Croydon typhoid outbreak of 1937

The Public Health Act 1848 gave local boards of health powers to improve the sanitary condition of towns and populous places in England and Wales by supervising the cleaning of streets, collection of refuse, disposal of sewage and supplying clean water. Subsequently, an integrated water supply and sewage disposal system was installed at Croydon, twelve miles south of London, one of the first towns to have one, when its population was around 20,000. Although the system was supposedly a sanitary pioneer, the death rate in the town rose after installation and typhoid outbreaks occurred in 1853 and 1875, possibly as a result of the new system permitting the disease to spread more efficiently.[2][3][4]

By 1937, when Croydon's population was around 250,000,[5][6][1] around 40,000 people, or between one-sixth and one-fifth of Croydon received its water supply from the Addington well sunk into chalk ground in 1885 at Addington.[5][7] The Addington well, 250 feet (76 m) deep and 10 feet (3.0 m) wide,[1] was one of five wells that supplied Croydon,[5] and it collected water from the surrounding ground, some of which housed cesspools and a pig farm.[8]

Along with the Stroud Green well, the Addington well fed the Addington Well Pumping Station. The water was then filtered, chlorinated and filtered again before being pumped into the Addington reservoir and fed through what was termed a "high level system".[8][9] As the water was already at high risk from contamination, the Croydon Corporation installed a number of methods to filter and clean the water, in 1908, 1928, and 1936. These included an ozone plant, rapid pressure filters, a chlorinating plant and an ammoniating plant.[8]

However, the filters and chlorinator worked together and it was not possible to operate them separately. This point would later cause problems when the filters required repairs.[7] Worrying levels of the bacteria E. coli in the Addington well water resulted in regular chlorination from 20 July 1936, but without any continuous record of its use. Both the reservoir and well waters were supposedly tested monthly, until the end of April 1937, when for no explainable reason except by "mere oversight", it stopped.[1][8]

On 22 November 1937, Harold Gourley, an eminent civil engineer, and Sir Humphry Rolleston, who was previously physician-in-ordinary to King George V, became expert assessors, with Harold Murphy leading the inquiry.[5][6][16] The inquiry began on 6 December 1937 during the outbreak, with the Croydon Corporation represented by Sir Walter Monckton. Its transcript filled more than 1,000 pages.[5][6] Murphy later replied to the Minister of Health;

The immediate cause of the outbreak was a portion of the public water supply becoming infected by the typhoid bacillus. The infected portion was that derived from a chalk well at Addington. How that well became infected is a question that cannot be answered with absolute certainty, but all the circumstances and probabilities point so strongly in one direction that I feel justified in coming to a definite conclusion on the subject. That conclusion is that the well was infected by the fact that at the end of September and during October, 1937, men, one of whom was an active carrier of typhoid, were working in the well and that during large parts of such period water from the well, unfiltered and unchlorinated, was being pumped to supply.[6]

The inquiry lasted 16 days,[10] and its report was published as a white paper on 14 February 1938.[5] Murphy reported that the origin of the typhoid came from a workman, known as "Case A", who had become unwell with typhoid fever during the First World War, but hadn't realised he was a carrier.[5][13] He was employed in building works on the Addington well between 28 September and 26 October 1937.[5][1]

Holden was however, unaware of the cessation of chlorination while works were being carried out,[6] and he was accused of not notifying local doctors earlier. The journal Medical Officer was both critical of Holden and of higher medical authorities.[13] Murphy pointed out that a number of practitioners would not be familiar with cases of typhoid, and may not have realised that the water was a risk. In addition, some practitioners from surrounding boroughs may not have been aware of the outbreak.[5][6] A combination of factors were concluded to have caused the incident, including the repair works on the well, the worker who was a carrier of typhoid and the water supply not being chlorinated. Management was criticised for not effectively managing the water supply and for not adequately communicating with each other. It was noted that the medical officer of health (Holden) and Borough engineer (Boast) had little or no contact with each other.[1] Holden was also noted to have been "ignorant of the fact that water was the most common cause of transmission".[10]

Subsequently, legal claims began to be issued to the corporation from spring 1938.[10] Around 230 claims were made against Croydon Corporation. Hence, it was decided that one case should be used as a test case,[17][10] one where the father of one of the survivors was successful in arguing that the water undertaker was liable.[18] In December 1938, this test case, Read v. Croydon Corporation, took place in the High Court. It concluded with compensation for medical expenses and "pain and suffering and general inconvenience caused by [the plaintiff's] illness".[10]

The cases attracted national media attention, as was reflected in the number of scrapbooks of newspaper articles contained in 17 volumes collected by Walter Monckton and the Croydon Corporation. According to the Daily Sketch, Croydon in 1937 was "a dangerous and frightening place".[10] By the late 1930s, with 75% of the British population now possessing a wireless, the BBC was used to publicise news on the outbreak.[10] One reaction was that workers from Croydon were stigmatised by their London colleagues.[19] A detailed review of the outbreak also appeared in The American Journal of Public Health.[1][20]

Between 1937 and 1986, the UK witnessed over 11,794 cases of water‐borne disease over 34 outbreaks. At least six deaths were reported during this time.[21] In The Classical Quarterly in 1979, the typhoid outbreak of 1937 was described as the "most recent serious event of this kind to take place in this country",[22] typical of "when a large population draws its water supply from a central source".[22] In his book When Food Kills (2003), bacteriologist Hugh Pennington quotes the Croydon Public inquiry's conclusion that "there was both misunderstanding and lack of communication between the responsible officers" at Croydon, and in his opinion "this is a recurrent theme in the incubation periods of disasters".[7]

• List of epidemics

• "Croydon Typhoid Enquiry". The Lancet. 231 (5968): 165–171. 15 January 1938. doi:10.1016/S0140-6736(00)93139-8.
• "Croydon Typhoid Report". BMJ. 1 (4026): 530–531. 5 March 1938. doi:10.1136/bmj.1.4026.530. PMC 2085900. PMID 20781306.