accordingly
called upon Dr. Millson, the medical officer of health of Southwark, who placed the services of
one of the officers of his department at my disposal, and we commenced a visitation of infected
houses. It then soon became clear that there had recently been a well-defined localised prevalence
of enteric fever in an area immediately to the east of Walworth-road. Detailed inquiries as to
the water supply of this area were at once instituted, and this duty was undertaken by two of
the Council's inspectors, Messrs. Perry and Swinson.
As my own inquiry progressed it became clear the evidence to hand strongly pointed
to the conclusion that the localised prevalence referred to above was attributable to the consumption
of fried fish obtained from a particular shop. It was therefore a matter of much
interest to find that the houses in the near neighbourhood of this shop constituted as it were an
island of buildings exclusively supplied with Southwark and Vauxhall water, while surrounding
houses were supplied some by the Southwark and Vauxhall Company and some by the
Lambeth Company. Thus, on the assumption that an infected article of food had been
distributed from this shop and had caused the localised prevalence, the involvement of the water of
one company to the almost complete exclusion of that of another was at once explained ; the
area in question being a Southwark and Vauxhall supplied area, the fact that houses deriving
water from this company were especially attacked, may be regarded as a mere coincidence. It will,
however, be seen in the sequel that, the Southwark outbreak apart, there was reason for concluding
that the behaviour of enteric fever in other parts of the Southwark and Vauxhall Company's
area of supply had been exceptional, and that some special cause of enteric fever had operated in
South-West London during November and December. In point of fact, further inquiry led to the
entertainment of a strong suspicion that infected fish had been somewhat widely distributed in
London during this period, but that a considerable proportion of the whole amount had been sold
in South-West London. Again, on reviewing the facts ascertained, the further suggestion
presented itself that enteric fever might have been intermittently caused at various times during
recent years in numerous widely separated parts of London by the agency in question.
The reasons for entertaining this suspicion are briefly set out in section (d) of this report.
In sections (a) and (I) the Holborn and Southwark outbreaks, respectively, are dealt with,
and in section (c) the behaviour of enteric fever in South-West London during November and
December, 1903, is referred to.
* Reference may here be made to the question as to the extent to which fried fish is consumed in certain localities in
London. Inquiry in Southwark in 1900 showed, taking an area bounded by a circle with a radius of a quarter of a mile, having
as its centre a fried fish thop, that 42 per cent, of the population had, shortly prior to the time of inquiry, eaten fried fish from
the particular shop, 16 per cent, had eaten fried fish obtained from other sources and 42 per cent, had not eaten fried fish at
all. The area chosen in Southwark was one in which fried fish was consumed to a quite exceptional extent, and it may be
assumed that the percentage of persons eating fried fish from a particular shop, viz., 42 per cent., would be very unlikely to be
exceeded in any area of the same size and configuration elsewhere.