1344

Horrocks read notes on two cases of Hypertrophy ofthe Breast. One of the patients was an unmarried woman,aged 22 years, who was admittea to the Bradford RoyalInfirmary on Oct. 31st, 1898, complaining of enlarge-ment of the right breast of 12 months’ duration. It hadbeen painless till 14 days before admission, when it hadbecome red and painful and there had been a slight rigor.Her general health was good and the catamenia were regular.There was very great enlargement of the breast but therewere no enlarged glands. The breast was amputated and thewound healed without trouble. The left breast was small andill-developed. The other patient, a married woman, aged 21years, was admitted in April, 1899, complaining of enlarge-ment of both breasts. The catamenia were regular till fivemonths before admission when she became pregnant. Thebreast had always been rather large since puberty and rapidincrease in size began in the second month of pregnancy,rendering her miserable from the great weight and constantdragging pain. Both breasts reached almost to the umbilicuswhen she sat up. The circumference of the right breast atthe base was 29 inches and that of the left base was 30inches. The right breast was amputated on April 2lst. Thewound healed readily. Eleven days after the operationshe was delivered of a five and a half months foetus.The left breast was amputated on June 21st as it causedgreat trouble from its weight and its unsightly prominence.The wound healed readily.-Dr. Jason Wood read notes ontwo cases of Moveable Kidney giving rise to severe symptoms.One of the patients was a married woman, aged- 38 years,very tall and stout, who had enjoyed good health till 18months ago when she was seized with severe pain in the lefthypochondriac region. The left kidney could be palpatedfor about half its extent and was tender. With a few days’rest and the wearing of a pad relief was obtained. Therewere no further symptoms till two months ago when shewas again seized with pain and tenderness which passedoff in about a week with rest in bed. The otherpatient was a married woman, aged 38 years. Whenseen on Oct. 6th, 1900, she had a temperature of102° F. and a dry brown tongue ; she vomited and was con-stantly passing bloody urine. There was a large swelling inthe right hypochondrium which was excessively tender. Onthe 8th she was much better. On the llth the tumour wassmaller, moved freely, and felt like a kidney. On the 15thboth kidneys could be palpated over the lower half and therewas no pain or tenderness.-Dr. F. W. Eurich read a paperon Some Types of Locomotor Ataxia.

DERMATOLOGICAL SOCIETY OF GREAT BRITAINAND IRELAND.-A meeting of this society was held at

20, Hanover-square, London, W., on April 25th, Dr. A. J.Harrison, the President. being in the chair.-Dr. C. HerbertThompson (for Dr. J. H. Stowers) showed a case of

"Erythema ab Igne" in a young woman who was accustomedto take very hot baths, but had not been exposed to radiantheat sufficient to explain the cause of the eruption.-ThePresident considered the eruption could not be produced bythe hot baths.-Dr. E. G. Graham Little showed a case of acircumscribed patch of Lupus Vulgaris of the size of a six-pence on the cheek of a boy, aged 10 years, of almostidentical appearance with the case shown to the society byDr. Stowers some four months ago.-Mr. George Pernetshowed cultures from the case of Ringworm in a youngwoman, aged 23 years, which was brought forward by himat the last meeting of the society, and gave a demonstrationof the means of differentiating the types of ringworm metwith in this country. ’

Reviews and Notices of Books.The Law Itelating to Poor-law Medical Officers and

Vaccination. By M. GREENWOOD, M.D.Brux., LL.B.Lond., of Lincoln’s Inn, Barrister-at-Law. London:Bailli6re, Tindall, and Cox. 1901. Pp. 104. Price2s. 6d. net.

THIS is a work published under the direction of the

council of the Poor-law Medical Officers’ Association of

England and Wales in order to provide a handbook for theuse of Poor-law medical officers that will inform them uponquestions which may occur to them relating to the duties oftheir office, and which will contain its information in such a

form that it may be readily ccnsulted and easily under-stood. Such information has hitherto been mainlyavailable in more or less weighty volumes compiledby lawyers for lawyers, and from which information

upon the various branches of the subject treated of

can only be dug out by dint of research, while the researchcan only be conducted with reasonable speed and with anycertainty by those who have had training and practice in.

