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The pioneering use of a questionnaire to investigate a food borne disease outbreak in early 20th century Britain
  1. Alfredo Morabia1,
  2. Anne Hardy2
  1. 1Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
  2. 2The Wellcome Trust Centre for the History of Medicine at University College London, UK
  1. Correspondence to:
 Professor A Morabia
 Division of Clinical Epidemiology, Geneva University Hospitals, 25 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland;


This paper describes the investigation by a British local government board inspector in 1902, H Timbrell Bulstrode, into the cause of an outbreak of enteric fever after a mayoral banquet given at Winchester. This investigation helped to confirm the role of oysters as an agent of transmission of typhoid fever. The data are also reanalysed using a modern approach, which confirmed the role of oysters (odds ratio  = 11.2, 95% CI 2.5 to 50.1). This episode is illustrative of the role of British public health inspectors at the turn of the 20th century as well as of the conditions in which the technique of investigating outbreaks of food borne diseases using a standardised menu was developed. Current methods of outbreak investigations that differ from Bulstrode’s pioneering work are also discussed.

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  • Funding: none

  • Conflicts of interest: none declared.

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