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Case No. 2.
On the 26th October the manager of the canteen in a Government building in the City
reported that several people had complained of illness following a meal eaten in the canteen
the previous day.
On investigation it was ascertained that thirteen people had been affected, the symptoms
being abdominal pain and diarrhoea. The number of persons served with lunch on 25th
October was about 750. From a number of items on the menu the only one which had
been eaten by all the affected persons was roast veal and seasoning. Some 200 portions of
roast veal were served but only 13 complained of illness.
About 4 lbs. of the veal remained, and this was sent for bacteriological examination.
The bacteriologist reported that the meat was normal in appearance and smell, but direct
films showed rather large numbers of Gram positive cocci, and cultures yielded a profuse
growth of micro-cocci. The colonies were non-pigmented and coagulase tests were negative.
His comment was, "it is abnormal for meat to contain as many bacteria as this of any kind,
but it is not possible to say with certainty whether their presence was the cause of the
intestinal disturbance".
The veal was delivered to the canteen on 20th October and was immediately placed
in a refrigerator. On 22nd October it was boned, cut up and cooked for about 3 hours.
It was then placed by hand in four separate tins to make pressed jellied veal. It was
allowed to cool in the kitchen then put in the refrigerator till 25th October, when it was cut
into thin slices, which were put on individual plates, warmed up in a hot cupboard and
served.
This history of the treatment of the veal explains why an abnormal number of bacteria
were found. Fortunately there were no specific food-poisoning organisms, but excessive
contamination with non-specific bacteria will give rise to symptoms in susceptible people.
In this instance only thirteen out of about 200 were affected.
A thorough inspection of the canteen was made; and though a fair standard of cleanliness
was maintained, there were some unsatisfactory conditions due mainly to wear and tear of
fittings and equipment. A schedule of defects was forwarded to the appropriate senior officer
at the request of the manager, and I have received an undertaking that they will be
remedied.
Year by year I report one or two outbreaks of food-poisoning of the Clostridium welchii type
from canteens in the City but rarely one from a public restaurant. This might suggest that the
standard of food hygiene in the commercial canteens is lower than that in the public restaurants.
This is certainly not the case. I think the explanation is that if there is an outbreak of foodpoisoning,
even of a mild type, in the canteen of a business house, a number of the staff are away
for a day or part of a day, moreover there is an interchange of experiences and the occurrence
becomes known to the management, who inform my department, and an investigation is undertaken.
In a similar occurrence in a public restaurant, the affected persons would probably be
widely distributed as regards their places of employment, and still more so as regards their places
of residence. The attack of abdominal pain and diarrhoea usually comes on in the evening after
the consumption of the infected mid-day meal and continues through the night, but by the
morning the patient has begun to recover and is perhaps even well enough to go to work, so a
doctor is not called in. There is consequently no notification and we hear nothing about it.
I find it difficult to believe that there are not in fact proportionately as many cases of this
type of food-poisoning from public restaurants as from canteens, but we only hear about the
latter.
An interesting outbreak which appeared not to be due to food-poisoning but possibly to a
virus infection, occurred in September. The details are as follows:—
Late in the evening of 15th September I received a telephone enquiry at home from a
reporter of one of the daily papers, asking if there was an epidemic of gastro-enteritis in the
City. I replied that so far as I was aware there was no epidemic, and asked the reason for
the enquiry. The reporter then said that many of the staff of his newspaper had been
affected.
It occurred to me that the cases of illness might be due to food-poisoning, and I arranged
for enquiries to be made next morning. These revealed that approximately 2,000 persons are
employed on the day and night shifts, and that some 50 people were known to have been
taken ill during the night of the 14th-15th September, though probably there were many
more who had been less severely affected.
The symptoms were severe frontal headache; nausea and abdominal pain followed by
violent sickness which persisted through the night; and diarrhoea of varying severity.
The illness lasted from 24 to 48 hours, and all the cases recovered completely in 3 or
4 days.
There is a canteen which is well equipped and maintained. A mid-day meal is served,
but many of the persons affected did not have the mid-day meal. The canteen is, however,
open day and night for the supply of snacks, and all the affected persons had something from
the canteen. No remains of the food consumed on the 14th September were available for
bacteriological examination.
It was found that milk in churns was stored under unsatisfactory conditions for some 24
hours.
One of the women employed in the preparation of food in the canteen had suffered from
diarrhoea during the week-end before the outbreak. A sample of feces was examined
bacteriologically, and an organism which appeared to be serologically related to Shigella
flexneri, the cause of one type of dysentery, was found, but it was atypical, and on full