similar operations. As far as it goes the small volume whichDr. Greenwood has produced, and to which the title hasbeen given of " The Law relating to Poor-law MedicalOfficers and Vaccination," is capable of conveying to Poor-law medical officers and public vaccinators useful informa-tion in a compendious form, much of which they will beglad to acquire readily, particularly when first approachingthe duties of their appointments. It is written in

a clear style, it gives the author’s opinions or deduc-tions so that they can be understood and followed, andlittle or no space is wasted by the citation of authoritiesto which the reader is perhaps not likely to wish to refer.On the other hand, it is a handbook only and a smallone at that, while, although it is possible to overburdena book for the use of those who are not lawyers by pro-fession by the citation of law reports and by referencesto statutes and sections, it is to be remembered that amedical man in a difficulty as to his legal position may attimes want to rely upon the precise wording of an Act ofParliament, or to refer an adversary to an authority that willconvince him. Sometimes the quoting of all materialsections of an Act of Parliament, with brief notes in smallprint, a method commonly adopted in legal works for theuse of lawyers, will give quite as clear an exposition of thelaw as a paraphrase or summary of it, and one less likely toomit matters which occasionally, though perhaps not often,it may be useful to know. As an example of what we meanwe may refer to a brief summary of the position of theperson known as the "conscientious objector" to vaccinaotion at p. 42 of the little book before us. It seems tous to contain little more than is known already tomost people, whether medical men, lawyers, or parents.Quotation of Section 2 of the Vaccination Act of 1898 wouldhave shown that the unwilling parent before he is exemptfrom penalties has not only to satisfy the magistrates speci-fied that he conscientiously believes that vaccination wouldbe prejudicial to the health of the child, but also to deliverwithin seven days to the vaccinatiop officer for the districta certificate by such justices or magistrates of such con-scientious objection. We may have overlooked referenceto this delivery of the certificate to the vaccination officerin the perusal of the work before us, but reference to theindex does not enable us to discover it, although the dutiesof the vaccination officer (a layman) as well as those ofthe public vaccinator (a medical man) are treated of.

Again, to take an example at random of a case in which apublic vaccinator might desire to ascertain his duties, we donot recall, nor do we find by reference to Dr. Greenwood’sindex, any mention of what is to occur where a child hasbeen successfully vaccinated by an unqualified person andthe parent seeks the certificate from the public vaccina-tor that will exempt him from prosecution. This,we believe, is regulated by the seventh and twelfthsections of the Vaccination Act of 1871, the public vaccinatorgiving the certificate if he chooses, but not being compelledto do so, and being able in such a case to make his ownterms as to the payment of a fee for the certificate by theparent who asks for it. We are quite aware that it is possibleto overload a handbook with learning and with over-fullquotation from Ac:s of Parliament and Orders, but at thesame time in dealing with vaccination we have to bear inmind that where legal proceedings are taken to enforce itdefences of a technical description are very frequently

1345

successfully raised by legal practitioners who have thetechnical duties of the public vaccinator and the vaccinationofficer at their fingers’ ends, and who are ready to take

advantage of the smallest technical omission or mistake

on the part of anyone connected with the prosecution.It is as well, therefore, that those who have to do

with the carrying out of the law of vaccination shouldbe fully informed as to technical points and should

have them constantly and clearly before their eyes.The medical practitioner who wishes to become a districtmedical officer, or workhouse medical officer, or publicvaccinator will, however, find a good deal that he may wishto know explained by Dr. Greenwood and will be ablefurther to study in the appendices at the end of Dr. Green-wood’s work forms of contract such as will be used by himand by the guardians with whom he agrees to fulfil his

duties ; he will also if he be, or intends to become, a publicvaccinator, find some general remarks and suggestions,compiled at the request of the Poor-law Medical Officers’Association by Dr. A. E. Cope, which, while not formingpart of the law relating to his office, may be of use to him inhis performance of its duties.

Fract1l’l’es. By CARL BECK, M.D., Visiting Surgeon to theNew York German Poliklinik, and formerly Professor ofSurgery in the New York School of Clinical Medicine.With 178 Illustrations. London and Philadelphia:W. B. Saunders and Co. 1901. Pp. 327. Price 15s.

