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25th-27th, he took the unusual course of helping the temporary
hand engaged in fdling in the pies with gelatine, by himself adding pepper and
salt—and it was understood that he had on occasion done this bv hand.
Assuming him to have been infective, this direct contact, by handling, at a
stage of the manufacture where there was no subsequent heating to destroy
infection, would readily account for the sudden outburst of cases of paratyphoid
fever connected with the two batches of meat pies, in the preparation
of which he assisted in a way which was not his usual practice; the object
of his assistance being clearly the laudable one of assisting a worker unaccustomed
to a particular process, and the result of his assistance being
just as clearly the likely chance of infecting the pies at a critical stage in
their preparation.
This foreman pastrycook was also responsible for making the buttercream
and whipped cream for the various types of fancy cakes which had
produced infection. He was, therefore a sufficient cause for, at any rate,
the bulk of the outbreak, and his return was awaited with interest, in order
that the source of his own infection should be traced.
Meanwhile, it was felt desirable that the firm should deal with the processes
in pie manufacture not subjected to subsequent heating, and should
establish a routine whereby the seasoned gelatine bone stock should be kept
boiling for at least twenty minutes after preparation. This precaution was
at once tested, found practicable, and adopted by the firm.
An interview with the foreman pastrycook on his return on September
18th yielded the following interesting information which, while throwing
much light on his own share in the outbreak, raised perplexing problems,
never fully solved, as to the course of events prior to his own illness. For
convenience, the foreman pastrycook is referred to as Z:—
Z and Mrs. Z., a married couple without children, lived in a cottage
on the bakery premises. Z has been foreman pastrycook with the firm for
some twelve years. Neither he nor Mrs. Z had had in their past history any
illness suggestive of enteric group infection.
From July 23rd to August 3rd, 1&25, there were staying as visitors at Z's
cottage a family of relations from another part of London, consisting of
father, mother, and two children, together with Z's own mother. To celebrate
the occasion, Z arranged for a specially large veal and ham pic to be
baked for him at the bakery, on Thursday, July 30th. This was brought to
his cottage on Saturday, August 1st, together with a cream gateau, also
made at the bakery, and both articles were eaten on that day by Z and Mrs.
and the five guests. The latter returned to their home on August 3rd.
Two of them developed abdominal symptoms on August 3rd, and two on
August 4th, one child escaping all symptoms. It seems very probable that
these were cases of paratyphoid (B) fever, though, judging from correspondence
with the Medical Officer of Health of the district, they did not appear
to have been notified as such. Z himself developed diarrhoea on August
4th, with moderately severe headache. The diarrhcea continued for two
days, after which he felt fairly well again. He kept at work throughout. In
spite of his own light-hearted description of his indisposition, he must have
been seriously unwell, as the manager of the firm had a lively recollection
of the fact that the man was much indisposed.
It was thus clear that the foreman pastrycook had suffered from a mild and
unrecognised attack of paratyphoid (B) fever, that he had been capable of infecting
foodstuffs from August 4th, the onset of his indisposition, until September
5th, when he ceased work to go on holiday, and that he did in all probability
account for the sudden outbreak of cases infected from pies and other
foodstuffs prepared during the week August 24th to 29th, when he was in close
contact with the processes of preparation. On the assumption, based on the