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in the sand and not be examined lest their fears be confirmed. I therefore think that by
applying the findings in 11 per cent. of the population to the whole, the Medical Director does not
arrive at an over-estimate of the number of sputum positive cases of pulmonary tuberculosis
working in the City.
In an urban community at least it is impossible to avoid exposure to the tubercle bacillus.
Whether a person falls a victim to infection depends on his natural powers of resistance, which
vary according to his general health and the conditions under which he is living and working; on
the dosage of infection, and on the frequency of exposure.
Modern methods of treatment have greatly reduced the mortality from Pulmonary
Tuberculosis, but the incidence of the disease, as judged by notifications, shows no comparable
decline. This may be due, at least in part, to improved diagnosis to which mass radiography has
contributed, but, though we are gratified by improved methods of treatment resulting in cure or
postponement of death, our aim must be prevention, and this is dependent on the detection and
control not only of the 'open' cases which are definitely infectious, but of the early cases which,
by prompt treatment, may be prevented from becoming infectious. Mass Radiography can make
a contribution to the prevention of pulmonary tuberculosis proportionate to the extent to which
the general public avail themselves of the facilities for examination.
The Mass Radiography Unit at Golden Lane discovered in the examinees a number of other
thoracic diseases and abnormalities, including 18 cases of new growths, 121 cases of disease of the
heart and large blood vessels, 22 cases of bronchiectasis, 20 cases of non-tuberculous pulmonary
fibrosis, 19 of chronic bronchitis and emphysema, 5 of pneumonia, 2 of pneumokoniosis, and many
others of less significance.
Food Poisoning.
There were only four cases of food-poisoning actually notified, but there were two outbreaks
of food-poisoning both of which occurred in canteens of business houses in the City. Details of
these are given below:—
Case No. 1.
On 16th July, 1954, a telephone message was received from a firm in the City asking for a
tin of tomato pure to be inspected and condemned. When asked the reason for the request,
the caller stated that a number of employees had been ill as the result of the use of the
pure in their canteen.
The canteen was visited and the following facts were elicited.
On 15th July a number of employees complained that they had suffered from abdominal
pain and diarrhoea during the previous night. This appeared to fix the responsibility on the
lunch served in the canteen the previous day, 14th July. The menu at that meal comprised
cold lamb and salad, braised lamb, meat patties made from steak and kidney remaining from
the previous day's lunch, egg salad, egg moynay, potatoes, butter beans, steamed sponge
roll, stewed apricots and custard, stewed rhubarb and custard, rice pudding, cheese and coffee.
Both the braised lamb and the cold lamb were from a piece weighing 19 lbs. 10 ozs.
which was cut into three pieces of approximately equal size and rolled and cooked the day
before it was served; the braised lamb being re-heated on the day of service and served with
hot gravy.
On 14th July 80 meals were served and 25 persons, of whom 20 were interviewed,
suffered from abdominal pain and diarrhoea during the subsequent 18 hours (extremes 5J-18J,
average ll4 hours). There was no vomiting and all recovered within 24 hours, the average
duration of symptoms being 10½hours.
The common food factor was lamb, cold or braised. Some portions of the lamb remained
and these together with a bowl of the meat patty filling and a can of tomato pure were
submitted for bacteriological examination. Samples of fasces from the 5 members of the
kitchen staff, four of whom had suffered from diarrhoea after the meal, but not before, were
also sent for bacteriological examination. The bacteriologist reported that no organisms of the
salmonella group were recovered from any of the food specimens, but anaerobic culture gave
a growth of Clostridium welchii from the lamb and the stewed steak and kidney.
Three of the five specimens of fæces yielded pure growths of heat-resistant Clostridium
welchii identical with those obtained from the lamb.
Both clinically and bacteriologically this appears to have been an outbreak of food
poisoning due to heat-resistant Clostridium welchii, the infected food being lamb. It is
noteworthy that the lamb was rolled and therefore part of what had been the exposed surface
would be in the centre of the piece of meat when cooked. The degree and duration of heat
in the centre was apparently not suffcient to kill a heat-resistant strain of Clostridium welchii.
Further, the meat was not eaten till the next day and as the method of storage was unsatisfactory,
conditions in the centre of the roll would be favourable for the growth and
multiplication of the organisms. Where and when the surface of the meat was infected it
is impossible to say; it might be anywhere between where the carcase of lamb was dressed
and the kitchen of the canteen.
The kitchen was carefully inspected. It is situated in a basement in rooms converted,
though inherently ill-suited, to this purpose. I wrote to the occupiers to suggest that, as
there is less need for canteens in the City now that food is no longer rationed, they should
consider closing down their canteen. They replied that they would be vacating the premises
in the near future and wished to carry on meanwhile. They are being advised as to how they
may make the best use of the existing accommodation from the point of view of hygiene in
the preparation and service of food, and on the change of tenancy I will endeavour to ensure
that this basement is not again used as a canteen.