Tms excellently got up treatise on fractures is dedicatedto Professor Wilhelm Conrad Roentgen, "without whose

discovery," says the dedication, 11 much of this book couldnot have been written." We may go further and

say that the discovery of the x rays was the reason

obviously of writing the book. The sections of our

surgical manuals dealing with the diagnosis and treat-

ment of fractures and dislocations which were written

before Roentgen’s valuable discovery were necessarily illus-trated largely from the cadaver. Displacements of frag-ments, if fairly gross, can be ascertained by sight or

palpation ; in many fractures obvious deformities are present,their reason being very generally furnished by the muscularattachments ; while in other fractures pain in certain regionsand motional disabilities of certain sorts are characteristic.Before the discovery of the x rays surgical handbooks couldonly deal with the diagnosis of fractures as illustrated inthe experience of their authors by these different signs andsymptoms. Fractures and dislocations were generally dis-cussed together, the aim of the association being diffe-rential diagnosis, and anatomical proofs being furnishedfrom the dissection-room in proof of the conditions thatwere supposed to be existent. But the x rays in manyinstances enable the surgeon, familiar with the manipala-tion of the apparatus, to detect exactly what fracture is

present and to deduce the cause of any deformity.The diagnosis that was wont to be a matter of

doubt, only to be arrived at after the elimination of

several, even of many, alternatives, may now be made with-out a possibility of error in a few minutes. It is from this

improved surgical position that Professor Beck writes hishandbook on fractures and the result is a very interestingwork, though we doubt if many surgeons have found

skiagraphy quite such an infallible finger-post to diagnosisas he has found it. The accurate recognition, for example,of fractures of the pelvis or of the base of the skullis not, in our opinion, much helped by the x rays.In each set of fractures it is occasionally easy to

understand exactly what injury is present withoutrecourse to any but the slightest manipulation, but

we very much doubt if the x rays could be invariablydepended upon to give the differentiation between the

various lesions-fractures, dislocations, and simple con-tusions-that may occur about the hip-joint. ProfessorBeck admits that fractures of the base of the skull are stillwith difficulty demonstrated, and, for our part, we havenever seen any skiagrams which illustrated the condition atall convincingly.The book is a useful adjunct to treatises upon general

surgery, and while it is intended to show that Roentgen’sdiscovery created an epoch it really shows that the work offormer observers has been so careful that many generationsof surgeons have treated fractures with a perfect knowledgeof the conditions although they were unable to avail them-selves of skiagraphy in proof of their surgical faith. Theillustrations are beautiful and we assume that the originalskiagrams of which they are reproductions have not beenunduly touched up.

Manual of Diseases of the Ear, including those of the Noseand Throat in Relation to the Ear, for the Use ofMCM o .PyaeMMeM c/’ Medicine. By THOMASStudents and Practitioners of Medicine. By THOMASBARR, M.D. Glasg., Lecturer on Diseases of the Ear,Glasgow University ; Senior Surgeon to Glasgow Hospitalfor Diseases of the Ear, &c. Third edition, revised, andpartially rewritten. With 236 Illustrations. Glasgow:James Maclehose and Sons. 1901. Pp. 454. Price12s. 6d. net.

Ti-iis valuable work has passed through an honourableprobation, and has established itself in the forefront oftext-books on the ear. Dr. Barr distributes the anatomical

portion of the text through his work, instead of making it aseparate part. This arrangement has the advantage of

preparing the student for a consideration of diseased con-

ditions with the normal state of each part fresh in his

memory. We think that in no other text-book on diseasesof the ear will such a clear and useful description of themore severe intracranial complications of aural suppurationbe found as that given by Dr. Barr. The chapters devotedto the consideration of nasal and naso-pharyngeal affectionsare kept admirably within due limits, all extraneous matterbeing omitted. The above are but two points in a workthat is of the highest order throughout, though we mayperhaps take exception to the introduction of illustrativecases which we believe is not helpful to the student andadds unnecessary length to the book. Dr. Barr is to be

congratulated on his manual; it is thorough, and will befound invaluable to those for whom it is written-studentsand practitioners.

The Asphyxial Factor in Anæsthesia, and other Essays. ByH. BELLAMY GARDNER, M.R.C.S. Eng., L.R.C.P. Lond.London: Bailliere, Tindall, and Cox. 1901. Pp. 63.Price 3s. net.

