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With this distribution of cases and with the great difficulty often
experienced in tracing any connection between the supply, with its
intricate ramifications, and the sufferers, it is difficult to see what useful
purpose could have been served by circulating information on the source
of infection at the time when this was first suspected.
In 13 cases the patients were admitted to Hospital (10 to the Wandle
Valley Isolation Hospital), while 6 were treated at home. Unfortunately,
in addition to the doubtful case, 2 deaths occurred, these being
the cases first notified, and presumably those most heavily infected.
Four of the local cases had been treated by inoculation during the
incubation period, but subsequently developed the disease.
The steps taken during the outbreak followed almost exactly those
adopted in Croydon, and very close co-operation was maintained between
the two Public Health Departments. While the numbers affected in
this District were much smaller than in Croydon, the staff available
was correspondingly small.
Enquiries were first directed to discovering the source of infection
at the houses in which the cases occurred, and then, when the Addington
Well water was suspected, to tracing possible sources of pollution including
any from that part of the gathering ground situated in this
District, or among those persons who were known to have worked at
or near the Well, but who reside on this side of the boundary. Numerous
consultations were provided and advice on desirable preventive measures
was given to the very many residents, including head teachers, who
enquired of the Department. The isolation of cases and disinfection
of premises, etc., followed the recognised lines, with the exception that
more attention was given to the disinfection of the laundry of cases
nursed at home, before its dispatch to the public laundries, than has
hitherto been provided.
Advice on the preventive inoculation of cases which might have been
developing the disease was not easy to give owing to the lack of unanimity
both in the opinion expressed by experts and in the practice adopted
by the doctors locally.
As far as this District is concerned the Doctors residing in the
Urban District inoculated altogether approximately 372 persons, all
of whom, however, were not resident within these boundaries.
Of this number about 237 were so treated because they lived, worked
or visited in what was thought to be the area of the contaminated
supply.
With the exception of 40 who had 3 modified doses, the prescribed
doses of the usual T.A.B. vaccine were given in each case, bearing in
mind the age of the patient, and subsequently 6 developed typhoid fever,
while a seventh is believed to have had an abortive attack. In addition
to the latter, one of the definite cases, which was treated at home,
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