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examination of all the rest of the staff, that he was the sole active infecting
agent from the middle of August onwards, it was concluded that no fresh
cases arising directly from infected pastry would occur subsequent to September
10th to 12th, i.e., about five days after the date on which the foreman
pastrycook ceased work, five days having been the longest incubation period
then recorded, and allowing for some storage in the shops. These cases
would consult their doctors about September 17th-25th. It was, in fact, found
that no cases of food infection occurred with onset such as to imply infection
by pastry baked subsequent to September 5th. Only a few cases—four in
all—occurred in Croydon with a date of infection later than September 5th.
Of these, two were traced to infection from a previous patient who had been
infected through some form of pastry taken before September 5th, while the
origin could not be traced in the remaining two.
The batch of pies purchased by the Committee as a precaution was
baked on September 10th, and was therefore, in all probability, harmless,
though this does not render the precaution a superfluous one in relation to
the knowledge then obtainable. By the time the next batch was due to be
baked (September 15th), definite information as to the nature of the foreman
pastrycook's illness had been obtained from Southend, and the sale of the
pies was consequently allowed; and no cases of paratyphoid fever were
traced to these.
A satisfactory explanation of the bulk of the cases from early in August
onwards had thus been traced. But the source of the infection of the foreman
pastrycook himself brought the enquiry back in a surprising way to the
bakery, through the meat pie or the cream gateau, one or other of which
was the cause of his illness. Which of them was infected, and in what
way? Some light was thrown on the health of the staff by the foreman
pastrycook, who volunteered the information that one of the men (Y) employed
in the bakehouse, who was away on holiday from August 3rd to August 8th,
had abdominal pain for two days from August 5th, with some diarrhoea.
This may have been pure coincidence, or there may have been some significance
in the indisposition corresponding in date with "Z's" illness, and
suggesting a possible common origin. "Y" had had no pastry or pies
from the bakery; he had taken tea, in common with other employees, in a
manner to be described below, and this may conceivably be a link in the
chain of causation. Another employee (T) stated by Z to have had a bilious
attack with headache on July 12th-13th, denied the statement; neither in his
case, nor that of Y, could any bacteriological evidence of paratyphoid infection
be obtained.
These vague illnesses suggested the possibility of some unknown member
of the staff having been ill at some previous date—perhaps in July—and of
having (a) infected possibly Y and T through some common channel, and
(b) infected the pie or the cream gateau, which was the source of Z's illness.
The possibility of such earlier infection was supported by the fact that the
information received from another district suggested that there had been at
least one case associated with pastry bought from the firm concerned on
or about July 24th. It may be said that it was not possible to trace any
unsound ingredients in either the pie or the cake causing Z's illness, although
the whole procedure of their preparation was discussed in the greatest detail.
The only common channel through which infection from one worker could
be conveycd to others, except through pastry, appeared to be the rather remote
possibility of infection through tea. A bucket of tea was brewed twice a day,
and the workers dipped their mugs into this when they wanted a drink;
often the tea was almost cold before the bottom of the bucket was reached.
Assuming that one man with fouled hands had contaminated the tea while
dipping his mug into the bucket, it would be feasible, though not extremelv
probable, for indisposition such as that attributed to Y and T to have
arisen from the same source, and for one or other, or some other member