A retrospective cohort study was performed following several reported cases of gastrointestinal illness after a catered event. The attack rate was 45/77 (58·4%) by clinical case definition, with four individuals confirmed to have Campylobacter. There was near universal exposure to most foodstuffs served; consumption of duck liver pâté [relative risk (RR) 2·53, 95% confidence interval (CI) 1·05–6·10], mixed leaf salad (RR 2·91, 95% CI 1·22–6·92) and table water (RR undefined, P < 0·01) were associated with illness in univariate analysis, with only the latter associated in the final multivariable model (P < 0·001). Samples of cooked duck liver pâté subsequently prepared using identical methods at the venue were contaminated with Campylobacter jejuni and C. coli; water sampling was negative. Making inferences about causation in the presence of near universal exposures in this study required consideration of the limitations of statistical analysis, with the most compelling evidence of the causal role of inadequately prepared duck liver pâté provided by environmental investigation.

This investigation was initiated when twelve miners who were working in a certain part of the Mill Close Lead Mine complained of smarting of the eyes associated with marked congestion of the conjunctivae. They also suffered from a stinging sensation in the nose and throat. The particular area in which they were working differed from other parts of the mine in that there was a strong smell of sulphuretted hydrogen present. After recovery, and when the ventilation had been improved, the men were able to continue working in that area without experiencing further discomfort. The interesting part of the investigation was tracing the origin of the sulphuretted hydrogen. The odour proceeded from collections of mine water which the miners very appropriately called “stink water”. In this there was a deposit of sulphur mixed with black sludge which also smelt strongly of H2S. The sludge consisted of slightly gelatinous black masses mixed with a whitish felt work of a filamentous organism. On microscopical examination the filaments were seen to contain sulphur globules, and often to arise from a mass of black material. This black material consisted of sulphur and inorganic salts in a slimy matrix, the black colour being due to the presence of ferrous sulphide. On further examination these masses were found to be teeming with other bacteria, Gram-negative bacilli and spirilla, both of which were motile, the spirilla being actively so.

“White Australia,” the pleasant dream of a peculiar political party, is a subject on which a few years ago it would have been inadvisable if not unsafe to venture too unrestrained opinions. There was a time when in certain quarters the euphonious phrase was almost tantamount to a war cry. To some political dreamers it may even have been a perennial dream, full of visions of whiteness and purity, just as to us in England the mention of the “Pearly Pacific” conjures up vistas of prattling palms, wimpling waters and silvery strands. The dream is a pretty one, fitting theme for the poet and artist; Samoa and R. L. Stevenson, what a perfect juxtaposition! What delectable tales our romance weavers indulge us with! The gorgeous colouring, the wondrous life, the glorious moon, the ocean's unceasing sigh—all fine, all beautiful, all seeming perfect—but all superficial or tempered with prosaic features which mar the picture.

The plague suppressive campaign which is now drawing to a close in San Francisco has been conducted almost entirely on the principle that the great factor in the spread and continuance of the disease is the rat. The fact that the epidemic among human beings ceased within four months after the beginning of active operations and that in spite of the distribution of the disease in almost every quarter of the city, only one hundred and fifty-nine cases, with seventy-seven deaths occurred, proves the wisdom of this policy. The campaign has been conducted by the United States Public Health and Marine Hospital Service.

Reactions so far reported after the use of oil emulsion (OE) foot-and-mouth disease (FMD) vaccines in pigs have been infrequent and quick to resolve themselves. Although tentatively ascribed to anaphylaxis, these reactions have received little attention and their mechanism of causation has not been established conclusively.

During a filariasis survey conducted in northern Fiji in 1968–9 examinations were made for microfilaraemia, enlarged lymph nodes and elephantiasis. Analysis of the microfilarial densities at different ages and the number of anatomical sites showing lymph gland enlargement or elephantiasis have been used to provide evidence on the clustering of infections and pathogenesis.

Although there is no evidence of clustering of risk of infection, there is evidence favouring the clustering of adult filariae in individuals. Nevertheless the number of sites of lymph node enlargement do not correspond with this finding and statistical evidence suggests that lymph-node enlargement is not necessarily associated with the near presence in the body of adult filariae, whether dead or alive.

Males of Indian ethnic origin showed a higher prevalence of elephantiasis than males of Fijian ethnic origin, but women of either ethnic race showed prevalences lower than those of men.

