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of the staff similarly affected, to contaminate the pie baked for the foreman
pastrycook. This is obviously pure conjecture, and does not in any case
reveal the original source of the outbreak, which could not be further traced.
This has been the common experience in similar outbreaks of food-borne
paratyphoid fever elsewhere; and there is cause for satisfaction that apparently
the only factor in the continuance of the outbreak was detected and
the outbreak checked.
The foreman pastrycook was kept under observation for a number of
weeks, during which he was not allowed to work. Examinations of his
stools and urine were made in due course, in each instance with negative
results, suggesting that he was not a carrier, but the victim only of an
ordinary mild outbreak of the disease, with transient infectivity to others.
He did not return to work with the firm concerned, but left the town. While
there is no suggestion in this instance that the man remained at all infective,
it is clear that such a man, trained in bakery as a speciality
and without other means of livelihood, might, through no fault of
his own, develop enteric fever, remain a carrier of the disease, and so be
debarred from returning to his trade without prospects of other occupation.
Some system of unemployment insurance in the trade would be a wise safeguard
to meet such difficult cases.
Summary.—This outbreak of paratyphoid (B) fever, affecting probably
scores of individuals spread over half-a-dozen sanitary districts, was traced
definitely to veal and ham pies and to fancy cakes infected at a late stage
of their preparation by a pastrycook who had suffered from an unrecognised
attack of the illness. The source of his own illness could not be traced;
that source was within the bakery, through either infected materials or an
infective person, and it may have accounted for a few scattered cases of
paratyphoid (B) fever arising in areas outside Croydon, with dates of infection
late in July and early in August. 75 cases were known to be in all
probability associated with the outbreak. The earliest of these was probablyinfected
about July 24th; 62 of the 75 cases were probably infected between
August 4th (by which date the foreman pastrycook was a possible source of
infection) and September 5th, on which date he ceased to work, and of these
33 were probably due to meat pies, 21 to other confectionery, and 8 to infection
from a previous case; 4 cases were infected subsequent to September 5th, and
of these 2 were due to infection from a previous case. In no individual case
could infection be traced to pastry from this firm baked at a date subsequent
to the withdrawal of the infective pastrycook from his work.
Conclusions.
The outbreak brought into relief a number of problems needing the
serious consideration of the confectionery trade :—
(1) The need for the most rigid insistence on proper washing arrangements
for the staff, and a clear understanding with the latter on the subject
of cleanliness of person.
(2) The need for supervision of the methods of cleansing utensils in such
a way as to avoid risks of contamination during the process.
(3) The need for investigation of all trade processes which involve the
personal handling of foodstuffs, where there is no subsequent heating of the
latter to a temperature and for a period certain to destroy contaminating
organisms. This applies to such processes as the filling-in of pies with
gelatine stock, the removal of butter cream from mixing machines and its
working-up and subsequent piping on to cakes; the preparation of whipped
cream, etc. Every effort should be made to devise means whereby every
process involving personal handling is followed by a sufficient heating of the
foodstuff handled to prevent risks of retention of infection.