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Typhoid Fever and Paratyphoid Fever.
A small outbreak of paratyphoid B occurred in the
Borough of Bexley (18 confirmed cases), the Urban District
of Crayford (four cases) and the Borough of Erith (two
cases) in the months of June and July, 1956. A feature of
this was the relatively small number of cases, all of which
appeared, from the dates of onset, to have been infected
at about the same time. In 92 per cent. of the cases there
was a history of confectionery having been bought at a
particular bakery in the Borough of Bexley. In the remaining
cases no direct association with the bakery was discovered,
but there was a distinct possibility that confectionery
may have been eaten at canteens supplied from this source
or at the house of a friend.
The first intimation of the presence of paratyphoid B
infection in the locality came from a medical practitioner
to the effect that a patient living in Crayford had been admitted
to a local hospital on 25th June, 1956, as a pyrexia of
unknown origin, and had since been diagnosed as a case
of paratyphoid fever. Two further cases occurred in this
family. A letter was thereupon sent to all medical practitioners
in the area, and, during the next fortnight, many
suspected cases were visited at home and all those confirmed
clinically were admitted either to the Joyce Green
Hospital, Dartford, or the Brook Hospital, Shooters Hill.
The association with the bakery in question soon
became evident from the information brought back by the
public health inspectors, and a visit was paid to these premises
by the Medical Officer of Health and the Chief Public
Health Inspector and all members of the staff were interviewed
and the position explained to them. Instructions on
the need for the most stringent care in the matter of handwashing
was given and an inspection was made of all
machinery and equipment used in the bakery. Specimens of
faeces were taken from all members of the staff and sent for
bacteriological examination. Inquiry showed that no member
of the staff had any relevant past history of gastroenteritis.
In view of the fact that Chinese frozen liquid egg had
been implicated in various parts of the country in connection
with outbreaks of paratyphoid fever, samples of this
product in current use in the bakery were sent for bacteriological
examination, together with samples of powdered
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