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There must be many other people who have had symptoms not sufficiently
serious for them to summon a doctor who were really suffering from
this complaint and who were infective. On top of that are the many
symptomless excreters who, being symptomless, are not recognised as
such. That children are affected so commonly accounts for the facility of
passage to other children. On this the Chief Medical Officer of the
Ministry of Health in one of his Annual Reports says:—"The experience
is that the infection is rarely conveyed by food, and that direct or indirect
personal contact is mainly responsible. The danger of spread of the
infections is much enhanced by the large numbers of symptomless
excreters often associated with the clinical cases, not only within day
nurseries, schools and elsewhere in which outbreaks occur but also in
homes. This means that the home conditions as well as conditions in
institutions attended by children from these homes require full attention.
Good personal and environmental hygiene and in particular hand washing
immediately after a visit to the toilet are of outstanding importance."
FOOD POISONING
The number of notifications of cases of food poisoning gives only a
rough approximation of the incidence of this complaint. On the one
hand is the large number of cases not notified. In this district no single
one of those who suffered from the largest of the local outbreaks of food
poisoning was notified. There must be many other instances of a single
case or of family or larger groupings which are not notified. On the other
hand, many notifications are received of persons suffering from food
poisoning in which it is very doubtful if that was the real cause of the
trouble. In a number of cases laboratory investigation leads to the
detection of the Sonne organism in some of these cases.
During the year, allowing for the withdrawal of some of the notifications,
the number of cases notified was 44. The distribution was 9 in
the first quarter, 12, 16 and 7 in the remaining quarters. 17 were the only
persons in the home notified, though the notified case was not always the
only person in the house suffering from similar symptoms. In 5 instances
Salmonella typhimurium was recovered. In one of these cases infection
had probably been contracted at the place of work where there were other
sufferers. In some of the other cases no organisms suggestive of food
poisoning or of food infection were recovered from the stools. In a number
of these cases it is questionable whether the patient did in fact suffer from
tood poisoning. One of the notifications related to a person in whose
family six others were suffering from gastro-intestinal symptoms, but
none of the others was notified as suffering from food poisoning; the
course of the passage of the illness through the family was not typical of
a food poisoning, resembling more that of a food infection.,
Of the other cases, two members of a family were affected in two
instances; three members in three and four members in another three
instances. One of the cases of triple infection was due to salmonella
typhimurium. Another of the triple infections was due to a coagulasePositive
staphylococcus probably present in a macaroni pudding which
was consumed by the three members of the family who fell ill, but was