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(1) Although bacterial rat virus had no part in the outbreak in question,
it appears inadvisable that any form of bacterial poison likely to cause
sick, as well as dead, rats and mice should be used within the precincts of
bakeries or confectioners' shops.
(5) All foodstuffs and other ingredients used in baking should be protected
against rats and mice by automatically acting covers or other means not
depending on human initiative.
(6) In view of the possibility of an employee becoming at some time a
carrier of infectious disease, and therefore unfit to continue in the confectionery
trade, while untrained for other employment, the trade might with advantage
consider the adoption of some form of industrial insurance allowing for the
maintenance of such an individual, so long as he remained in an infectious
state.
H. P. NEWSHOLME,
Medical Officer of Health.
March, 1926.
APPENDIX.—Letters addressed to Medical Practitioners in Croydon
in regard to the outbreak.
To Medical Men and Women practising in Croydon.
I.
10th September, 1925.
Dear Sir (or Madam),
My attention has been drawn during the past few days to a series of,
so far, some fifteen cases of sudden acute illness, occurring in Upper Norwood
and in the immediately adjacent parts of Lambeth and of Penge, verv
suggestive of acute food poisoning. Two of these cases have now been shown
by the agglutination test to be suffering from paratyphoid (B) fever; others
are being subjected to the same test. The source of infection is now under
investigation. I send this note to say that the enquiry would be greatlv
helped if you would be good enough to let me know the name, address,
approximate date of onset, and foodstuff (if any) apparently involved, in
regard to any patient now or recently under your care showing symptoms as
below, and if you would allow me to consult with you as to their possible
relation to the cases here in question.
The onset of the cases so far known to me lie between August 27th and
September 2nd. I do not at present know of any except in the district
named above, but it is quite possible that they may be occurring elsewhere.
The onset in nearly all cases has been sudden. A patient, well one day,
on the next and immediately succeeding days, shows a rapid extension of
the following symptoms:—Acute headache, usually occipital; extreme lassitude,
with aching limbs and back; shivering, or a feeling of being flushed;
colicky abdominal pains; some nausea, often vomiting; in some diarrhoea,
in others constipation; epistaxis a few days after onset in several cases.
The patients have temperatures of 100° to 102°, and have the general appearance
seen in a fairly mild case of typhoid fever. Some are quite seriously
ill, a few have been ambulant in type. The fever in the milder ones has
lasted for a few days, but several are running a typhoidal course.
I cannot say with what frequency rashes have occurred. In the one case
definitely notified as paratyphoid (B), there has been the eruption—common
in this disease—profuse, discrete, piny-red spots, coarser and more profuse
than, but otherwise similar to, those of typhoid fever.