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caused him to go off work. Several cases occurred in which the infection was mild
at first, and this added to the difficulties of dealing with the outbreak, as through
one thing and another the persons involved were anxious not to leave off work
and in fact continued to work for a period during which they were undoubtedly
infectious. In some cases the infection was so mild at first that the person did
not really think he was ill; in other cases there was only at first slight pain or a
feeling of seediness.
It was during the last three weeks that the food handler was at work that the
infection spread and therefore persons may have been infected up to November
11th, the day on which he went off duty, and possibly for a few days after that,
due to food which might have been bought before that date and eaten later.
The most detailed investigation was made by the Health Department into
the cause, and very many shop employees were examined medically in an effort
to see if any one of them was a carrier. Notices were given to various shops in
the neighbourhood advising the employers to ensure a high standard of cleanliness
amongst their employees, and in addition to the free vaccine treatment already
mentioned, the public conveniences were open for free washing facilities. Complete
co-operation existed between the Health Department, local doctors and medical
officers of health, and the London County Council set aside beds for the diagnosis
of the infection in persons who might be suspected of having it. This was arranged
in order that these potentially infectious persons should not remain at home, where
they might cause the infection to spread further. Two extra staff were employed
in the Health Department so that others might devote their whole time duty to
the epidemic. The causal organism was the b. typhosus.
Anxiety as to the possibility of the spread of the infection was heightened
considerably at a later stage when one of the last patients to be diagnosed was
found to have been engaged in the bottling and distribution of milk. This however
proved to be a false alarm as this patient did not give rise to a single further case.
The amount of publicity advisable in outbreaks of infectious disease must be
decided in the light of the special circumstances found. It should, however, be
noted that from the earliest time at which information of cases was given to the
Health Department the Ministry of Health was consulted, and all steps which
were taken, apart from those of a purely routine nature, were on the advice or
suggestions of responsible officers of the Ministry. One or two recent large epidemics
have sensitised both the press and the public to the incidence of typhoid fever and
the fact that this borough was in an easily accessible part of London probably added
to the facility with which press representatives approached the subject.
There was no secrecy about the outbreak as far as the Health Department
was concerned. Cases were first heard of in the evening of November 9th and
all doctors and surrounding medical officers of health were notified on the following
morning, and all head teachers of schools, heads of youth organisations, etc., were