[Vicar's daughter died of cholera after drinking salt sea water]

In 1850 a vicar's daughter wanted to cure her lymphadenitis by health sea baths and drinking strengthening salt sea water. In the morning of the eleventh of August she took a bath and emptied three glass of salt sea water. At about 3 hours P.M. she fell ill with intensive watery diarrhoea and died on the following morning at 8 o'clock. Within one month 9 per cent of the population in the port of Malmo fell ill with cholera which killed every third of those affected. Necropsies were performed on some cases but did not reveal any remarkable changes. At the same time cholera attacked Lubeck and other ports of the Baltic sea. The sudden onset and the failure of quarantine precautions suggested intoxication of miasmic orgin. Thus the Swedish Medical Health authorities concluded that the disease was caused by atmospheric and telluric disturbances. Representatives of the Church opposed and considered that the disease was contagious. In 1883 Robert Koch discovered the cholera vibrion. Since then cholera has been considered as an intestinal infection. Cholera was supposed to affect only man, because it was not possible to transfer it to animals. Max von Pettenkofer disapproved the idea of contagiosity. He ingested cholera vibrions without falling ill. Recent findings have confirmed that there is need for at least one hundred billion of vibrions to cause clinical symptoms, whereas only 25 microgram of the toxin is required to produce intensive diarrhoea. Unlike true enteric bacteria, the cholera vibrions prefer aerobic conditions. They do not invade the tissues, and unlike dysentery, cholera disease does not induce inflammatory reactions. In 1855 John Snow proved that cholera was spread by water. All cholera outbreaks in Sweden have been associated with sea ports or inland seaways. Recent investigations have revealed that cholera vibrions are free-living planktonic organisms in sea water in many parts of the world. Human activities may help to spread the vibrions. Man is attacked by their toxin, but the infection takes place in the sea water rather than in the human gut. This is well illustrated by the present sad case report which was described without comments in the contemporary official medical report.