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In the same report, moreover, the attempt was made to estimate the extent to which the consumption
of ungutted flat fish may have determined the excessive incidence of typhoid fever, in a number
of poor areas in London during the years 1896-1903, and a chart showing the time relations of prevalences
in 24 such areas was exhibited.
In the 1906 report (pp. 42-43) reference was made to prevalences in West Ham, Finsbury and elsewhere,
in which fried fish fell under suspicion. Following upon this the Public Health Committee
reported to the Council, who communicated with the City Corporation, suggesting that " systematic
control by a sanitary authority, such as is now regarded as necessary in the case of other sorts of food,"
should be undertaken in respect of the food passing through Billingsgate.
In the 1907 report (p. 107) a family outbreak in Chelsea was ascribed to fried fish.
In 1908 considerable fish prevalences in Bethnal Green and Shoreditch were reported upon (Appendix
I., 1908).
In 1909 the Sanitary Committee of the Corporation submitted a scheme, the acceptance of which
would render "persons sending unwholesome fish to the City Fish Markets" liable to "incur the same
risk of prosecution as obtains in the case of the salesmen in the Meat and Provision Markets."
Early in 1910 several small groups of cases of typhoid fever occurred in different parts of London,
which were suspected to be due to infected fish. (See Vol. III., 1910, p. 107.) In the autumn of 1910,
a further outbreak occurred in Bethnal Green which was attributed to fish, and the enquiry (Ann. Rep.,
1910, Vol. III., p. 100) included an " Examination of the Behaviour of Typhoid Fever in Loudon generally
and in some Areas Outside the County Boundary " (see also Diagram V., opp. p. 35, Ann. Rep., Vol. III.,
1911). It transpired, in fact, that 33 small prevalences of typhoid fever had occurred, in 10 London
boroughs and in two districts outside the County of London, in which there was reason for thinking fish
was at fault.
It was now regarded as certain that the fish was infected before reaching the retail vendor. In
my report of 1910 the following observations were made in this connection:—
"It has been suggested to me that the possibility of contamination of small fish, in what
are known as the 'nursery grounds' in the North Sea, is not so remote as might at first sight
be supposed. The publication of Reports on the Research Work of the Board of Agriculture
and Fisheries has brought to light facts of great interest with reference to the distribution of
small fish. The first of these Reports published in 1908, stated that' large quantities of small
immature plaice were being swept up by the (North Sea) trawlers each year, especially in the
summer months'; and that the species (plaice), 'was annually being caught in an immature
state in vast numbers on certain grounds.' The small fish abound at some seasons in shallow
waters, but a particular shallow water area, known as A.3 (which with another area, B4, formed
the ' small plaice grounds' off the Danish Coast), is the only A area (i.e., the only shallow water
area) in which an appreciable quantity of plaice was caught.' Again in A3, the Danish inshore
waters and the so-called ' small plaice grounds,' 83 per cent, were small, while in B4, which is
immediately outside this area, the percentage of small was 76."
Attention was also especially drawn to that portion of the As area which adjoins the estuary of
the Elbe. Moreover, it was added : " The question of the three mile limit must not be overlooked ;
but there is always a possibility that fish caught by foreign boats may find its way to the London market."
Reference was made to efforts on the part of the fish trade to obtain legislation designed to protect the
destruction of small plaice, by imposing a minimum size limit, and it was stated that- "The admissibility
of small flat fish to market may prove to have importance from an epidemiological point of view as well
as from the industrial aspect."Reference was also made to the need for more adequate inspection. It
was stated—" The fact has been noted in earlier reports, and is amply confirmed by experience gained
in 1910, that some of the sufferers from typhoid fever have complained of a 'gassy' and again of a
' bitter ' taste in the fish, to consumption of which they have attributed their illness. "
"It is the custom with many 'friers' not to go to Billingsgate until the higher-priced fish has
been disposed of. Numbers of men do not attempt to buy in the early morning. There is, therefore,
special need of inspection in the case of this 'late fish.' In the Plaice Fisheries Report it is stated
that at Ramsgate the ' small stuff' is 'given to the crew as a perquisite,' or' sold to hawkers and
others on the open space outside the market.' At Billingsgate the 'late fish' falls largely into the
hands of costers and small' friers,' and, in the absence of a complete system of inspection at the market,
the question as to whether the fish shall be sold or not is left to the discretion of the coster or frier."
"Plaice is practically the only fish used by vendors of fried fish which is not gutted as a
matter of course at sea. The practice of gutting plaice seems, however, to be coming steadily into
favour as years go by, but the London steamer companies do not, as a rule, attempt to gut the small
plaice. In dealing with small' dabs,' which are sold at times when there are ' heavy quantities '
available, at ½d. a pound, or say three or four a penny, cleansing is doubtless often left to be carried out
by the purchaser, if performed at all."
"It is a suggestive fact that in the instances last summer (1910), in which several members of one
family were simultaneously attacked by typhoid fever, there was, generally, speaking, a history of the
consumption by all the sufferers in each family of small plaice or dabs. The fact that most, or all, of the
consumers of these fish were attacked, points to a degree of infectiousness which requires some special
explanation, and such explanation the absence of gutting of these small fish would possibly supply."
In September, 1911, a considerable prevalence of typhoid fever in Finsbury was traced to one
single consignment of fish delivered in London, at a time when there was dislocation of traffic caused by