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Immature plaice have gone much out of favour with fish friers during recent
years, but from the autumn of 1921 onwards there has been some evidence of increase
in the amount of the small plaice sold as "wet fish" in London. In July, 1921, the
Plaice Fisheries Sub-Committee of the International Council on Fisheries in the North
Sea recommended the prohibition of fishing by steam trawlers and motor vessels of
more than 50 h.p. in certain areas along the eastern and southern shores of the
North Sea, and limitation of use of other parts of these nursery grounds to April,
May, and June. These recommendations were approved in September, 1922, by
the Council, but it was recognised that restrictions could not be enforced without
the sympathetic support of the industry. The use of these grounds should from a
public health point of view be carefully watched.
A final reference must be made to the occurrence of multiple cases in
institutions, including hospitals, schools and colleges, infirmaries, prisons. M.A.B.
hospitals and private establishments. The grouping of these cases is very suggestive
of food infection.
Hospitals.—The numbers of notified cases in three successive decades 1891-1900,
1901-1910 and 1911-20 were 175,148 and 159. The largest groupsof cases were one
of 34 cases at the Foundling Hospital in 1891, and one of 23 cases at University
College Hospital in 1897. The former outbreak was contemporaneous with the
later part of the great prevalence in S.E. London (Greenwich and Bermondsey),
and may be strongly suspected, therefore, to have been a food outbreak. The
outbreak in 1897 was attributed at the time of its occurrence to water from a cistern;
it, too, may, however, have been due to infected food.
Schools and Colleges.—There were 133, 0 and 20 cases in the three decades.
The main outbreaks include first 28 cases in a school in Greenwich in 1892; none
of these cases were fatal, and it is possible that the outbreak was not really one
of typhoid; secondly, 14 cases in a home in Stepney in 1893; third, a persistent
series of cases in a workhouse school in North Islington, 8 in 1897, 59 in 1899, and
11 in 1900; these coincided in point of time with prevalences in the area surrounding
the school, and were all possibly of food origin; finally, in 1920 there were
some 20 or more cases of " paratyphoid fever " at Bedford College.
Asylums.—Here there were in all 9, 0 and 13 cases in the three decades. The
Middlesex County Asylum contributed 9 cases in 1900, 7 in 1915 and 4 in 1917.
There were, however, in addition a considerable number of London cases in the
Mental Hospitals situated just outside the County; in particular at Hanwell 12
cases occurred in 1897; at Colney Hatch 8 in 1899, 3 in 1900, 21 in 1901, 3 in 1902
and 5 in 1903; and at Cane Hill in the two years 1917 and 1918 there were some
90 cases notified. In these asylum outbreaks the water and milk could be exculpated
and shell-fish was certainly not at fault. The question as between possible case to
case infection and possible fish infection remains in doubt.
Infirmaries.—The numbers were 50, 49 and 37 in the three decades. In 1891
the Wandsworth and Clapham Union Infirmary contributed 13 cases.
Prisons yielded 15, 26 and 7 cases in the three decades; 13 of these were in
the year 1906.
Metropolitan Asylums Board Hospital Staffs.—There were 119,123 and 30 cases
notified in the three decades. The large majority of these were cases of nurses;
thus during the first two decades on an average some 10 nurses a year were attacked.
This gives a rate rather more than twice as high as the corresponding rate upon
women (of the average age of nurses) in the population generally. It must, however,
be remembered that nurses during those decades may have been equally, or perhaps
even rather more likely, than the average woman of similar age, to partake of
infected food, and in the event of any indisposition arising the nurse has more
highly-skilled expert diagnosis at her disposal than the average woman has. Hence
the total number of cases of typhoid in these M.A.B nurses is not so great as to
favour strongly the view that infection from patient to nurse can be held to be