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39
II.
11th September, 192o.
Dear Sir (or Madam),
The evidence which has accumulated since my letter to you of yesterday's
date is sufficient to justify a definite conclusion as to the article of food
involved in the cases of food poisoning due to B. paratyphosus (B), referred
to in that letter.
The cases are associated with a meal of shop-made veal and ham pie,
the earliest symptoms (general lassitude and aching limbs) appearing within
one to three or four days, and the more severe symptoms, which make the
patient take to bed, beginning within three to five days, of the date on which
the pie was eaten.
The cases at present are nearly all centred around two batches of these
pies, sold between Tuesday, August 25th, and Monday, August 31st. It
cannot vet be said—until the end of this week or the earlier part of next
week—whether the next batch, sold from the shops concerned between Tuesday,
September 1st, and Thursday, September 3rd, inclusive, was also
infected. The early determination of this will depend on the promptitude
with which medical practitioners draw my attention to suspicious illness under
their care. Appropriate measures are being taken in regard to issue of the
pies subsequent to the 10th instant, and there appears no reason why such
veal and ham pies, as are from this morning on sale in shops, should be
avoided.
I shall be glad to have Widal tests applied to any specimens of blood
which you send up to the Borough Hospital, and wish to urge the importance
of applying this test where suspicion of paratyphoid (B) arises. A markedly
positive reaction has been obtained on the eighth day after the earliest symptoms
in several cases in the present series, and very probably the reaction
may be evident at a still earlier stage.
In regard to the question of symptoms, I have seen several cases of
suspicious illness—all clinically paratyphoid fever—since my previous letter,
and in all these cases an eruption of discrete pink spots has been noted, in
one or two identical with those of typhoid, in others slightly larger and
more profuse than is usual in the latter disease.
I would again urge the importance of early notice to myself at the Town
Hall, Croydon (telephone Croydon 1964), at my house (Croydon 1713), or
failing these, the Resident Medical Superintendent at the Borough Hospital
(Thornton Heath 1767).
III.
17th September, 1925.
Dear Sir (or Madam),
I am now able to send some further particulars with regard to the
outbreak of food poisoning due to B. Paratyphosus B.
On enquiry into the history of the cases to which medical practitioners
were good enough to draw my attention, it became clear that, although the
first considerable batch of cases was entirely due to the eating of veal and
ham pies, there were also a proportion of cases due to eating other articles
of confectionery prepared by the same firm. On comparing these, it was
found that no single food constituent of the pastry was common to all of the
confectionery involved, except flour itself. Investigation of all the employees
brought to light a pastrycook who has been away on holiday throughout the
period of the enquiry, and he has now been shown to be suffering from an
unrecognised attack of paratyphoid (B) fever while at work. His blood
gives a positive agglutination against paratyphoid (B), and his history is
typical. This man has been on holiday since September 5th, and proper