Cholera is a bacterial infection of the small intestine. It is usually transmitted through drinking water or eating food that has been contaminated by the feces of an infected person, leading to intense vomiting and diarrhea. Dehydration causes the sufferer to shed weight at a rate of as much as a liter an hour, and death can come on rapidly, attended by hallucinations and convulsions. During Hawthorne’s lifetime, there was no vaccination available to protect against it and a major pandemic claimed the lives of 150,000 Americans between 1832 and 1849. Cholera would have had a particular significance for him at this time as it was this disease that was believed to have carried off President James K. Polk in June 1849, just 103 days after he left office.