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Symptoms.
In the more marked of these, and of subsequent cases, the
symptoms were strikingly alike—severe headache, often occipital in position,
abdominal pains, nausea or vomiting, chilliness with subsequent fever of
100° F., lasting for one to three weeks, early diarrhoea, often with constipation
later, and profound initial lassitude and debility. An eruption,
similar to that found in typhoid fever, but more abundant and coarser in
character, was a very constant feature. Epistaxis (nose bleeding) within the
first few days of the illness was also a frequent feature. Most of the cases
were sharply ill. None of the Croydon cases ended fatally, though some had
severe complications, including sharp haemorrhage from the bowels.
Incubation period.
Although it is anticipating the sequence of events, it is convenient to
state at this stage that the incubation period, from the moment of infection
to that of the earliest symptoms, varied from one to seven days, in no instance
known to me exceeding the latter period, and in only two cases exceeding
five days. This is a decidedly shorter incubation period than is often found
in this disease.
Source of infection.
The almost simultaneous occurrence of cases of illness among the
pastryshop staff pointed towards a common source of infection, probably
through food or drink. The many alternative sources and methods of infection
which might have needed investigation were fortunately limited by the
fact that a second group of cases had occurred, at precisely the same time,
in the house of the manager of the shop. It was reasonable to assume a
common basis of infection for the two groups, and enquiry into the factors
common to both showed that these were as follows:—
(a) The manager himself. His illness began on September 2nd, i.e.,
later than that of most of the members of his household (August
29th-September 2nd), so that he was unlikely to have personally conveyed
the infection from the shop to his house.
(b) The manager's son. His illness began on September 2nd, and the
same argument therefore applies in his case.
(c) Milk Supply. The pastryshop received milk from three dealers, one
of whom also supplied the manager's house. Enquiry at the milk
shop into the health of the employees, and the absence of any
evidence of widespread illness among customers; served by the dairy,
made this an unlikely source of infection. This conclusion was confirmed
when the next case of paratyphoid infection coming to light
was found to obtain milk from another source. Enquiry into subsequent
cases showed that there was no particular milk supply
common to all.
(d) Water. This also could be set aside as the source of infection,
in view of the absence of any generalised epidemic in the area served
by the same water supply.
(e) Provisions. The provisions regularly brought from the shop for the
manager's house were bread, madeira cakes, small fancy cakes, and
veal and ham pies.
Turning now to the provisions which might be consumed by members
of the shop staff, it was found that the staff had all their meals at the shop;
that these meals were served in a staff room on the first floor of the premises,
the ground floor being entirely for the purposes of shop and refreshment
rooms; that joints of meat, vegetables, and simple puddings were cooked on
the stove in the staff room, these foods being both for staff and for customers,