The onset of elephantiasis at a site does not directly reflect the number of infections sustained in the local area, but it appears that filariasis first induces for a limited period a proneness to elephantiasis. During this period a random and discrete event may induce the onset of elephantiasis. The nature of the event is unknown, but it probably is not trauma.

Fleas (Aphaniptera, Siphonaptera) are wingless insects which run or hop about. They are for the most part parasitic in their habits, being found only on the homoiothermic vertebrates, especially on those which build nests or have more or less fixed haunts or homes. Like the majority of other parasites they have the body flattened, but differ from most parasitic insects in that this flattening is in a lateral direction, so that the transverse diameter of the body is small and the vertical diameter great. Attention has already been drawn to certain other morphological peculiarities of these insects (vol. VII. p. 446).

We estimated prevalence and incidence of liver condition outcomes, and costs to the health service of diagnosed hepatitis B virus (HBV) in Tayside, UK. HBV patients were identified from electronic virology data between 1989 and 2003. The health resource costs of HBV for surface antigen-positive (HBsAg+) patients and HBV (HBsAg+ or immune, i.e. recovered) patients were calculated. A total of 633 patients had HBV (275 HBsAg+), and were more likely to be male (62% vs. 48%), older (mean age 42·6 vs. 39·2 years) and deprived than the general population. The prevalence of immune individuals increased steadily. Post-HBV diagnosis, 24% of immune and 13% of HBsAg+ patients were diagnosed with a liver condition. The median cost per immune patient (£3023) was greater than per HBsAg+ patient (£1498) (P = 0·02). While increasing prevalence of immune HBV patients highlights an increase in screening and treatment, the costs associated with this group are high.

1. The principle cause of post-scarlatinal diptheria is the admission into the scarlet fever wards of patients who, whether suffering from clinical diphtheria or not, are carriers of virulent diphtheria bacilli.

2. In large centres of population, where diphtheria always exists, diphtheria bacilli are to be found in a not inconsiderable proportion of school-children. In the absence both of evidence of clinical diphtheria and of a history of exposure to that affection, the bacilli are, in the majority of cases, of the non-virulent or saprophytic type and of little hygienic importance; in cases, on the other hand, where the clinical supports the bacteriological examination the bacilli are almost certainly virulent, and therefore dangerous; while in cases where the patient is known to have been exposed to infection the chances are great that the organisms are of the pathogenic variety, and such cases should always be regarded with grave suspicion.

3. On account of the prevalence of the non-virulent bacillus and the fallacies of single cultures, it may be doubted whether a routine bacteriological examination of throat and nose of all patients on admission would prove of sufficient value to repay the labour involved. Chief reliance must be placed on a careful inspection on admission, not only of the throat, but also of the nasal cavities, bacteriological examination being resorted to in cases of doubt.

4. In eradicating infection from an invaded ward bacteriological methods are, on the other hand, of prime importance, since children with apparently healthy throats and noses are often found to have acquired the virulent bacillus. An attempt to stamp out any outbreak of diphtheria by bacteriological examination of the throat alone is, however, futile, owing to the frequent infection of the nasal cavities.

5. Fibrinous rhinitis, which appears to be a not infrequent, though often unrecognised, affection of children is a common form of postscarlatinal diphtheria.

6. Although the treatment of diphtheria in the same hospital has no appreciable influence on the incidence of this complication of scarlet fever, it is advisable that precautions should be taken lest nurses harbouring diphtheria bacilli carry infection from the diphtheria to the scarlet fever wards.

7. To limit the risk of exposure to infection many-bedded wards should be avoided, and the mixing of patients from different wards prevented.

1. Cultures of Gärtner's bacillus grown on broth do not excrete any large amount of toxin into the fluid medium.

2. Suspension in broth made from ordinary agar cultures and killed by means of heat (30 mins. at 60°C.) are fairly toxic.

3. The most toxic preparations were obtained by autolysis of the bacilli, especially in the presence of toluol.

4. Cultures grown on agar and killed by means of chloroform vapour lose their toxicity to a considerable extent.

5. Autolysis takes place best in the presence of distilled water or of normal saline.

6. Autolysed material sterilised by heat is more toxic than the filtrate obtained from the same digest.

7. Shaking the bottles during the process of autolysis increases the yield of toxic substances.

8. Gärtner toxin withstands heating to 100°C. for 30 mins.

9. Paratyphoid B. bacillus cultures on autolysis yield a filtrate quite as toxic as those from the Gärtner bacillus itself.

