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93
The occurrence of 50 cases all in a limited area in the district of Bethnal Green
enabled a close analysis of the facts in relation to possible cause to be made, and from
this the fish hypothesis emerges as the only possible explanation.
There were contemporaneous excessive prevalences of typhoid fever in nine other
boroughs of London and in Tottenham and Edmonton, in all of which the fish
hypothesis might also explain the prevalences.
In 1906, between the 1st and 20th June, 100 cases of typhoid fever occurred in
seven areas in London, and of the London sufferers, 92 per cent, had eaten fried fish
during the four weeks preceding the attack.
Having come to the conclusion, that there was some casual relation between
enteric fever and fried fish, the Investigator further considers the question as to the
way in which such relation may be brought about.
(1) He points out that the kind of fish was plaice, that some plaice was especially
open to suspicion, and that there is a possibility that the question of failure to remove
the gut (that is imperfect cleansing of the fish) was an important one in connection
with communication of infection.
(2) That the fish was already infected before reaching the vendor. This fact was
already apparent in 1900, inasmuch as that in that year at least three widely separated
populations in different parts of London obtained fish from retail vendors having no
association one with another, were involved in the typhoid prevalence, and states that
it has been suggested that the possibility of contamination of small fish in the "nursery
grounds "in the North Sea, is not so remote as might at first be supposed.
Attention is called to the fact that the question of legislating with a view to limit
the destruction of small plaice has received much attention of late years from the fear
of depleting the North Sea, and suggests that the question may have importance from
an epidemiological point of view as well as from its industrial aspect.
It is stated in the Plaice Fisheries Report that at Billingsgate a 20 centimeter
limit (that is 7*874) is imposed, and that this is not at all times strictly observed.
Dr. Hamer points out that during the period in which special attention has been
paid to the question of depletion, the amount of small plaice brought to Billingsgate
has undoubtedly diminished, and further that the typhoid fever in London has also
shown a decline.
A quotation taken from the Report presented by Dr. Hamer in 1906 is of such
importance that I have deemed desirable its inclusion in these columns in full.
"The fish trade has its own Inspectors appointed by the Fishmongers'
"Company, and action in particular instances, more particularly as regards shellfish,
"has been taken by the City Corporation, but no systematic control by a sanitary
"authority such as is now regarded as necessary in the case of other sorts of food,
"has hitherto been instituted. A considerable experience of the condition of the
"fish arriving at shops in the poorer parts of London, acquired by officers of the
"London County Council, more particularly during recent years, shows that the
"inspection carried out at Billingsgate affords no sufficient security against the
"consumption of fish unfit for food."