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Food poisoning outbreaks
19~8.
PUBLIC HEALTH.
vaccination is of serious import and cannot fail to have an effect on vaccination both in its medical and purely administrative aspects. In fact, since the report of the Committee on Vaccination was issued, fatal cases of disease of the central nervous system following vaccination have been reported from Norfolk and exploited in Parliament, and it is not unlikely that the occurrence of this condition coupled with the mild character of the prevailing type of small-pox in this country will lead to an alteration of the vaccination laws. The Committee foreshadow such an alteration at the end of the first part of their report. Dealing with their third term of reference, namely, the methods of vaccination which are most appropriate to give protection against risk of small-pox in epidemic and non-epidemic periods, the Committee definitely come to the conclusion that the present method of vaccination might well be modified to the extent that one insertion with a minimum of trauma should replace the four insertions now advocated; that vaccination should be performed in infancy between the age of two and six months, and that re-vaccination should be offered when a child enters school at five to seven years of age, and again on leaving when it is 14-16 years old. It is further recommended that the public vaccinator should inspect the vaccinated arm between the seventh and tenth day, and again between the 14th and 17th day after vaccination. The Committee also recommend a partial reversion to the principle of stational vaccination, and in their report they suggest that such vaccination might be carried out at infant welfare centres. It appears extremely doubtful if infant welfare centres would want to be saddled with the onus of vaccination. Certainly the attendance of an infant with a septic arm or the death of a child from post-vaccinal encephalitis is hardly likely to popularise infant welfare centres. The Committee also recommend that the syllabus of vaccination in the instruction of medical students be revised in the light of present day knowledge and their report. They also recommend further research as to the further dilution of vaccine lymph without impairment of its efficacy, and advocate the continuance of experimental investigations as to the relationship between vaccinla and nervous complications. One important recommendation they make is that steps be taken to impress
379
upon the public mind the nature and purpose of vaccination. Entire agreement with this last recommendation of the Committee will be expressed, but it is to be feared that, having regard to the report of the Vaccination Committee, little can be done to re-assure the public mind that there is no risk from vaccination. The public can be assured that successful vaccination will protect against the risk of small-polx , which is prevalent in only a very mild form at the present time, but beyond that it is difficult to go and it is for the public to choose. There will be no lack of appreciation of the work of the Vaccination Committee, and that their recommendations have been framed so as to popularise vaccination, and induce people to be re-vaccinated, for, as the Committee rightly say, " vaccination and re-vaccination at suitable intervals afford the only sure means of preventing small-pox. " T h e Vaccination Committee have put forward their report in a masterly manner, and it is for Parliament and the public to decide on the future of vaccination having regard to the dangers of the process and the prevalence of small-pox and the type of small-pox prevalent. The report itself is a document of 202 pages, followed by two special studies by Dr. Mervyn Gordon and Dr. Perdrau, and 18 appendices. The Committee are to be congratulated upon producing a document of great scientific and administrative value.
Food Poisoning Outbreaks. H E opportunity presented b y the out-
T break of bacterial food poisoning amongst
the members of the metropolitan police force and the occurrence of groups of cases of paratyphoid fever in London and elsewhere was too ~ood to be lost b y the journalist and the publicity agent. T o the former, a year in which no section of the population is attacked by some disorder in circumstances that he can describe as " mysterious " appears to. be blank, and his end would be a h a p p y one if, before it arrived, he was allowed to see the nation decimated by a disease that swept swiftly over the land or stalked silently, slaying as it went. The police outbreak that gave him his mystery disease gave him something more; a chance to gird at the British cook and to make unfavourable comparisons between home cookery in this country and that in others. W h y there should have been a
38o
PUBLIC HEALTH.
