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water closet. Water was last taken in at Antwerp on the afternoon of 11.7.56, from a
pipe at Nos'. 142-143 berths. A shore hose was used, the water being allowed to run
first before filling the tank. The tank had not been cleaned for twelve months.
(b) Fresh Food. Meat, bought in Antwerp. Inspected by Senior Health Inspector and found
to be sound. Vegetables — ditto.
(c) Canned Food. Milk. A tin was opened and found to be sound. Tinned fish and spinach
had also been consumed but NOT by all the persons affected.
(d) Ice Cream. Bought in Purfleet and consumed by ALL the children.
The one clear factor emerging from this investigation was that the four unaffected had not
drunk any cold water since leaving Antwerp. They had used instead a case of lemonade
bought by the Master.
Conclusion. Any outbreak in a small and local community is likely to be explosive in nature
but the evidence to date would make the water supply suspect.
Action to be taken.
(a) All drinking water to be boiled pending (b) and (c) below.
(b) Samples of water from the tank and all taps to be sent for bacteriological examination.
(c) Tank and pipes to be treated.
(d) King George Hospital, Ilford, to be requested to take specimens (stool or rectal swabs)
from the three seamen presenting themselves at the hospital.
Six samples of drinking water were submitted to the Central Public Health Laboratory at
Colindale together with the reason for sending them. Reports were subsequently received that
all the samples submitted were satisfactory. Nevertheless, as a precautionary measure the
water in the tank was chlorinated, the tank then emptied and cleaned and finally refilled with
fresh water which was lightly chlorinated.
The vessel left her berth at Barking Creek for a berth at Erith where a visit was made by
your Health Ins pector on the Lower River District who found all on board to be well save the
Master's daughter, aged 5, who still had slight diarrhoea. Your Inspector also noted that the
Cook had developed some septic sores on his nose and he arranged with the Master that this
man should take over 'deck duties', another member of the crew taking over the cooking and
handling of foodstuffs.
The vessel left Erith on the 20th July for Grangemouth and the Medical Officer of Health of
that port was advised of the circumstances and the action taken to date.
On the 21st July, Dr. Mangat of the King George Hospital, Ilford reported on the results of
examination of the rectal swabs taken from the three members of the crew who had voluntarily
reported at the hospital. While two of the specimens were clear, the specimen from one man
showed a scanty growth of Salmonella typhi-murium.
This additional information was immediately sent to the Medical Officer of Health of Grangemouth,
by whom it was in turn forwarded to the Fife County Medical Officer who wrote to your
Medical Officer as follows
"I refer to my letter of the 24th July, 1956 and our subsequent correspondence regarding
the outbreak of diarrhoea on the above ship. You will recollect that you had isolated salmonella
typhi-murium from one of the ship's company and that on arrival here specimens were
obtained from seven of the ship's company. Two of these proved negative and five showed
an organism of the salmonella group which was referred for further investigation. A subsequent
report showed that the organism from one of the five was in fact salmonella Kentucky.
I have now received the reports from the Salmonella Reference Library on the organism
isolated. In three of the remaining four cases it has been identified as Salmonella
Dusseldorf. The organism isolated in the case of the fifth member originally thought to be
positive is now reported as not belonging to the salmonella group.
"These results may be of interest to you in view of the fact that you had investigated
the original outbreak of gastro-enteritis on the vessel. On the face of it the ship seems to
have been visited by a somewhat remarkable conglomeration of organisms".
Although the time and trouble taken in following up this little shipborne outbreak of infectious
disease has not led to the discovery of 'the villain in the piece', it has been an interesting
epidemiological study which could not have been pursued fully without ready co-operation within
the port health and public health services of the United Kingdom.
m.v. "TROMAAS" - ENTERITIS
The above-named vessel arrived at the Isle of Grain at midday on Sunday, 4th November, having
sailed from Mena al Ahmadi (Persian Gulf) on the 14th October, direct to the United Kingdom,
via the Suez Canal.
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