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and that all fancy pastry, meat pies, cakes and bread issued from the shop,
whether for customers or for staff, were cooked at a central bakehouse not
connected with the shop. It was further found that the meals served to the
staff included bread, cooked meat, vegetables, sometimes ham and veal pies,
but never fancy cakes, and it was said to be unusual for the staff to buy
such fancy cakes for themselves.
The provisions in common between the shop and the manager's house
were thus limited to bread and meat pies. Of these, the pies would be a
more likely means of conveying a gross degree of infection than the bread.
Enquiry now showed that the staff had had a veal and ham pie, one of a
batch baked on August 27th, for their breakfast at the shop on August 28th.
Miss X had developed her first symptoms on August 29th, and other members
of the staff at various dates from August 31st to September 1st. The
manager's household had had a veal and ham pie, baked on August 25th,
at midday on Friday, August 28th; a daughter developed symptoms on
August 29th, and other members of the family between August 31st and
September 2nd. Bread from the shop had also been eaten, both by the shop
staff and by the manager's household.
It was clear, therefore, that there were grounds for suspecting the meat
pies, of two bakings, viz., those of Tuesday, August 25th, and of Thursday,
August 27th, or possibly the bread, sold at the shop. The suspicion of the
pies was confirmed when news was received, through a medical man practising
in the district, that six members of a private household living near
the shop had simultaneously developed paratyphoid (B) fever, with onset
in three cases on August 29th, and in three on August 30th, after eating on
the night of August 28th a veal and ham pie obtained from the shop in
question. Almost simultaneously with the receipt of this information I saw,
in consultation with the Medical Officer of Health of an adjoining area, a
household of five persons suffering from anomalous illness, which we agreed,
and which subsequent tests proved, to be paratyphoid (B) fever. These five
persons had bought and eaten a veal and ham pie from the same shop on
August 26th, and had developed symptoms of illness at dates between August
29th and 31st.
Attention was thus concentrated on the veal and ham pies as the probable
source of infection, and on the manner in which these might possibly have
been infected.
Manner of infection of meat pies.
The meat pies were not prepared at the shop, but at a central bakehouse
serving a number of branch shops, situated in various parts of Croydon
and neighbouring districts. The pies were then delivered ready-made at the
shop, and were sold over the counter to customers, while occasionally a
pie was taken from the storeroom in the shop to the staff room for the
meals of the staff.
The details of the investigations into the various possible chances of
infection and into the health of each employee at the shop need not be given.
Briefly, the main possibilities of infection appeared to be:—
(1) Contamination of pies at the shop by the assistant serving them to
customers, the same assistant possibly picking out a pie from the storeroom
to send upstairs to the staff room. This appeared to be a very unlikely
method of infection; the occurrence of groups of cases suggested massive
infection of the interior of the pies rather than the slighter contamination
of the exterior which would occur in handling.