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Iii view of tlie inquiries made by officers of the sanitary authorities, it may be assumed
that milk cannot have played any considerable part in causing these outbreaks, and the localised
distribution of the cases is not consistent with an hypothesis of water-borne infection. In a
number of the areas inquiries have been made from which it appears clear that infection by icecream,
watercress or shellfish would not account for any considerable percentage of the cases ; in
each of them, however, fried fish is largely consumed, and while it has been found impracticable,
owing to removals, death and absence from home, to make inquiry of individuals on any comprehensive
scale, it is at least clear that an hypothesis of infection by fish is consistent with such
facts as have been ascertained concerning the general habits of the populations in question.
The inferences drawn in this report suggest that it by no means follows because outbreaks of
the magnitude of those of 1900 in Southwark and Lambeth are of quite rare occurrence, that the
infection of enteric fever is only exceptionally transmitted by fish. That such transmission is not
more often recognised may be in part due to the very fact that the mischief is widespread and not
localised. While the consumption of oysters, cockles, etc., a fortnight before attack by enteric
fever is regarded as significant, no corresponding importance is attached to consumption of fried
fish. This attitude of mind, it may be said, is justified by the consideration that fried fish eating
is common, and the eating of oysters, cockles, etc., rare. If a food be frequently consumed
this in itself tends to render it unlikely that notice will be directed to it, while on the other hand,
oysters, etc., which are rarely purchased, are, partly on that account, more likely to be regarded
as a possible source of mischief. In the case of fried fish, as in that of oysters, the sufferer
is often the only member of the family who has consumed the food, and this renders inquiries at
the home, after the removal of the patient to hospital, unlikely to be productive of positive
result. Again, in the comparatively rare instances in which inquiries as to fish have been
made by sanitary inspectors, they have been limited to the question as to fried fish ; there is, of
course, no reason for supposing that frying enhances the infectivity of fish, though it may perhaps
be a fact that the kind of fish which is apt to convey infection is, as a rule, fried. Plaice, haddock
und skate are the species of fish ordinarily fried, but it is noteworthy that in all instances
save one (in which question arose as to " lemon soles ") suspicion has fallen upon " plaice "—under
which term " flounders " and " dabs " are apparently often included by fishmongers.
Experience in Southwark in 1900 indicated that it was the " halfpenny bit" which was
especially mischievous, and it was found that this consisted in some instances, at any rate, of an
entire fish, and, therefore, of a very small one. " Dabs " and " small plaice" are sometimes
bought in quantity at Billingsgate, more particularly in the summer, at times when large fish are
scarce. In July, 1901, " dabs " were being sold at that market at 3s. to 2s. 6d. per trunk of about
84 lbs.—i.e. at approximately ½d. per lb. As it takes one man about 1½ hours to clean a trunk of
small fish, the temptation during busy times to remove the heads only, the fish being fried with
the gut in them, must be great; in the case of small fish there is, moreover, special difficulty in
removing the gut. It is noteworthy in this connection that sufferers from enteric fever have in
several instances complained that the fish eaten by them had a disagreeable flavour, and even that
it made them sick, while insufficiently cleansed fish is, it appears, well known to have a characteristic
bitter taste. Imperfect gutting is apparently far from uncommon, at any rate at busy
seasons. I have seen small fish from which the heads and portions of the intestinal contents had
been cut away by one stroke of a knife but from which the gut had not been completely removed,
displayed for sale in a fried fish shop, and among some 30 or 40 penny and halfpenny pieces of
fried fish purchased two samples were obtained—one from North London and one from South
London—in which the intestines were in the fish. It may be surmised that frying under these
conditions, having regard to the short time of exposure in the dripping or oil to a high temperature,
would be unlikely to result in sterilisation of the intestinal contents.
W. H. Hamer,
Assistant Medical Officer of Health.