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The number of cases of typhoid fever attributed to-fish or shellfish was 49, constituting a rather
lower percentage of the total cases than usual. Five cases occurred in persons who had eaten cockles
said to have been obtained from Southend.
In the Annual Report for 1916 it was pointed out that from 1912 onwards, accompanying the
decline in the annual case rate, there had been a marked smoothing out of the autumnal rise of typhoid
fever in London; 1917 and 1918 exhibit the same phenomenon; it is difficult- to explain on the carrier
hypothesis and more in accord with the rival theory of food causation. Reference was made to the
steady improvement as regards elimination of dangerous shellfish, and to the Council's representations
to the City Corporation-in 1906 as to the need for regarding small ungutted dabs or plaice as a possible
source of danger. It was further pointed out that a particular area in the North Sea not far from the
mouth of the Elbe, from which in earlier years large numbers of small plaice were derived, had not been
visited at all by English boats since 1912
With the advent of the war the supply of foreign shellfish was practically cut off from this country
and very great interference with the fishing industry in the North Sea also resulted. The Fish Trades
Gazette noted on May 17th, 1918, that "apart from an occasional cargo of Government 'ish. practically
no Water borne fish has reached this (Billingsgate) market." The Billingsgate steamer were again at
work during that month and, in 1919, "the services between Grimsby, Holland, Belgium and the
Netherlands were resumed, and on several occasions resulted in large supplies of Dutch ,sh at Grimsby
and Billingsgate. . . . Steamer fish, of course, often accounted for nearly half the annual deliveries
at Billingsgate in pre-war times, but at present (May, 1919) the daily arrivals—all u il borne—often
equal the combined land and waterside supplies recorded prior to 1915."
Plague and
cholera.
The low incidence of typhoid fever in soldiers during the war has been widely ascribed to inoculation.
The low" incidence in the civil population of London cannot, of course, be thus explained. In view of the
correspondence in time between the marked falling away in typhoid fever incidence, and alteration
in the extent of consignment to London of foreign shellfish and of ungutted flat fish from the German
bight, it is clearly desirable that a close watch should be kept upon the behaviour of the disease, especially
now that there is the possibility that one or both of these sources of supply may again come into operation.
No cases of plague or cholera occurred in London during 1918. Six cases of plague, however,
were removed to the Isolation Hospital of the Port Sanitary Authority at Denton, Gravesend; two of
these were on board the s.s. Somali from Bombay, which arrived at Gravesend on 19th May, and both
patients died after admission to hospital. One was a storekeeper who had killed several rats during
the voyage and who had found several dead rats in the store room. Many of the passengers and crew
came to London and were kept under observation, but none of them contracted the disease. One of
the persons on board the vessel, who proceeded to Rochester, subsequently died of plague.
On 8th August the s.s. Hector arrived at Gravesend from Calcutta with four cases of plague on
board which were removed to Denton Hospital. There were no passengers, and the crew* were only
partially paid off; the only two members of the crew who came to London stayed at the Scandinavian
Sailors' Home and were kept under observation bv the Council's inspectors.
Anthrax.
During 1918, seven cases of anthrax occurred in London. The affected persons were all engaged Al
in occupations associated with the handling of imported hides, furs or hair, i.e., five of the patients were
employed in dealing with imported skins at riverside wharves, one was a furrier working on the hair of
the South American fox, and the other was engaged as a labourer in a leather factory handling goat
skins from India and South America.
The Departmental Committee of the Home Office appointed in November, 1913, to enquire into
the dangers from infection by anthrax in the processes of sorting, willeying, washing and combing, and
carding wool, goat hair and camel hair, reported in August, 1918, and their report was published later in
the year. The Committee recommended that the principle of compulsory disinfection of animal skins,
wool and hair, of defined kinds and from specified sources, should be substituted for the policy of attempting
to control the danger of infection by factory regulations. It was further proposed that a "Disinfection
Authority should be constituted by the Government with powers for bringing into operation and
enforcing disinfection of wool and hair, that steps should be taken to secure the co-operation of all organised
countries for this purpose, and that the capital cost of disinfection should be provided by the British
Government to be repaid by a charge imposed on all material disinfected. The main object of the
Committee was to ensure that all dangerous or potentially infective material should be disinfected before
being exported to this country. With this object it was recommended that central disinfection stations
should be established under expert supervision at the various ports abroad from which the material is
exported.
A Bill has since been prepared with the object of giving effect to the Committee's recommendations
by Orders in Council. At the time of writing the Bill has already passed the House of Commons and is
awaiting the second reading in the Lords. When passed into law it will be cited as the Prevention of
Anthrax Act, 1919.
Tuberculosis.
The deaths from pulmonary tuberculosis in the civil population of London during 1918 numbered
7,048 as compared with 6,908 in 1917 and 6,491 in 1916. The increased mortality in 1918 occurred in the
latter half of the year and is associated with the epidemics of influenza, th^ excess in the phthisis mortalitv
during the summer epidemics being about 130 deaths and in the autumn about 570, or in all 700.
Tuberculosis, other than phthisis caused 1,398 deaths in 1918 and 1,575 in 1917. There has been
a steady decrease in mortality among children under five years of age for many years past.