ABSTRACT
Cholera victims appeared healthy one moment but then quickly experienced agonizing symptoms: vomiting and voluminous diarrhea filled with blood plasma and flakes of the small intestine that gave the stool a characteristic rice-water appearance. No one understood, in those days before germ theory, that the bacteria Vibrio cholerae caused the illness, that one contracted it by consuming sewage-contaminated water or food, and that the bacteria released one of nature's deadliest toxins into the small intestine. Mild cases resulted when an individual ingested relatively few bacteria and when an individual's relatively high level of stomach acid killed significant quantities of the germs before they reached the small intestine. Pandemics-whether influenza in 1918 or COVID-19 in 2020-have generally had higher case fatality rates in the United States among recent immigrants, African Americans, and Indigenous populations.6 As has happened in the more recent past and as is happening today, a pandemic and injustice marched in lockstep through the American South in 1832.7 In midsummer of that deadly year, cholera penetrated the American South.