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abdominal pains were noted on June 8th and 9th. His blood serum
gave a positive agglutination in dilutions of 1 in 10 up to 1 in 5,000
with the Bacillus Paratyphoid B. An abdominal rash meanwhile
formed a sign. The patient had eaten watercress obtained from the
same shop "E" as in O.B.'s case. All the other food and family
history enquiries were negative and no "carrier" was responsible.
(3) L.L., male, 22 years, Drakefell Road, a clerk, was notified as
having Paratyphoid B fever on June 8th. For some days he had had
loss of appetite, a bad taste in the mouth and abdominal pains. The
blood test was negative, but a consultant who was called in diagnosed
Paratyphoid B. fever. Watercress had been eaten, the same having
been purchased at two shops, one of which was the same as that in the
two cases mentioned above. All other cases were negative.
(4) E.C., female, 19 years, Wallbutton Road, was notified on
June 14th. A music teacher, she taught at home and at people's houses.
There had been abdominal discomfort, headache and dizziness for some
days. Ice cream had been eaten a month before the illness commenced,
but the patient was certain she had not consumed watercress.
An outbreak of four cases of the kind occurring close to each other,
both geographically and in point of time, called for further investigation.
Communications were addressed to the Medical Officers of Health
of London Boroughs enquiring into the history of such cases as had
occurred within recent weeks in their respective districts. Replies
pointed to the following as causes:—(a) infected oysters consumed in
France; (b) infection in America; (c) infected water at Gravesend;
(d) three cases were caused through consuming watercress.
In our four cases the evidence pointed (l) in the direction of watercress
; (2) ice cream; (3) possibly milk and (4) perhaps a " carrier."
Milk submitted for bacteriological examination was found to be
"negative," and enquiry as to the health history, recent and remote, of
employees and their families gave no grounds for anxiety. The milk
arrived at the depot in question in bottles.
Next, the watercress premises were inspected and found to be untidy.
No history of illness was found in the salesmen and their families.
There was no watercress on the premises at the time of inspection, but
it was ascertained that the source of supply was from a vendor "T,"
who had a place at the Borough Market, Southwark. Dr. Wilson,