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REPORT BY Dr. HAMER, MEDICAL OFFICER (GENERAL PURPOSES), ON LOCAL
PREVALENCES OF ENTERIC FEVER IN BETHNAL GREEN AND SHOREDITCH
DURING 1908.
A local outbreak of enteric fever occurred in Bethnal Green during the months of September
and October. After conference with Dr. Bate, the medical officer of health of Bethnal Green, and
with the assistance of Mr. Henley, one of the sanitary inspectors, I made inquiry at the houses of the
persons attacked and I later visited most of the patients after their removal to hospital. In summary
of the conclusions ultimately reached it may be here at once stated that it appears to be clear that
the outbreak was caused by infected food, and that while a hypothesis of shell fish (mussel) infection,
which prima facie appeared a plausible one, is not in accord with the phenomena observed, a hypothesis
of infection by fish must, on the other hand, having regard to all the circumstances, be looked upon as
affording a possible explanation of the Bethnal Green prevalence.
The special Shoreditch prevalence was more strictly limited in area, but not so limited in time
as the Bethnal Green prevalence. Cases had already occurred in the affected area in Shoreditch early
in the year (subsequent inquiry revealed the fact that there was some prevalence in the Bethnal Green
area at this time also) ; but in the Shoreditch area cases continued to occur month by month until
September and October, when Shoreditch and Bethnal Green were simultaneously involved. The
fact that some of the Shoreditch cases were thus developed contemporaneously with those occurring in
Bethnal Green led to conference with Dr. Bryett, the medical officer of health of Shoreditch, on the
subject generally. Question necessarily arose as to whether the Shoreditch and the Bethnal Green
cases were due to one common cause. Dr. Bryett has placed on record in his annual report the facts
ascertained by him with regard to the Shoreditch cases. He says, "A large proportion of the cases
certified were infected from previous cases in the borough," and he thus inclines to the view that the
outbreak in his district was due in the main to direct infection from person to person. In the light
of the facts of the Bethnal Green outbreak, it seems deserving of note, however, that there must remain
at least a suspicion that infected food may have also played a not unimportant part in determining the
Shoreditch prevalence, and to the reasons for entertaining this suspicion it will be well to refer
after first giving a summary of the facts brought to light in Bethnal Green.
The Bethnal Green Outbreak.
The area affected.—With four exceptions all the cases, 36 in number, of enteric fever developed
in Bethnal Green, from 1st September to 25th October, were notified in an area covering nearly one
square mile, situated on either side of the eastern half of the Bethnal Green-road.
The time relations of the outbreak.—In the 35th, 36th and 37th weeks of 1908 no cases of enteric
fever were notified in the area above defined. In the following week, that ending 19th September
two cases were notified (one of which proved not to be enteric fever) ; the cases notified in successive
weeks from the 38th week onwards were as follows:—
Week ended Saturday, Sept. 19, 38th week, 2 cases (one not enteric fever)
,, 26, 39th ,, 2 ,,
Oct. 3, 40th „ 6 ,,
„ 10, 41st „ 1 „
„ 17, 42nd „ 5 „
„ 24, 43rd „ 2 „
„ 31, 44th „ 6 ,,
Nov. 7, 45th „ 5 „
„ 14, 46th „ 4 „
„ 21, 47th „ 1 „
„ 28, 48th „ -
It may be assumed, having regard to the extent of prevalence of enteric fever in London at the
time, that the area above defined was entitled to yield two or three cases of that disease per month.
While, however, this figure was not reached in August or early September, nor again in the latter
part of November and in December, it will be seen that from the 38th to the 46th week the number
of cases was excessive, with the exception, perhaps, of the 41st week. This nine-week period must
therefore be regarded as one of unusual incidence of the disease upon the area in question.
If the dates of onset of illness (see table appended) be studied, there will be noted a tendency
for the cases to occur in groups as follows:—
3 cases commenced within a day or two of September 6th.
5 ,, ,, ,, ,, „ 17th.
3 „ „ on October 6th.
5 „ „ „ 18th or 19th.
It may have been that infection was introduced into this area on four separate occasions, but
having regard to the variable incubation period of enteric fever, the facts as to dates of commencement
of illness would fairly well accord with a smaller number of occasions on which infection was
introduced—say, for example, (1) a first introduction about 6th September with associated development
of symptoms in three cases almost immediately, and with later development of symptoms in some
nine or ten other cases after an interval of a fortnight or rather longer ; (2) a later introduction
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