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symptoms for about a week at home. He was admitted to St. Ann's
on January 14th and required two courses of treatment to clear
him of the infection. RF. (39) (no relation) had been ill since
Christmas but responded to treatment at home, although his
condition was confirmed as paratyphoid on January 18th. B. McN.
(aged 37), another nurse, became ill on January 18th, and hers
was the only case in which contact could be demonstrated, she
having nursed cases 1, 3 and 4 some two to three weeks earlier.
The final case, M.H. aged 24, was sent into St. Ann's on February
11th by her family doctor, who had suspected the condition within
a few days of onset. Both these ladies recovered fully without
complications.
At first sight it seems extra-ordinary that eight cases of a
comparatively rare infectious disease could occur in a circumscribed
area within a few weeks of each other without some direct contact
between them being discovered but, in fact, it is extremely difficult
to trace the source of infection in this condition. Although
it is a food borne infection and quite extensive outbreaks have
occurred due to contaminated egg products and (more recently)
desiccated coconut, it is most often spread by human carriers
who may infect only one or two people at a time and who, moreover,
may only excrete the organism intermittently and give repeated
negative tests between episodes of excretion.
Unlike bacterial food poisoning where the effects follow within
a few hours of eating the affected food, Paratyphoid is a systemic
infection whose symptoms may not develop for several days. The
early symptoms of headache, loss of appetite, lassitude and feeling
generally off colour are not very specific (especially on this
occasion just after Christmas) and it was difficult to date' the
onset in most of the cases with any accuracy Even where the date of
onset was known witn certainty, as in the first case, (December
26th), the actual infection might have occurred from a day or two
to almost two weeks before, so that the tracing of contacts was
extremely difficult and examination of any suspicious foodstuff
consumed, quite impossible Apart from the second nurse, who
clearly picked up the infection from her patients, only one other
promising lead was discovered The family of S.S. had suffered
from a gastro intestinal upset during the first week in December,
which they attributed to a ready cooked meat pie bought from a
local trader s s father and grandmother were affected, but her
mother, who had also consumed part of the pie, was not, but she
(Mrs S.) was the only one of all the contacts of all the cases
to produce a positive specimen She was, in fact, a symptomless
carrier (subsequently cleared by prolonged treatment at home) and
she, rather than the pie, may well have been the source of infection
to her family. However, the pie supplier's premises were at