revival of this stupid fable because of a ham cooked in a police canteen, and in some obscure manner contaminated with Gmrtner bacilli, is more difficult to understand than the attempt to throw the blame upon the operation of the Public Health (Preservatives, etc., in Food) Regulations and the unwillingness of the average housewife to place an order with the fishmonger for a daily supply of ice or to instal a domestic cold storage plant. In these the hand of the publicity agent was obviously at work. The fight against the regulations •thai fo.rbid the use ,of chemical preservatives in food is not yet over and any and every excuse, no matter how trivial or far-fetched--such as these para-typhoid fever and bacillary poisoning c a s e s - w i l l always be seized upon by those who are engaged to watch the interests of a certain type o.f food producer and distrilSutor. So also in the case of the domestic refrigerator, for reasons that cannot but be obscure to anyo.ne who kno.ws a n y t h i n g of the climate of this country and the catering methods of the bulk of the population, it was believed that here was a land in which refrigerators for ho.me use would sell - - i f the phrase may be used--like hot cakes. The bright and glorious fortune failing to materialise with the rapidity anticipated, a scheme of publicity was devised with the object of inducing the ho.usewife to put into operatio.n such system of cajolery as she usually employs in order to secure the things that she feels she cannot live without. By those responsible for the operation of the scheme, no opportunity is lost of impressing that the domestic refrigerator is of this category. The occurrence of the police epidemic and of the cases of partyphoid fever must have appeared heaven-sent, providing material of inestimable and endless value from the publicity point of view. While it might be regarded as hypercritical to cavil at the use of these outbreaks for the purpose of advertising appliances that it may be admitted have a very real value, exception may be taken to the suggestion offered or implied that with the more general employment of cold as a method of food preservation risks of infection from such a source will disappear. Those interested in this method commercially, as well as the public at large should know that the root fault in these cases is careless handling and lack of cleanliness, and that no amount of provis!on for cold storage of food can do away with the necessity for 'care and scrupulous clea,nl!iness on the
SEm'E=~el~,
part of all concerned with handling and preparation. In the police food poisoning outbreak, ham was held to be the vehicle of infection, and not even an alien, with all the culinary skill that foreign birth must confer and surrounded by refrigerators, in theabsence of care and cleanliness in connection with handling could have prevented contamination. So with the para-tybho.id fever outbreaks, it x~as because some article consumed by those attacked--and it may have been ice-cream and presumably exposed to a sufficiency of cold-had been contaminated as a result of lack of appreciation of the need for care and cleanliness in the treatment of food and of real respect for material for the use of the human body. The British cook may, as the journalist says, fall behind her foreign rival because her cookery methods are limited and she may not be h a p p y - - a s she is assured by the publicity agent--until she gets a refrigerator (domestic pattern) costing an appreciable number of pounds; o.n the whole, however, they who rely upon her may take it as certain that even if she maintains her monotony they will not suffer so long as she buys in a clean market where reasonable precautions are taken against contamination, and sees that in the kitchen and the larder the care and cleanliness traditional of the land are secured.
The Prevalence of Paratyphoid Fever. U R I N G the last quarter of 1927 a somewhat sharp outbreak o.f paratyphoid B fever occurred in three sanitary areas of West Hertfordshire, and this outbreak has been made the subject of a special report x by Dr. Vernon Shaw which has recently been issued by the Ministry o.f Health. A paper by Dr. Hyslop Thomson, County Medical Officer of Health for Hertfordshire, on the P o s t - W a r Prevalence of Paratyphoid Fever, which appears in the present issue, also deals with the same subject. T h e Ministry's report describes in detail the steps which were taken to investigate the causation of the outbreak and the action adopted by the various sanitary and hospital authorities to control the outbreak and to provide facilities for the hospital treatment of the disease.
D
~Report on an O u t b r e a k of Paratyphoid Fever in Hertfordshire. By W . Vernon S h a w , O.B.E., M.A., M.D. Ministry of Health Reports on Public Health and Medical Subjects, No. 53. H . M . Stationery Office, 1928. pp. 16. Price 3d. net.
PUBLIC HEALTH.
vaccination is of serious import and cannot fail to have an effect on vaccination both in its medical and purely administrative aspects. In fact, since the report of the Committee on Vaccination was issued, fatal cases of disease of the central nervous system following vaccination have been reported from Norfolk and exploited in Parliament, and it is not unlikely that the occurrence of this condition coupled with the mild character of the prevailing type of small-pox in this country will lead to an alteration of the vaccination laws. The Committee foreshadow such an alteration at the end of the first part of their report. Dealing with their third term of reference, namely, the methods of vaccination which are most appropriate to give protection against risk of small-pox in epidemic and non-epidemic periods, the Committee definitely come to the conclusion that the present method of vaccination might well be modified to the extent that one insertion with a minimum of trauma should replace the four insertions now advocated; that vaccination should be performed in infancy between the age of two and six months, and that re-vaccination should be offered when a child enters school at five to seven years of age, and again on leaving when it is 14-16 years old. It is further recommended that the public vaccinator should inspect the vaccinated arm between the seventh and tenth day, and again between the 14th and 17th day after vaccination. The Committee also recommend a partial reversion to the principle of stational vaccination, and in their report they suggest that such vaccination might be carried out at infant welfare centres. It appears extremely doubtful if infant welfare centres would want to be saddled with the onus of vaccination. Certainly the attendance of an infant with a septic arm or the death of a child from post-vaccinal encephalitis is hardly likely to popularise infant welfare centres. The Committee also recommend that the syllabus of vaccination in the instruction of medical students be revised in the light of present day knowledge and their report. They also recommend further research as to the further dilution of vaccine lymph without impairment of its efficacy, and advocate the continuance of experimental investigations as to the relationship between vaccinla and nervous complications. One important recommendation they make is that steps be taken to impress
379
upon the public mind the nature and purpose of vaccination. Entire agreement with this last recommendation of the Committee will be expressed, but it is to be feared that, having regard to the report of the Vaccination Committee, little can be done to re-assure the public mind that there is no risk from vaccination. The public can be assured that successful vaccination will protect against the risk of small-polx , which is prevalent in only a very mild form at the present time, but beyond that it is difficult to go and it is for the public to choose. There will be no lack of appreciation of the work of the Vaccination Committee, and that their recommendations have been framed so as to popularise vaccination, and induce people to be re-vaccinated, for, as the Committee rightly say, " vaccination and re-vaccination at suitable intervals afford the only sure means of preventing small-pox. " T h e Vaccination Committee have put forward their report in a masterly manner, and it is for Parliament and the public to decide on the future of vaccination having regard to the dangers of the process and the prevalence of small-pox and the type of small-pox prevalent. The report itself is a document of 202 pages, followed by two special studies by Dr. Mervyn Gordon and Dr. Perdrau, and 18 appendices. The Committee are to be congratulated upon producing a document of great scientific and administrative value.
