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23
once inspected and the standard of hygiene found entirely
satisfactory. Two pies were taken for bacteriological examination
on January 11th and both were free from infection.
Failing any common source of contact between the cases intensive
sampling was carried out on foodstuffs liable to be contaminated
with paratyphoid organisms and during the second week in
January twenty-three samples of egg products and synthetic cream,
etc., were examined by the bacteriologist. One sample proved to
be infected with a food poisoning organism but none with paraty
phoid. Towards the end of February information was received from
a trade source that some supplies of desiccated coconut from
Ceylon had been found to be contaminated with paratyphoid germs
and this was later confirmed by the London Port Health Authority.
This at once suggested a possible source of the local outbreak
and we endeavoured to obtain samples of all supplies of
desiccated coconut in the town. Forty-two samples were taken
and two of these were contaminated with food poisoning organisms,
but we again drew blank for paratyphoid.
The outbreak ceased as abruptly as it began, and apart from
McN. no secondary cases arose. We were most thankful for this as
we were by this time coping with a more serious outbreak of
diphtheria. The satisfaction in controlling effectively an outbreak
of infectious disease is always tempered by some disappointment
if the source of origin remains untraced but, for the reasons
I have given, this is the usual experience with paratyphoid.
The Chief Medical Officer, Ministry of Health, reported 379
cases during 1959 and, in describing a widespread outbreak,
stated - "despite extensive investigations the vehicle of
infection was not identified'. Sir John Charles went on to say
'Man remains the ultimate source of well-nigh all the infections
causing the enteric fevers, and the transmission of the
organisms concerned is closely related to the various means by
which food and drink become contaminated by infected human excreta.*
Vigorous enforcement of the provisions of the Food Hygiene
Regulations, and continued efforts to educate the public, and
especially food handlers, in personal hygiene, is our best
defence against these costly outbreaks of enteric infections.
FOOD POISONING
Fifty seven cases were notified and in addition ten cases
were ascertained' i.e. became known otherwise than by notification,
by following up notified cases. None was fatal.
There were three small familial 'outbreaks' , in each case the