10. Paratyphoid toxin is also heat resistant (100° for 30 mins.).

11. A colon bacillus gave a toxin which was fatal to mice. It was not heat resistant.

12. Feeding experiments with Gärtner-infected meat, both cooked and uncooked, proved successful.

13. So far as the present experiments go the connection between virulence and toxicity does not appear to be very definite.

14. The Gärtner bacillus contains a toxin of the endotoxin type as is shown in comparing results 1 and 3. This toxin gives rise to very definite clinical symptoms of which the gluing together of the eyelids and the prolonged narcosis before death are the most notable. The post-mortem signs have much in common with those arising from other intestinal intoxications.

In April, 1917, while examining some rats (probably M. decumanus) in company with Mr L. D. Cleare, Jnr., my assistant, for external and internal parasites, the lungs of a male specimen were observed to be in a highly diseased condition.

In autumn 1978 an epidemic of respiratory disease resembling allergic alveolitis occurred in a small Finnish community. The disease was caused by repeated exposures to tap water aerosol. The raw water of the community and the sand filters of the purification system were heavily contaminated with mesophilic actinomycetes. Fourteen different strains of actinomycetes were isolated. Exposed persons with and without symptoms as well as unexposed control persons were tested for antibodies against five of these actinomycetes and against Enterobacter agglomerans. Both the exposed and the control persons had antibodies to actinomycetes but the exposed persons had antibodies against more actinomycete strains than the control persons. Precipitating antibodies against E. agglomerans were also found in control persons as well as in patients. There was a significant difference between the patients and the exposed healthy persons in bacterial agglutination tests with flagellar antigen of one E. agglomerans strain. However, the role of mesophilic actinomycetes and E. agglomerans in the aetiology of the disease could not be firmly established.

1. Avian tubercle bacilli were grown in hanging-drop cultures in embryo extract prepared as for tissue culture, but diluted to 25–5% of its usual concentration.

2. Microscopic branching colonies of pseudomycelia developed in the surface film of the hanging drops during the first few days of incubation, after which growth declined.

3. The development of these colonies was studied on the warm stage and proceeds as follows:

(a) The original rods elongate into filaments.

(b) The filaments multiply by ordinary fission and also by forming fine, pin-like terminal sprouts which grow into independent bacilli.

(c) After division the daughter filaments usually remain in contact at the site of fission; their terminal growth continues at an angle to the former cleavage plane and the colony thus acquires its characteristic branching structure.

(d) The colony enlarges and ramification becomes increasingly complex until about the fifth day of incubation when growth declines. The bacilli remain filamentous.

4. When transferred to embryo extract of normal concentration the pseudomycelial colonies revert to the ‘standard’ type of development characteristic of the more concentrated medium, i.e. they pass through a phase of filamentous proliferation followed by disintegration of the filaments into short discrete rods.

5. The development of a pseudo-mycelium is compared with the three common types of growth previously seen in more concentrated embryo extract.

6. The results of this investigation shed light on the controversial question of whether the ‘mycelial’ form of the tubercle bacillus is a single individual formed by ‘true’ lateral budding or a composite structure produced by the terminal, angular growth of coherent but independent bacilli. Our observations on the living organisms have shown that under appropriate experimental conditions both these forms may develop.

1. African pouched rats (Cricetomys gambianus) are very suitable animals for plague experiments on account of their tolerance of captivity and their extreme susceptibility. After inoculation with small doses of plague culture of ordinary virulence they always die.

2. Broth-grown vaccine was much more efficient as a prophylactic than agar-grown vaccine. When two doses were given a survival rate of 56 per cent, was obtained with the former and 25 per cent, with the latter.

3. A vaccine composed of carbolised spleen pulp from animals, which had died of acute plague, was rather more efficient than broth vaccine, giving a survival rate of 75 per cent. But it is not likely to be of practical value, as preparation is difficult, there are undesirable local effects and its superiority over broth vaccine is not very great. Its efficiency is attributed to the fact that the organisms which it contains are a true “body strain.” The method of preparation is similar to that of Hindle's yellow fever prophylactic.

4. A number of experiments are described in which virulence was abolished or reduced by passage through immune or partially immune rats. This occurred only when the passage animal showed a considerable degree of immunity, as indicated by the length of the survival period after the test infection. Cultures made from the abscess at the site of infection were less often attenuated than those from the liver of an immunised animal, but this was observed only in the case of large well-defined abscesses. It is suggested that a firm abscess wall protects organisms inside it against the action of antibodies appearing in the general circulation.

