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5
be held accountable for a large proportion of the excessive number of cases occurring in the two special
areas. Articles of food such as mussels, cockles, watercress and ice-cream, though in common use at
one time or another, were not eaten in these areas at the several periods when the prevalences occurred.
In Bethnal-green, it is true, the chief prevalence was in the mussel season ; but, as has been pointed out,
the inquiries made concerning mussel-eating make it clear that the majority of the sufferers were not
infected by this article of food.
In fact, consideration of a fish hypothesis and a mussel hypothesis, in relation to the circumstances
of the Shoreditch and Bethnal-green outbreaks, shows that there is a point of agreement and an
important point of difference in the two cases. If the percentage of mussel-eaters among sufferers from
enteric fever be compared with the percentage of mussel-eaters in the population generally, there is
fairly close correspondence. So again, if the percentage of fish-eaters among sufferers from enteric
fever be compared with the percentage of fish-eaters in the population generally, there is no very marked
discrepancy. But, on the other hand, while the percentages in the case of mussels are comparatively
low, in the case of fish, the percentages are high. This method of comparing a population attacked with
a control population results, therefore, in exclusion of mussels as the one and only cause of the special
prevalences. While, on the other hand, it does not demonstrate that fish was almost exclusively at
fault, it should be noted that it does not exclude this possibility.
W. H. Hamer,
Medical Officer (General Purposes).