View report page

105
Report of the Medical Officer of Health
than one-tenth of the fish sold at Billingsgate could be thus classified. There is, moreover, the further
consideration that the fish which came under suspicion was "plaice." Hence it may be stated that
with regard to at least 95 per cent. of the Billingsgate fish, no question whatever arises. It transpires,
in fact, that all the retail vendors coming under suspicion had obtained fish included in a category
comprising only a comparatively small percentage of the fish sold at the market. The odds against
such a distribution of fish to the 31 retailers being the result of mere chance are, of course, enormous.
The attempt was made to pursue the matter further and to learn whether the fish had passed
through the hands of any particular salesman or salesmen in the market, or whether one or other of the
four steamer companies supplying the market was solely implicated; but the records kept by the retail
vendors were not of a kind to enable this to be done. Incidentally, however, some curious facts were
elicited with regard to the conveyance of fish from the market. It has already been noted that the
supplies to shops A and B were brought from Billingsgate by the same man. It was further ascertained
that a particular fish carrier supplied shops F, G. and H all in one borough, and shop I and some neighbouring
shops at a considerable distance from shops F, G, and H, and, situated in another borough. It
was found, moreover, that a second carrier who supplied vendor D occasionally supplied fish to fishmongers
in market street e. This man sometimes supplied shop O, and he always carried the empty
boxes back to market from this shop. It is, moreover, probable that he supplied the suspected stall U.
A third carrier frequently supplied the retailers Q and N, and this carrier on his outward route
passed by street c, and occasionally supplied fish there. He also supplied fish to vendors in North
Hackney, where a group of six cases occurred. It should be noted, however, with regard to this group
that the patients did not belong exclusively to the poorest class of the population.
Lastly, a fourth carrier, one of whose customers was the fishmonger P, also supplied a vendor
in Islington, two of whose customers were attacked early in August; it is probable, moreover, that he
occasionally supplied K, and in the course of his rounds to his other customers he passed the shops of
two retailers whose supplies came under suspicion, and it is possible that he supplied yet another
suspected retailer. This carrier said he could not furnish a list of those whom he supplied, and no
further light on the matter could be obtained from the retail vendors themselves. The series of
coincidences just detailed is especially remarkable in view of the fact that the general practice in the
fried fish trade is for vendors to cart their own fish home; indeed, it is only in rare instances that
the employment of a carrier, even on exceptional occasions, is resorted to.
The Tottenham and Edynonton Cases.—For the information with regard to these, I am indebted
to the County and District Medical Officers and to Dr. F. Thomson of the North-Eastern Hospital,
to which Institution some of the Tottenham cases were admitted. Here again, in Tottenham and
Edmonton, as in I ondon, comparatively well-to-do persons are included among the residual cases outside
the groups, but within them the same class as in the London groups was affected, and fried fish eating
is the only ascertainable common circumstance. In the case of both districts the evidence pointed to
particular fish shops having been concerned in supplying the patients.
The September groups of London cases.—As has been seen, in the case of 24 of the 31 London
retail sources of supply, and of those in Tottenham and Edmonton, the period of invasion of illness
extended from 11th or 12th August for four or five weeks (g).
In the case of the seven remaining sources of supply the period covered by the dates of onset
of illness extended for four or five weeks from the beginning of September. In these later groups of
cases it is important to note that the retail sources were distinct from those implicated in the previous
groups. Among the seven groups now under consideration is a remarkable group in Hackney, deriving
fish from two immediate (retail) sources, but possibly from one wholesale source, to which special
reference must be made. A single case of typhoid was associated with each of two shops belonging to
the retailer P, and this man supplied also two institutions, in one of which five cases of typhoid
fever occurred. He supplied, moreover, another institution from which a single case of typhoid
fever had been notified some weeks previously in fact at about the time of occurrence of the principal
prevalence (that commencing in early August) already referred to. Coincidently with the cases
among P's customers a group of seven cases occurred among persons who had brought fish from a
vendor 0, whose shop was close to the institution yielding five cases. It was surmised that the cart
which brought fish to P might possibly also have brought O's fish; and that thus fish from one and
the same source was supplied to O and P; this was not conclusively demonstrated to have been the case,
though there was evidence supporting the conjecture (h).
(g) In a few cases the period was even longer (at furthest six weeks), but most of these later cases were from
houses in which a previous case had occurred.
(h) The facts concerning the cases in the Institution may be briefly summarized as follows:—Between 17th
September and 18th October, four nurses and a dormitory maid developed typhoid fever. Three of the nurses had
been Working in typhoid wards, though in one case there was only just time for the incubation of the disease. The
fourth nurse, though not regularly employed in the typhoid wards, had on exceptional occasions entered them. The
dormitory maid had never been in typhoid wards, nor, so far as could be ascertained, had she been brought into contact
with infected persons. Moreover, the ward maid, who was attacked early in August at the other Institution, had not
been associated with typhoid patients. With regard to the incidence of the disease upon those working in typhoid
wards, examination of the records as regards nurses and patients by the medical superintendent and myself, showed
that at the time when the staff illnesses commenced it was roughly an even chance that any nurse selected at
random in the hospital would be a "typhoid nurse." It cannot, therefore, be assumed without question that the
cases among the nurses were necessarily cases of direct infection. It was noted that no patient in the hospital had
been attacked, and it further transpired that patients did not eat plaice; this fish was consumed by nurses and ward
maids. This circumstance, together with the fact that cases of typhoid fever had coincidently occurred among eaters
of plaice in the neighbourhood of the hospital, undoubtedly arouses suspicion. There was, indeed, coincident attack
of nine consumers of plaice, all living close to the Institution; and, furthermore, as regards two of these persons there
was the certainty, and as regards seven others the possibility, that this fish had been brought from Billingsgate by
a particular van, and was all presumably, therefore, derived from one common source.
5176 H