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46
Annual Report of the London County Council, 1910.
It should be stated that in some of the reports the information given does not include that
concerning cases in which the patients were infected outside London. Adding together the cases in
which particular articles of food are mentioned, the resulting numbers are: shell fish (unspecified),
100; oysters, 15; cockles, 2; whelks, 2; cockles and whelks, 1; mussels, 17; mussels and cockles,
1; periwinkles, 1; mussels and periwinkles, 1. So far as these figures indicate, some 19 per cent,
of the 735 persons who suffered from enteric fever in these districts had eaten shell fish shortly before
their illness began, a proportion, the significance of which entirely depends upon the proportion of
shell fish eaters in the population. In numerous instances the consumption of fried fish is also mentioned
among the articles of food which had been consumed, the statement being made that the
patient was an eater of fried fish. It has, however, to be remembered that the London poor are large
eaters of fried fish, and the question whether this article of food has been responsible for enteric fever
occurrences cannot be judged by the circumstances of isolated cases. Inquiry into the circumstances
of groups of cases occurring among poor people has been frequently made by Dr. Hamer, who has
found reason for associating these outbreaks with the occasional supply of fried fish from particular
shops. A report by him on a localised prevalence of enteric fever in Bethnal Green in 1910 will be
found in Chapter XXXII., page 100.
Of the 735 cases mentioned, 43 cases are stated to be due to infection from an antecedent
case, and to the 43 cases must be added "a number" observed in one of the districts. Several of
the annual reports contain interesting particulars of such occurrences. Dr. Thomas mentions a
group of cases in model buildings in the borough of Finsbury, one of the cases being nursed by a
woman who herself contracted the disease, and apparently while ill conveyed infection to a child under
her care in a creche. Dr. Priestley gives account of a series of six cases in a court in Lambeth which
appeared to have had origin in a person who had been thought in the first instance to have
influen/a. Dr. Lennane found several groups of cases in Battersea, which appear to have been
caused by infection from one person to another, and Dr. Caldwell Smith gives the particulars of a
series of cases in Wandswort, apparently due in the first instance to infection of a child through
eating winkles, and afterwards by infection of an infant who had been taken to the house of the
first case and who in turn subsequently gave rise to five other cases.
Reference is made in several of the annual reports to an inquiry which the Medical Officer of
the Local Government Board is making into the persistence of the existence of the bacillus typhosus in
some persons who have suffered from enteric fever, and in which the medical officers of health are
assisting him by collection of material from patients who have been discharged from the hospitals of the
Metropolitan Asvlums Board.
Bacteriological
diagnosis.

Enteric
fever—
Errors of
diagnosis.