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84
Annual Report of the London County Council, 1911.
The analysis includes 54 cases notified from houses within or immediately adjoining the area
of the explosion, and 8 other cases.
Limiting consideration for the moment to the 54 cases—
*22 of the sufferers had within a period of one month, and at a time before the beginning
of the illness which was consistent with the hypothesis that the article of food might have
been the cause of the illness, obtained ice cream from a particular vendor, Y.
7 may have done so.
*25 had not done so.
§48 of the sufferers had within a period of one month, and at a time before the beginning
of the illness which was consistent with the hypothesis that the article of food might have
been the cause of the illness, obtained fried fish from a particular vendor, X.
†l may have done so.
*5 had not done so.
The 8 cases notified from outside the area include a man living at Walthamstow and a girl
living in Camberwell, both of whom worked in the area; a child, aged 9, living in Fulham who was
staying with relations near the area, at the time when she was presumably infected; a man, a lad,
and two girls, all of whom lived at some little distance from the area, but frequently made purchases
withinit. Of these 8 patients, 2 had frequently eaten ice cream, obtained from Y, 4 others ate ice cream,
but had not obtained it from the suspected shop, the remaining two were adults who were quite clear
that they never ate ice cream. Seven of the patients had been in the habit of visiting the suspected
fried fish shop, but one of them as a rule only bought fried potatoes there. The remaining
case was that of a girl who passed the fish shop on her way from work and may have purchased
there, though as to this there was an element of uncertainty.
If the 8 cases just referred to be included as constituting part and parcel of the special outbreak,
and if the 6 notified within the area which were probably not cases of typhoid fever be excluded, there
are 56 cases in all. Of these 21 had, and 28 had not, partaken of ice cream from the suspected shop,
and as to 7 others there is an element of doubt. Again, 52 had, and 2 had not, partaken of fried
fish, and as to 2 cases there is an element of doubt. It is clear that an ice cream hypothesis is in
itself inadequate as an explanation of the special prevalence.
A fried fish hypothesis, on the other hand, would account for all the cases save two, or at most
four. ‡ Having regard to the size of the population residing in the area, and to the degree of prevalence
of typhoid fever in London at the time, it might have been anticipated that, apart from any
special cause operating in the area, some two or three cases would have occurred there during the month
of September (i.e., coincidently with the special prevalence). Thus the exceptional cases referred to
above might conceivably be regarded as entirely unconnected with the special prevalence, and on this
view of the matter a fried fish hypothesis would fit the facts ascertained concerning all the 54 cases
of the special prevalence. This hypothesis is seen, therefore, to demand careful examination, but
before proceeding further it is desirable to refer to a preliminary difficulty which may perhaps
be felt.
A consideration frequently advanced in connection with study of the percentage of sufferers from
typhoid fever, who give a history of having obtained fish from a particular source, is the following.
Everyone eats fish just as everyone eats bread or meat, and hence it can be no matter for surprise
if all the sufferers in a particular outbreak are found to have eaten fish. Further, it is argued, when,
an outbreak involves a particular area, it may be that one fried fish shop has practically a monopoly
of the supply in that area ; and hence again, it is said, no one need be surprised if it transpires that
all the sufferers have obtained fish from the particular shop. These lines of argument, prima facie,
command acceptance. Anyone, however, who endeavours to obtain a considerable number of
histories as regards fish eating from sufferers from typhoid fever in London, will be convinced of their
inapplicability, and observation of control populations conclusively demonstrates that the lines of
argument in question are beside the mark. In 1900, on the occurrence of the first recognised outbreak
of fish typhoid, enquiry was made by the Council's officers in Southwark as to the habits as regards
fish eating of a control population ; a similar enquiry was made in 1908 in Bethnal Green, and yet
* Includes three cases which were probably not typhoid fever.
§ Includes two cases which were probably not typhoid fever.
† Includes one case which was probably not typhoid fever.
‡ The two cases occurred in one family. Both patients had been out of London during some portion of the
period in which they must have been infected, and it may be that the cases were thus wholly unconnected with
the cause of the special prevalence in Finsbury. On the other hand, the patients lived only a few doors from the
fried fish shop, and it is, of course, conceivable that they may, despite the testimony given by them, have been
infected from this source by reason of their having eaten fish of unknown origin which was, as a matter of fact,
obtained there. The two remaining cases were those of the child who, when she went to the fried fish shop, usually
purchased "taters," and of the girl who passed the shop on her way from work and may have purchased there.
It should be added that a worker in the Finsbury area who did not live there developed typhoid fever in
Poplar at the time of the occurrence of the prevalence in Finsbury. This man was a fried fish eater, but he stated that
he had not obtained fried fish from the Finsbury shop.