THE first essay gives the title to this little book. It

presents the author’s views upon the undesirable sym-ptoms arising when, through faulty administration of the

ansesthetic, the patient does not obtain sufficient oxygen.The author’s personal experience appears to agree with thatof most other writers upon this well-worn subject. Studentswill no doubt find the rules laid down useful. For a widercircle of readers the omission of all reference to the scientificwork which has been done from the time of Bichat andReid down to the present militates against the value of theessay. The paper dealing with nitrous oxide gas givenwith oxygen in general surgery is better written andof interest. We gather that this mixture has not provedof so much value for cases lasting over a few minutes as ithas done in dental surgery. The remaining part of the bookdoes not present any very novel features. The essays as awhole are a meritorious effort to enforce the necessity forattention to detail and the appreciation of dangers whichlurk in the careless use of anaesthetics. They show that Mr.Gardner has carefully studied his cases and has arrived

1346

at his conclusions as a result. From the surgeon’s pointof view we cannot endorse his experience that the best

position for the patient for whom an empyema thoracis hasto be dealt with is " almost on his face, with the diseasedhalf of the chest lowermost." The use of the expression" stages of anaesthesia " for degree of narcosis " is, as Snowpointed out, objectionable and misleading. Mr. Gardner isa painstaking and intelligent worker in his field of medicalscience and has produced a book which will prove useful tothe student and tyro in anaesthetics.

Oral Sepsis as a Oanse of .. Septic Gastritis," ° ’oxicNeuritis," and other Septic Conditions. With IllustrativeCases. By WILLIAM HUNTER, M.D. Edin., F.R.C.P.Lond., Senior Assistant Physician to the London FeverHospital ; Physician to the Electrical Department, JointLecturer on Practical Medicine and Pathological Carator,late Pathologist, Charing-cross Hospital. London: Casselland Co., Limited. 1901. Pp. 30.THE object of this book is to direct attention to the

importance of septic conditions of the mouth as a cause ofdisease. Dr. Hunter has given considerable attention tothis subject, and has succeeded in showing that certain

general conditions, such as pernicious ansemia and gastritis,are at times traceable to infection from the mouthDr. Hunter considers that he has met with cases of"neuritis" arising from septic oral conditions, but the

egamples which he quotes are not conclusive. The book,however, is instructive and is worthy of perusal by allmedical and dental practitioners.

A Handboo7z of 3lateria Medica, Pharmacy, and Thera-peu.tics. By SAMUEL O. L. PO’ITER, A.M., M.D.Jefferson Med. Coll., Phil., M.R.C.P. Lond., formerlyProfessor of Medicine, Cooper College, San Francisco.Eighth edition, revised and enlarged. London : Rebman,Limited. 1901. Pp. 950, 8vo. Price 21s. net.

WE are glad to welcome another edition-the eighth-ofthis valuable work. It has been closely criticised and

thoroughly revised, and much new matter has been addedas a result of two years’ medical practice in the tropicalPhilippines. We feel that we may recommend the book toBritish practitioners with the utmost confidence, though, ofcourse, they must bear in mind that the word" official "

throughout refers to the United States Pharmacopoeia andnot to our own.

The arrangement of the matter is in some respectsunique, and will be found to make reference an easy matter.An elaborate classification of medicines is given in thefirst part of the book, and the definitions of each headingare thoroughly lucid and scientific. In dealing with indi-vidual drugs the physical properties and chemical con-stituents are first briefly described, a list of the official pre-parations follows, while important unofficial preparations arenot forgotten. Next the physiological action in each caseis described, and the therapeutics proper follow. The

effects of toxic doses and physiological and empirical anti-dotes are also given. It will be seen that the work is nothingif not thorough. The second part of the book, devoted toPharmacy," is also valuable and will be found to containan enormous amount of detailed information and good adviceto the student on the writing of prescriptions.The third part is entitles 11 Special Therapautics," and in

its compilation a very large number of the works of acceptedauthorities have been laid under contribution. It forms a

very complete and reliable index of treatment which willbe a godsend to many a busy practitioner who has no timeto wade through the copious literature that accompanies eachnew drug into the market. A long list of the supposed oralready discovered ingredients of various quack preparationsis given at the end of the book, together with some tables of I

differential medical diagnosis and a most carefully-preparedindex. We quite agree with the author that, however excel-lent a book, its value as a work of reference is small unlessit possesses a thoroughly good index. But the tables ofmedical diagnosis seem to be hardly in place in this workon materia medicd, and in their presence lies the one andonly objection to the book, which is well written, well

arranged, and printed on good paper.

