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34
jelly" cakes hitherto implicated were flour and water, and that the "buttercream"
consisted of margarine and sugar. The process by which butter-cream
was made showed some points of interest. The margarine and sugar were
churned together in a dough-mixer, and then emptied out—partly by gravity
and partly scooped out by the hand of the maker—into a large mixing
pan, where flavouring and colouring agents were beaten in with a spoon.
No suspicious feature arose in regard to the preparation of the rest of
the cake-substance, to which a layer of butter-cream was added, and it is
unnecessary to give details here. All that need be noted is the exclusion of
gelatine as an infecting agency, and the renewed possibility of human contamination.
Exclusion of bacterial rat virus as infecting agent.
Almost simultaneously with the removal of the shadow of suspicion
against the gelatine came reports from the Ministry of Health laboratories
and from the Borough Hospital that the bacterial virus did not correspond
in cultural features with the organism isolated from the blood of the first
known patient, Miss X, nor was it agglutinated by Miss X's blood serum,
which was known, by test against a number of other proved cases, to be
rich in paratyphoid (B) antibodies—in other words, the bacterial virus used
at the bakery was not the organism of paratyphoid (B) fever.
Detection of human source of infection.
The whole position had, therefore, again to be reviewed and the false clues
discarded. The lack of direct evidence of human infection, associated with
the indirect evidence of its likelihood, continued to be disturbing. In order
that the employees engaged in making the various types of confectionerymight
be collated, the firm were asked to indicate appropriate particulars
on the lists which they had provided of their various employees. It was
then found that there had been inadvertently omitted from the list the name
of the foreman pastrycook, who was away on holiday at Southend-on-Sea
at the time of the enquiry. Enquiry showed that this man was known
to have had a temporary illness, involving frequent visits to the lavatory,
early in August. He had been on duty during the period in which all the
confectionery so far incriminated had been made at the bakerv, and was
capable of having helped in one way or another in their preparation.
A telephone message to the Medical Officer of Health of Southend-onSea,
giving particulars and asking for an examination of the man and of his
blood, received very prompt response, and a reply was obtained on the next
day (September 15th)—eight days from the beginning of the enquiry—showing
that the man's history was very suggestive of an enteric group infection,
and that his blood gave a strongly positive reaction in regard to paratyphoid
(B) fever.
The man was to return to Croydon on September 18th. Measures were
taken to see that he did not return to work; he was to see me directly
on his return. Seeing that all the articles he might have helped to make up
to the time of his departure on holiday had by now been sold or otherwise
disposed of at the various branch shops, that no other member of the staff
could be found at all suspicious of having had paratyphoid infection, and that
no other source of infection and no other infected material could be traced
at the bakery, it was felt to be safe and advisable to take up the position
set out in letter No. 3 of the 17th September, to medical practitioners, set
out in the appendix.
Source of infection of foreman pastrycook.
Pending the return of the foreman pastrycook, it was ascertained that,
apart from general supervision, he was personally responsible for making
the paste of the ham and veal pies. During, the week which included August