“A farther support of this idea is furnished by Berlin, where in the same way frost has repeatedly interfered with filtration. In the following table are shown the deaths from diarrhœa and cholera infantum for a few winter periods having unusual increases in mortality in comparison with the bacteria in the water-supply.” (These tables show that in March, 1886, March, 1888, February-March, 1889, and February, 1891, high numbers of bacteria resulted from frost disturbance at the Stralau works, and in every case they were followed by greatly increased death-rates from diarrhœal diseases.—A. H.)
“No one who sees this exhibition can doubt that here also the supply of inadequately purified water has every time cost the lives of many children.” (100 to 400 or more each time.—A. H.) “Even more conclusive is the evidence, published by the Berlin Health Office, that this increase was confined to those parts of the city supplied from Stralau” (with open filters.—A. H.), “and that the parts supplied from the better Tegel works took no part in the outbreaks, which was exactly the case with the well-known typhoid epidemic of February and March, 1889.... It was also found that those children nursed by their mothers or by wet-nurses did not suffer, but only those fed on the milk of animals or other substitutes, and which in any case were mixed with more or less water.”
Under Cholera, page 28, he says: “The revised statistics here given differ slightly from preliminary figures previously issued and widely published.” (The full tables, which cannot be here reproduced, show 16,956 cases and 8605 deaths. 8146 of the deaths occurred in the month ending September 21. Of these, 1799 were under 5 years old; 776 were 5 to 15; 744, 15 to 25; 3520, 25 to 50; 1369, 50 to 70; and 397 over 70 or of unknown age. The bulk of the cases were thus among mature people, children, except very young children, suffering the least severely of any age class.)
“The epidemic began on August 16, in the port where earlier outbreaks have also had their origin. The original source of the infection has not been ascertained with certainty, but was probably from one of two sources. Either it came from certain Jews, just arrived from cholera-stricken Russia, who were encamped in large numbers near the American pier, or the infection came from Havre, where cholera had been present from the middle of July. Perhaps the germs came in ships in water-ballast which was discharged at Hamburg, which is so much more probable, as the sewage of Havre is discharged directly into the docks.
“It is remarkable that in Altona, compared to the total number of cases, very few children had cholera, while in the epidemic of 1871 the children suffered severely. This may be explained by supposing that the cholera of 1892 in Altona was not introduced by water, but by other means of infection....
“It is well known that the drinking-water (of Hamburg) is supposed to have been from the first the carrier of the cholera-germs. In support of this view the following points are especially to be noted:
“1. The explosive rapidity of attack. The often-compared epidemic in Munich in 1854, which could not have come from the water is characteristically different in that its rise was much slower and was followed by a gradual decline. In Hamburg, with six times as large a population, the height of the epidemic was reached August 27, only 12 days after the first cases of sickness, while in Munich 25 days were required. In Hamburg also the bulk of the cases were confined to 12 days, from August 25 to September 5, while in Munich the time was twice as long.
“2. The exact limit of the epidemic to the political boundary between Hamburg and Altona and Wandsbeck, which also agrees with the boundary between the respective water-supplies, while other differences were entirely absent. Hamburg had for 1000 inhabitants 26.31 cases and 13.39 deaths, but Altona only 3.81 cases and 2.13 deaths, and Wandsbeck 3.06 cases and 2.09 deaths.
“3. The old experience of cholera in fresh-water ports, and the analogy of many earlier epidemics. In this connection the above-mentioned epidemic of 1871 in Altona has a special interest, even though some of the conclusions of Bockendahl’s in his report of 1871 are open to objection. First there were 3 deaths August 3, which were not at once followed by others. Then unfiltered Elbe water was supplied August 11 to 18. On the 19th an outbreak of cholera extended to all parts of the city, which reached its height August 25 and 26, and afterwards gradually decreased. In all 105 persons died of cholera and 186 (179 of them children) of diarrhœa. In Hamburg, four times as large, only 141 persons died of cholera at this time, thus proportionately a smaller number. The conditions were then the reverse of those of 1892, an infection of the Altona water and a comparative immunity in Hamburg.
“It is objected that the cholera-germs were not found in the water in 1892. To my knowledge they were first looked for, and then with imperfect methods, in the second half of September. In the after-epidemics at Altona, they were found in the river-water by R. Koch by the use of better methods.