The recent epidemic of food poisoning at Nelson, Lancashire, is an event which is unfortunately not unknown in this country, especially in summer time. It has been said that at least two hundred people have been affected more or less seriously, and that there have been four deaths from acute gastro enteritis. Cases of suspected food poisoning are now in many places compulsorily notifiable to the local authority by medical practitioners to whose notice such cases may have been brought in the course of their practice. As far as we know such notification was not made compulsory before the year 1924, when Wakefield obtained powers under a Corporation Act to do so. A large number of places since that time have followed the lead of Wakefield. Thus among watering places, Cleethorpes, Bridlington, Brighton and Bournemouth; among manufacturing centres, Sheffield, Stoke‐on‐Trent, Bradford, Blackburn, Oldbury, Smethwick, Cardiff and Rochdale have powers of compulsory notification.—Cheap, rapid, and frequent means of road and rail transport has in these days resulted in an enormously increased influx of holiday makers from the manufacturing centres into seaside towns during the summer. Here, then, is a floating population amounting to several thousands. They are at a place that has been freely and emphatically advertised as a health resort. The have come for a “change” in every sense of the word. It is high summer. The weather is hot. The holiday spirit in the air. A very natural result is for people to eat more fruit, ice cream, and fancy dishes than they would ordinarily do. Assume through some mischance there are one or two cases of food poisoning. These are now automatically reported to the local authority, which at once institutes investigations, tries to trace the evil to its source, and check it from spreading. A serious outbreak is a damning catastrophe for the place, and may adversely affect its future for years to come. In manufacturing centres the need for action on the part of the local authority is still more urgent. The danger is perennial. It may easily reach the dimensions of an epidemic in a poor and crowded district. The people are there from necessity not from choice, and there they would have to stay even if the place were swept by cholera. In the County of London notification is compulsory under the London County Council (General Powers) Act, 1932, Pt. II., s.7, which says : “ Every registered medical practitioner, if he suspects that a person is suffering from food poisoning shall notify the Medical Officer of Health for the district.” This section it is pointed out, was drawn up on the lines of the Sheffield Corporation Act, 1928, s.190, one of the main Corporation Acts that insist on notification. There seems indeed to be a growing belief that compulsory notification of food poisoning is desirable in the interests of public health. Processed foods are particularly liable to become sources of infection. Thus the Act just quoted, Pt. II. s.5, states that premises used for the sale or manufacture of ice cream; or for the preparation or manufacture of sausages or potted, pressed, pickled, or preserved meat, fish or other food must be registered with the Sanitary Authority of the district. Under the same section registration may be refused or registration may be cancelled. Many towns have similar regulations. This section of the London County Act is founded on the Exeter Corporation Act, 1928, s.111. The fact that the London County Council have adopted these two regulations that had already been “ tried out ” in two important cities of such widely different interests as Sheffield and Exeter is a good illustration of how closely associated all municipal bodies are in matters connected with public health. Medical Officers of Health and Public Analysts are officers of the Ministry of Health, and the Ministry itself is a clearing house for general information, investigation, and the co‐ordination of statistics. The sanitary authority of, and the medical practitioners in, any given district discharge not only admittedly most important but, as it seems to us, complementary duties. Each has knowledge not possessed by the other. Diagnosis in cases of suspected food poisoning is by no means easy. Time is not on the doctor's side so that the sooner the sanitary authority is notified the better are the chances of being able to trace the trouble to its source and to deal with it— assuming, of course, that it did not originate in some piece of purely domestic carelessness or ignorance. The information acquired may be slight, or even negative in any given case, but in the aggregate a fund of knowledge must accumulate that cannot fail in the long run to be of value. In many cases of suspected food poisoning further investigation has shown that they are not due to food poisoning at all. For instance, in one borough nine cases reported were found to be due to “ dietetic indiscretion ”; in another twenty reported cases were only forms of more or less acute digestive disturbance of the ordinary kind; in another it was found that daffodil bulbs had been eaten in mistake for onions. Other instances could be given. Facts like these would seem to support the argument that compulsory notification is unnecessary, but it is surely better that twenty suppositious cases should be reported than that the circumstances of one real case should escape investigation. In other cases the cause may remain unknown, but as to the seriousness of the matter there can be no doubt. In a recent outbreak in a home for “unwanted” children out of thirty‐nine infants in one dormitory twenty‐seven were attacked, and twenty died in from two to four days from some obscure form of gastro enteritis. Bacteriological examination of excreta and vomit yielded negative results. The high rate of mortality was attributed to the poor physical condition of the children when they were admitted to the institution in which they died. The case is admittedly an extreme one. Another was reported of exactly the opposite character. Twelve cases of undoubted food poisoning were reported, but these were of so slight a character that no action was taken in regard to the circumstances. In general, however, there is no room for giving the benefit of the doubt. The error—even if it may be so called—of reporting what turns out to be a case of indigestion instead of one of food poisoning is an error on the right side. A question arose recently in the House of Commons as to whether it was necessary to retain an Act on the Statute Book when there had been no prosecutions under the Act. It will be remembered that the Solicitor‐General replied that the mere fact that the Act was on the Statute Book had a very salutary effect. As far as it may be possible to draw an analogy it seems that even better reasons exist not only for retaining, but for extending, compulsory notification of cases of suspected food poisoning. Registration and inspection of premises, plant, storage conditions, and the food itself in places where food is prepared and sold is now a general practice in all centres of population. How necessary this is a glance at the Law Reports of this journal will show. The state of the places mentioned in the records of the prosecution was often such as to ensure them being potential centres of food poisoning. Had it not been for the vigilance of the respective sanitary authorities they would have become actively and permanently so. Such prosecutions are comparatively rare having regard to the large number of food shops in existence, but it would certainly be a backward step to cease to register and to inspect.
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