JOURNALS AND MAGAZINES.

b’eottis7c Medical and Surgical J01lrnal. - The openingarticle in the May number is a description of the ClinicalFeatures of Myasthenia Gravis by Dr. Edwin Bramwell of

Edinburgh, who has examined nine cases of the disease.He states that up to the present time only some 80, or pos-sibly 90, cases have been reported. In a paper on Twin

Pregnancy Dr. Alexander MacLennan of Glasgow says thata diagnosis of twins can readily be made by abdominalexamination. Apart from the size of the abdomen, whichmay be excessive, it is from palpation that the presence oftwins can be most easily recognised. The shape of theuterus may be unusual. There may be a groove at the

fundus, as has been pointed out by Kuneke, or the conforma-tion of the uterus may be irregular. Fcetal movements,produced by more than one set of limbs and felt at differentplaces, are also more or less characteristic. Two areas ofmaximum intensity of the heart sounds, separated by anarea of silence, point towards there being more than oneovum ; hearing two foetal hearts having different rhythms isconclusive evidence. Dr. J. C. Dunlop of Edinburgh writeson the Food Requirements of Varying Labour, his data beingobtained from prison experience. He considers that formoderate labour a diet of 3500 calories is insufficient, one of3900 is excessive, and one of 3700 is sufficient without beingexcessive. Dr. H. O. Nicholson of Edinburgh contributesan article on the Sphygmographic Appearances of the Pulsein Infancy.

The Journal of Physiology. Edited by Sir MICHAEL

FOSTER, K.C.B., F.R.S., and J. N. LANGLEY, F.R.S.

Vol. xxvi., No. 5. London : C. J. Clay and Sons. April 24th,1901. Price 7s.-The contents of this number of the Journal

of Physiology are : 1. Galvanotaxis and Chemotaxis of

Ciliate Infusoria, by H. H. Dale, B.A., Coutts-TrotterStudent and Scholar of Trinity College, Cambridge. Part I.with 49 figures in the text. 2. The Action of Ether andChloroform on the Cerebral and Spinal Neurons of Dogs, byHamilton Wright, M.D., Director of the PathologicalInstitute, Federated Malay States. Supplementary papers:3. On Dilatation of the Pupil from Stimulation of the CortexCerebri, by J. Herbert Parsons, B.Sc., Research Scholar ofthe British Medical Association, with two figures in the text.4. The Physiological Properties of the Muscle of Echidna

Nystrix, by H. G. Chapman, M.B., B.S. (Melbourne), witheight figures in the text. 5. A Further Inquiry into theSupposed Existence of Cerebral Vaso-motor Nerves, byLeonard Hill, F.R.S., and J. J. R. Macleod, M.B., with 11figures in the text. Lastly, the Proceedings of the

Physiological Society on Feb. 12th and March 16th are given.

Mercy and Truth.-Dr. Minnie Gomery writes on the

prospects of medical work at Islamabad in Kashmir. Dr.

T. L. Pennell has an illustrated article on the BannuMedical Mission in 1900. Bannu is in the Punjab. In

the hospital there were 607 in-patients with 18 deaths.In the out-patient department 43,100 visits were made.

Friend of G’7cina.-The April number deals chiefly withthe annual meeting of the Society for the Suppression ofthe Opium Trade held in Exeter Hall on Feb. 26th. The

publishers are Messrs. P. S. King and Son, Westminster.

1347ENTERIC FEVER AND FOOD-SUPPLY.

THE LANCET.

LONDON: SATURDAY, MAY 11,1901.

Enteric Fever and Food-supply.WE are always learning of new channels by which the

virus of the acute infectious diseases may be conveyed toman. Before the majority of us were born it was a well-

recognised fact that water was a frequent vehicle of

infection. Later it was found that milk served to

disseminate enteric fever, then it became clear that a similar

charge could be brought against ice-creams and shell-fish ;and now we are presented by the London County Councilwith a report in which fried fish is accused of behaving inthe same manner. The report deserves careful considera-

tion, not only on account of the extreme importance of

the subject-matter concerned, but because the investigationwhich has led to this conclusion has been made by a com-

petent observer. The report relates to three outbreaks

of enteric fever occurring respectively in September, 1900,in Southwark, and in the latter part of August and in

September in Lambeth and in Kensal Town. The South-

wark outbreak furnishes the most valuable material for

etiological investigation because a larger number of personswere attacked and because the social condition of the

persons living in the infected area was more uniformly thesame throughout the whole of it than in the other areas.

