Intestinal Section Damaged by Cholera

After being bottled up for 164 years, this specimen was opened in 2013 for a genetic study to successfully identify the strain of cholera that killed this patient. Different strains of Vibrio cholerae can cause more or less severe effects, and a better understanding of the genetics of this terrible disease may help efforts to control it in the future. Cholera was one of the most feared diseases of the 19th century. Emerging from the Indian subcontinent, cholera began to spread to cities around the world in 1817. Repeated outbreaks of cholera felled hundreds of thousands in the United States and millions worldwide, leading to intense controversy among medical experts about what caused the disease, how it was spread, and how it killed. Although the ancient humoral theory of disease gave cholera its name—“choler” is bile, one of the four humors—19th-century physicians hypothesized instead that local climate, bad smells, stagnant air, decomposing organic matter, improper diet and lifestyle (especially among the poor), and many other factors could cause cholera. Rising international trade and urbanization were creating ideal conditions for the microbial culprit to circulate worldwide. The bacterium Vibrio cholerae, spread through contaminated water and food, attacks the wall of the small intestine and causes diarrhea and vomiting so severe that the patient can die of dehydration within hours. Today, cholera rarely occurs in the developed world where modern sanitation prevails, but it continues to be a global pandemic in poorer parts of the world. It also strikes after disasters when people are displaced and water supplies are compromised. Treatment of cholera in the 21st century can include antibiotics for severe cases, but usually the most effective treatment is oral or intravenous rehydration, which reduces the case fatality rate from 50–60% for untreated disease to less than 1%. During a cholera outbreak in 1849, members of The College of Physicians of Philadelphia preserved and examined specimens of intestines, including this one, from cholera patients. They observed that the mucous membranes of the diseased intestines were damaged; the layer of epithelial cells lining the intestine had detached from the underlying cells. Contemporary analysis of the microbe’s genome reveals that this strain is related to the classic cholera strain and that certain differences may account for its ability to cause severe disease