Different centuries, same old story

The recent Escherichia coli outbreak in Walkerton, Ont., is remarkably similar to a cholera outbreak in Hamburg, Germany, in 1892. However, it is not the outbreak of waterborne disease that makes these stories similar but the delays in warning citizens of the emerging epidemics threatening them.

In Hamburg, the first person to die from cholera was a building worker who inspected a sewage outlet on Aug. 15. Although his vomiting and diarrhea were consistent with cholera, an official diagnosis could not be made without a cultured bacillus. Another building worker became ill with the same symptoms and died Aug. 17. However, gastrointestinal upset was not uncommon during the summer months in Hamburg and local doctors were not persuaded to take the time to investigate the cause of each illness. Physicians did not attempt to culture the bacillus until Aug. 20. In the meantime, others began to show signs of infection: 2 people on the 16th, 4 more on the 17th and 12 on the 18th. By Aug. 19, 31 patients had received treatment.

Although "official" confirmation of the cholera outbreak had been received by Aug. 22, the chief medical officer and the Senate chose not to warn people to boil water, and the contamination was not publicized until Aug. 24. By then, every part of the city had been infected and thousands of citizens had unsuspectingly consumed the infected water; they soon became ill with cholera and began to infect others. By the time the cholera outbreak was fully contained almost 17 000 people had been infected and 8600 had died. The outbreak of 1892 killed 13.4% of the population of Hamburg; it killed as many people as all other cholera outbreaks in Germany during the 19th century.1

Although several public inquiries and investigations are taking place to ascertain just went wrong in Walkerton, the Hamburg outbreak does illustrate the fact that history, even medical history, does tend to repeat itself.