This outbreak, therefore, best deserves consideration, for theextent to which Dr. W. H. HAMER’S conclusions concerningits cause are accepted must govern the view that is enter-tained of the soundness of his conclusions as to the other

outbreaks.

In Southwark in the course of three weeks about 100

people were attacked with enteric fever. They were all

poor people, living and eating as poor persons do, and

subject to that amount of prevalence of enteric fever which

usually manifests itself, especially in the poor districts ofLondon, at that period of the year. The suddenness

of the outbreak and the rapidity with which the residentsof a small and fairly compact area were attacked un

doubtedly suggested that the disease was caused by aninfected food-supply, and Dr. HAMER’S inquiries were Iconsequently directed to determining whether the cause ofthe attack of this considerable number of people was water,milk, ice-creams, or shell-fish. The facts ascertained,however, completely failed to show that these possiblecauses had been operative and hence attention had to bedirected to other possibilities. Among these was the excel-lent habit of the younger people of resorting to public baths,but examination of the relation between bathing and theincidence of the disease failed to show any association.

Lastly, Dr. HAMER was led to make detailed inquiryinto the relation between the incidence of the disease

and the consumption of fried fish from a particularshop, and here he found so close a connexion that

this relationship was fully investigated. It then became

evident that there was a parallelism between the con-

sumption of fried fish and attack by enteric fever that is

not explicable on any other hypothesis than that the twostand in the same relation as cause and effect ; for not onlydid people visiting the fried-fish shop suffer out of all

proportion to others, but persons in their own homes to

whom the fish was brought suffered, while other membersof the same families who did not eat fish escaped. Dr.

HAMER has not professed to account for every single caseof enteric fever which has occurred in the affected area

on this hypothesis. Some small number of " secondarycases " occurred, caused no doubt by an antecedent case

in their homes, itself possibly due to infection from fish.

Again, a much smaller number of cases occurred for which

explanation was wanting, but these were not more numerous

than might well have arisen without any cause other thanthose which govern the autumnal prevalence of enteric feverin the London population. Indeed, Dr. HAMER’S hypothesismust be accepted or the method of statement of the cir-

cumstances of the case contains some fallacy. In the main

it is an arithmetical statement of the incidence of the

disease upon two populations living under identically thesame conditions, except in respect of the habit of eatingfried fish. It is the method which was adopted by SirJOHN SIMON in his investigation of the cause of cholera inLondon in the middle of the last century, and in other

similar circumstances it has been accepted as satisfactory.There is no reason for assuming that it is not completelytrustworthy when applied by Dr. HAMER to prove the

existence of a new method by which typhoid fever can be

spread. We note that Mr. SHIRLEY MURPHY in his

prefatory remarks has submitted Dr. HAMER’S reportto a definite arithmetical test. He has taken a.

fixed period for the statement of the proportionateincidence of the disease upon the two populations wehave mentioned and has thus brought out clearly the vastdifferences between the liability of these two populationsto be attacked. The reader of the report will observe

that, setting aside the few cases which Dr. HAMER had,for reasons stated in his report, not regarded as belongingto the 11 special outbreak," the only persons who were

attacked were the fish-eaters.

The circumstances of the Lambeth outbreak differ some-

what from those of the Southwark one, but this appears to be

explicable on the ground that the population was less homo-geneous, and hence the distribution of the cases was less

compact than in Southwark. It is, however, noteworthythat the disease was limited to fried-fish eaters. In Kensal

Town the conclusion is less positive, and perhaps nothingstronger can be said in support of the fish hypothesis inthese cases than that it affords a possible explanation ofthem. We observe that neither Dr. HAMER nor Mr.

SHIRLEY MURPHY is disposed to lay more stress upon thehypothesis than this. Now that attention has been directlydrawn to this subject it is to be hoped that medical

officers of health will bear in mind Dr. HAMER’S

conclusions whenever they are concerned with out-

breaks of typhoid fever or cholera for which other ex-

planation is not forthcoming. It will be recollected

that in 1893 certain persons, attacked with choleraic

symptoms in London, had eaten fish received from