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and serving of food. Some experience of various nationalities engaged in various capacities in the
catering trade, leads me to believe, that the standards of hygiene in some countries more esteemed
for their mastery of the theory and practice of the culinary art than we are, are distinctly lower than
ours. I suggest that many people who criticize adversely both English cooking and English food
hygiene, never think whether they would always enjoy what on holiday is a delightful change, and
when abroad, give their critical faculties in matters of hygiene, a holiday too.
In fact I do not believe that we arc as bad as we represent ourselves to be, and no visitor need
feel that by coming to England he is really in danger of suffering illness or even temporary inconvenience
from an attack of food poisoning.
In support of this point of view I would point out that whereas there are over a thousand catering
establishments in the City, and well over a quarter of a million main meals are served daily, only
three outbreaks of food poisoning were reported during the year, none of which were connected with
catering establishments open to the general public, and the worst of which was not due to a defect in
food hygiene. It may of course be contended that people who eat in the City may not be taken ill
till they arrive home, but I only received two complaints of this nature during the year, both of which
referred to industrial canteens. Only three persons were involved, and on investigation it appeared
highly improbable that the infection had been contracted in the City, since in each canteen hundreds
of exactly similar meals had been served at the same time and no other complaints had been received.
In only one case was a complaint received that food poisoning was due to food purchased in the
City, and in this instance it did appear that the allegation was justified, since samples of the food
concerned (sausages) were obtained in the City and on bacteriological examination were found to
contain a variety of bacteria including coliform organisms, streptococcus faecalis and a coagulase
positive staphylococcus. The sausages, though sold in the City, were manufactured elsewhere and the
Medical Officer of Health of the district concerned was informed.
It is not intended to convey the impression that all is well with food hygiene in the City. Indeed
there is much still to be done even in the matter of premises, many of which are old and cramped,
and still more to be done in the very difficult problem of educating and training food handlers in the
routine observance of high standards. But it is suggested that more harm than good may result from
overstatement. The medical profession is trained up to the standard of the modern surgical operating
theatre and expects employees in the catering trade to understand and approach this standard.
Those who are brought into close contact with the employees and know the conditions under which
many of them live and often work, appreciate that, while visible dirt may be understood to be a
potential sources of danger, it is extremely difficult, if not impossible, to convey a degree of understanding
of the dangers of bacterial contamination sufficient to, result in strict observance of all the
desirable precautions.
We are making and shall continue to make progress, but meanwhile we need not and should not
cry to the world "stinking fish" where our catering trade is concerned. I submit that we are rather
inclined to compare the worst in this country with the best in other countries.
Food Poisoning.
An extensive outbreak of food poisoning occurred in St. Bartholomew's Hospital.
The source of infection was ducks' eggs.
On Thursday, July 7th, I was informed by the Medical Officer of Health of Islington that a woman
who worked in the kitchen at Bart's had brought home some trifle on July 5th, and had given some
to her son and daughter. The woman and her son were subsequently admitted to St. Mary's Hospital,
Islington, suffering from food poisoning. The daughter was also affected and was removed to the
North-Western Hospital on July 12th.
I rang up the Bacteriology Department at Bart's, who said they were investigating an outbreak
of food poisoning in the Hospital, and that these Islington cases confirmed their suspicions that the
source of infection was a pudding with a meringue top made from 200 ducks' eggs, on Tuesday, July
5th. It is, of course, well known that ducks' eggs are occasionally infected with food poisoning
organisms by reason of the dirty conditions in which some farm-yard ducks live and feed and lay
their eggs.
A meringue is not heated to the point of sterilisation, and therefore any infection in the eggs would
survive the cooking.
Symptoms developed from 24 to 48 hours after the meal at which the sweet was served.
Nurses and other members of the staff and patients were affected, and all had eaten the suspected
food.
The illness was an actual infection with food poisoning organisms and not due simply to the
ingestion of bacterial toxins. Salmonella typhi-murium was recovered from the stools in a number
of cases, but no pudding or ducks' eggs remained for bacteriological examination. It is because the
illness was due to the consumption of living organisms as opposed to toxins, that the incubation period
was so long (24-48 hours).
A total of 144 persons were affected (72 nurses, 18 maids, secretaries and other employees, 2
kitchen staff, 2 relatives of one of the kitchen staff and 50 patients). In most of those attacked the
illness was brief and did not endanger life, but in some patients already ill from other causes, its
effects were serious. Several of these were treated with streptomycin given orally with good effect.
In one elderly patient suffering from arthritis and nephritis the illness was fatal.
I visited the Hospital and discussed the outbreak with the bacteriologist, Professor Garrod, with
whom I subsequently visited the kitchens, which are clean and well run.
Certain members of the staff had gone on short leave from the Hospital after July 5th and had
informed the Matron that they were ill. I notified the Medical Officers of Health of the districts in
which these persons lived.
I also wrote to the Medical Officers of Health of the districts from which the ducks' eggs were
delivered. They had been collected from a number of farms, and these were investigated as to
the conditions under which the ducks were kept. In three farms the ducks had access to polluted
ponds and ditches.