Food Poisoning Outbreaks. H E opportunity presented b y the out-
T break of bacterial food poisoning amongst
the members of the metropolitan police force and the occurrence of groups of cases of paratyphoid fever in London and elsewhere was too ~ood to be lost b y the journalist and the publicity agent. T o the former, a year in which no section of the population is attacked by some disorder in circumstances that he can describe as " mysterious " appears to. be blank, and his end would be a h a p p y one if, before it arrived, he was allowed to see the nation decimated by a disease that swept swiftly over the land or stalked silently, slaying as it went. The police outbreak that gave him his mystery disease gave him something more; a chance to gird at the British cook and to make unfavourable comparisons between home cookery in this country and that in others. W h y there should have been a
38o
PUBLIC HEALTH.
revival of this stupid fable because of a ham cooked in a police canteen, and in some obscure manner contaminated with Gmrtner bacilli, is more difficult to understand than the attempt to throw the blame upon the operation of the Public Health (Preservatives, etc., in Food) Regulations and the unwillingness of the average housewife to place an order with the fishmonger for a daily supply of ice or to instal a domestic cold storage plant. In these the hand of the publicity agent was obviously at work. The fight against the regulations •thai fo.rbid the use ,of chemical preservatives in food is not yet over and any and every excuse, no matter how trivial or far-fetched--such as these para-typhoid fever and bacillary poisoning c a s e s - w i l l always be seized upon by those who are engaged to watch the interests of a certain type o.f food producer and distrilSutor. So also in the case of the domestic refrigerator, for reasons that cannot but be obscure to anyo.ne who kno.ws a n y t h i n g of the climate of this country and the catering methods of the bulk of the population, it was believed that here was a land in which refrigerators for ho.me use would sell - - i f the phrase may be used--like hot cakes. The bright and glorious fortune failing to materialise with the rapidity anticipated, a scheme of publicity was devised with the object of inducing the ho.usewife to put into operatio.n such system of cajolery as she usually employs in order to secure the things that she feels she cannot live without. By those responsible for the operation of the scheme, no opportunity is lost of impressing that the domestic refrigerator is of this category. The occurrence of the police epidemic and of the cases of partyphoid fever must have appeared heaven-sent, providing material of inestimable and endless value from the publicity point of view. While it might be regarded as hypercritical to cavil at the use of these outbreaks for the purpose of advertising appliances that it may be admitted have a very real value, exception may be taken to the suggestion offered or implied that with the more general employment of cold as a method of food preservation risks of infection from such a source will disappear. Those interested in this method commercially, as well as the public at large should know that the root fault in these cases is careless handling and lack of cleanliness, and that no amount of provis!on for cold storage of food can do away with the necessity for 'care and scrupulous clea,nl!iness on the
SEm'E=~el~,
part of all concerned with handling and preparation. In the police food poisoning outbreak, ham was held to be the vehicle of infection, and not even an alien, with all the culinary skill that foreign birth must confer and surrounded by refrigerators, in theabsence of care and cleanliness in connection with handling could have prevented contamination. So with the para-tybho.id fever outbreaks, it x~as because some article consumed by those attacked--and it may have been ice-cream and presumably exposed to a sufficiency of cold-had been contaminated as a result of lack of appreciation of the need for care and cleanliness in the treatment of food and of real respect for material for the use of the human body. The British cook may, as the journalist says, fall behind her foreign rival because her cookery methods are limited and she may not be h a p p y - - a s she is assured by the publicity agent--until she gets a refrigerator (domestic pattern) costing an appreciable number of pounds; o.n the whole, however, they who rely upon her may take it as certain that even if she maintains her monotony they will not suffer so long as she buys in a clean market where reasonable precautions are taken against contamination, and sees that in the kitchen and the larder the care and cleanliness traditional of the land are secured.
The Prevalence of Paratyphoid Fever. U R I N G the last quarter of 1927 a somewhat sharp outbreak o.f paratyphoid B fever occurred in three sanitary areas of West Hertfordshire, and this outbreak has been made the subject of a special report x by Dr. Vernon Shaw which has recently been issued by the Ministry o.f Health. A paper by Dr. Hyslop Thomson, County Medical Officer of Health for Hertfordshire, on the P o s t - W a r Prevalence of Paratyphoid Fever, which appears in the present issue, also deals with the same subject. T h e Ministry's report describes in detail the steps which were taken to investigate the causation of the outbreak and the action adopted by the various sanitary and hospital authorities to control the outbreak and to provide facilities for the hospital treatment of the disease.
D
~Report on an O u t b r e a k of Paratyphoid Fever in Hertfordshire. By W . Vernon S h a w , O.B.E., M.A., M.D. Ministry of Health Reports on Public Health and Medical Subjects, No. 53. H . M . Stationery Office, 1928. pp. 16. Price 3d. net.