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(ii.) In Lambeth (6 cases) on either side of South Lambeth-road, and again, in this
borough and in the adjoining parish of Clapham (8 cases), near the southern end of
Clapham-road.
(iii.) In Battersea (6 cases) in the neighbourhood of Battersea-park-road.
(iv.) In Wandsworth (5 cases) near the point where Garratt-lane approaches the
county boundary.
(v.) In Newington there is suggestion of grouping in two or three localities, but it
must be borne in mind that in the Borough of Southwark, of which that parish forms part,
there had been increased prevalence of the disease in weeks preceding the time now
under consideration, and some of the cases notified in the latter periods (over and
above the three cases excluded as already mentioned) may have been secondary cases.
Two groups of three cases are particularly noteworthy, one to the south-east of Kennington-park,
on the borders of Newington and Lambeth, and one near the southern end
of Walworth-road, and to these attention will be further directed later. (See 3rd and 4th
paragraphs from bottom of this page.)
The question of age and sex distribution, as well as that of the topographical distribution of
cases at this period, may be thought of as possessing importance in connection with inquiry as to
the nature of the superadded cause of enteric fever operating in South-West London during the
period in question. Examination of the returns shows that of the 70 cases on the map 40 were
males and 30 females, and that 45 were under and 25 were over 25 years of age. These results do
not deviate widely from the normal; there is, however, some slight tendency for younger ages,
and more particularly for persons aged 15-20, to suffer unduly.
Two hypotheses naturally present themselves as possible explanations of the superadded
cases—(i.) That in the 40 or 45 cases in question infection was water borne ; (ii.) that the cause
(infected fish), to which the Southwark and Holborn prevalences have been ascribed, had been
operative just prior to the 47th and 48th weeks in two or three areas in South-West London.
In connection with the first hypothesis, it may be noted that during late October and early
November the River Thames was in flood, the maximum height (5 ft. 1 in. above summer level)
being attained on October 30th; the height above summer level was still 4 ft. 9 in. on November
3rd, after which date the flood somewhat rapidly abated. From the water examiner's reports it
appears that " for the first ten days of the month [of November] the Southwark, Grand Junction
and Lambeth Companies' supplies were of bad quality, but after that time they steadily improved
in quality until the end of the month." The cases, constituting the groups above referred to,
sickened for the most part in the days between the 20th and 24th November, so that they must be
thought of as having been infected about the period November 6th to 10th.
It will be seen, therefore, that the flood attained its maximum a week or ten days before the
date at which infection in these superadded cases was probably contracted, though the contaminating
effects of the flood were still apparent at this date. An hypothesis of water-borne infection
is, of course, difficult of acceptance in view of the topographical distribution of the cases—the
exceptional incidence being clearly manifested only in the area of one water company, while there
is suggestion of grouping of the cases within that area. Such distribution would not, on the other
hand, be inconsistent with the second hypothesis referred to above, and the behaviour of enteric
fever in parts of London other than the south-western portion of the county, at about the time
when the unusual prevalence in South-West London was manifested, raises question as to whether
the same cause may not have been concerned in producing the several observed abnormalities of
incidence of the disease.
The following further points of interest may be noted in connection with this second
hypothesis—
One of the groups referred to under the head (v.) mentioned above was a striking one. It
consisted of two boys and a young girl belonging to families living at some distance from and
having no communication with each other, and each of these patients had, independently of other
members of his or her own family, partaken of fried fish obtained from a particular shop about a
fortnight before the commencement of illness. Attention was directed to the existence of these
cases by a man whose son had obtained fried fish from the same shop, had shortly after eating it
complained that it made him feel sick, and had then after a fortnight's interval developed enteric
fever. The series of events in this last case antedated * by about three weeks the corresponding
events in the later group of cases.
In a second group of three cases referred to under heading (v.), the patients who sickened at
about the same time had all shortly before that time eaten fried fish from one shop.
In examining most of the other groups occurring in the 43rd-49th weeks, I had the
help of Mr. Shapley, one of the Council's inspectors, and I am also indebted for assistance in
particular instances to Inspectors Lewis, Perry, Williamson, Garner, Gibb and Wood.
As regards the group in North Camberwell under the heading (L), no article of food had
been obtained, so far as could be ascertained, from one common source—fish had been frequently
eaten by all the sufferers at the time when infection must have been contracted, but it had not
been obtained so far as could be learnt from one and the same vendor. A shop near the centre
of the group of houses attacked had been an ordinary source of supply of the inmates of three of
these. Again, much fish was bought from hawkers, and in one instance the sufferer was the only
member of her family who partook of a dish of " lemon soles " purchased from a hawker about a
fortnight before the child began to be ill; the fish " tasted bad," and the mother said it must be
thrown away, but this particular child had then eaten her piece. The habit of buying from
hawkers was common amongst persons in this locality, but it did not transpire that any one
particular hawker had supplied all the sufferers.
* A further case was found to have occurred in this locality—the patient, a girl, had sickened a few days before the first of the
four cages referred to above ; she also had shortly before her attack from time to time bought fish at the particular shop.