A culture attenuated by passage through an immunised rat was restored to normal virulence by successive passages through normal rats, but the process was slower than in the case of cultures attenuated by long cultivation, five passages being required in the former case and only one in the latter.

5. Cultures used in the later work, unlike those used in the earlier work, lost virulence rapidly when kept at room temperature. Experiments and observations are described which suggest that old strains, even when subjected to rat passage, are less stable as regards virulence than those recently isolated from human epidemic cases, and that the high temperature of the Gold Coast has an adverse effect upon virulence.

6. Attempts to isolate stable variants of B. pestis were not successful. Colonies vary much in form. Three types of colony are mentioned, but all intermediate grades were observed. Certain old avirulent strains had a greater tendency to produce large irregular colonies than recent strains, but the relation was so loose that the form of colony gave little indication of the degree of virulence. In old avirulent strains the bacilli tend to become longer and filaments of great length may be present. Salt stability tends to become less as a strain grows old and avirulent, but the change is not very marked and is apt to be masked by individual fluctuations.

On February 10th, 1911, the attention of the Medical Officer of Health was called by the practitioner in charge to an outbreak of diarrhoea in a family named R. residing in Paddington. The note made at the interview was to the effect that cases had occurred on the 8th, 9th, and 10th (2 cases) of the month, the four patients having violent diarrhoea and passing much blood. The onset was quite sudden in every case. It was thought that “food poisoning” could be excluded, and the main object in directing attention to the outbreak was to ascertain if any defective drainage existed at the house. Incidentally it may be remarked that the house drainage, etc. had been completely overhauled in 1907 and that no defects existed in February last except one leaky joint on a waste pipe.

Surveillance is a key public health function to enable early detection of infectious disease events and inform public health action. Data linkage may improve the depth of data for response to infectious disease events. This study aimed to describe the uses of linked data for infectious disease events. A systematic review was conducted using Pubmed, CINAHL and Web of Science. Studies were included if they used data linkage for an acute infectious disease event (e.g. outbreak of disease). We summarised the event, study aims and designs; data sets; linkage methods; outcomes reported; and benefits and limitations. Fifty-four studies were included. Uses of linkage for infectious disease events included assessment of severity of disease and risk factors; improved case finding and contact tracing; and vaccine uptake, safety and effectiveness. The ability to conduct larger scale population level studies was identified as a benefit, in particular for rarer exposures, risk factors or outcomes. Limitations included timeliness, data quality and inability to collect additional variables. This review demonstrated multiple uses of data linkage for infectious disease events. As infectious disease events occur without warning, there is a need to establish pre-approved protocols and the infrastructure for data-linkage to enhance information available during an event.

Information is lacking on the integrated evaluation of mortality rates in healthcare-associated infections (HAIs). Our aim was to differentiate the risk factors responsible for the incidence from those for the case-fatality rates in association with HAIs. We therefore examined the time trends of both incidence and case-fatality rates over a 20-year period at a tertiary-care teaching medical centre in Taiwan and the mortality rate was expressed as the product of the incidence rate and the case-fatality rate. During the study period the overall mortality rate fell from 0·46 to 0·32 deaths/1000 patient-days and the incidence rate fell from 3·41 to 2·31/1000 patient-days, but the case-fatality rate increased marginally from 13·5% to 14·0%. The independent risk factors associated with incidence of HAIs were age, gender, infection site, admission type, and department of hospitalization. Significant prognostic factors for HAI case-fatality were age, infection site, intensive care, and clinical department. We conclude that the decreasing trend for the HAI mortality rate was accompanied by a significant decline in the incidence rate and this was offset by a slightly increasing trend in the case-fatality rate. This deconstruction approach could provide further insights into the underlying complex causes of mortality for HAIs.

In 1930 the author (Graham-Smith, 1930) showed that of spores of B. anthracis inoculated on 7 July 1907, on to dry, sterile pieces of canvas, measuring about 0·5 × 0·5 in., which were kept in a Petri dish in a cupboard with a glass door in the laboratory and therefore exposed to diffuse daylight at room temperature in a dry atmosphere, large numbers were capable of germinating in ordinary laboratory media after 10 years and progressively smaller numbers after 17 and 20 years. Very few germinated after 22 years and none after 22½ years.