Two errors in enteric epidemiology: the stories of Austin Flint and Max von Pettenkofer

The misconceptions of two physicians, Austin Flint and Max von Pettenkofer, in interpreting epidemiologic data on the water transmission of enteric disease are reviewed. Austin Flint failed to recognize the transmission of typhoid fever from well water in an epidemic he investigated in North Boston, New York, in 1843. He later discovered and freely admitted his error. Max von Pettenkofer, who had studied cholera in the 1854 outbreak and in many subsequent outbreaks, failed to confirm John Snow's observations in England on the water transmission of cholera. Pettenkofer eventually swallowed live cholera bacilli and did not develop cholera. He remained convinced to the end of his life that cholera is not directly transmitted by drinking water.