“June 3 Passed through St. Joseph on the Missouri River. Laid in our flour, cheese, crackers and medicine, for no one should travel this road without medicine, for they are almost sure to have the summer complaint. Each family should have a box of physicing pills, a quart of castor oil, a quart of the best rum and a large vial of peppermint essence.” -Elizabeth Dixon Smith
Today, we all have the same basic idea of whatmedicine is and how diseases work. We all know about germs, antibiotics, andvaccines. We watch surgeons replace internal organs on cable television. Themedical professionals who keep us healthy are among the most respected men andwomen in the world.
Forget everything you know, because to understandmedicine in the mid-1800s you will need to accept a completely different way oflooking at disease. The doctors of that time had no idea that infection anddisease were caused by microscopic organisms such as bacteria and viruses, andthey had only recently realized, thanks to French battlefield physicianstreating soldiers during the Napoleonic Wars, that wounds contaminated withdirt, bullet fragments, or other foreign matter would fester, turn gangrenous,and ultimately kill their patients.
Doctors and medical students often unknowinglyinfected their own patients by spreading germs from one person to another, asthey did not change clothes, clean their instruments, or even wash their handsafter treating one patient and before moving on to another. Hospitals were notplaces of healing — they were for the poor, the dying, and the insane. Anyonein a hospital with an open wound or sore would almost certainly contract aninfection and die within two weeks.
As a result, some of the best-selling books of theNineteenth Century were home medical references such as Gunn’s DomesticMedicine, or the Poor Man’s Friend and the Family Hand Book. The last thingmost people wanted when they were sick was to be treated by a doctor, becauseit was more or less an open secret by then that the medical professionals hadno real idea of what they were doing when it came to curing disease.Physicians, as a profession, were held in such low regard during the early andmid-1800s that several states stopped certifying and licensing doctors —anybody could put up a sign and call themselves a doctor, and a lot of folksdid.
Predictably, the 1800s became a golden age formedical quackery. Some of the bizarre treatments prescribed by NineteenthCentury quacks included placing patients in bathtubs full of cold water orwrapping them in wet sheets for hours at a time, restricting patients to narrowvegetarian diets such as only eating apples or bread, using hypnotism torelieve pain (which did sometimes offer temporary relief but did nothing totreat the cause of the pain), and, later in the century, delivering electricshocks. The current popularity of allopathic and naturopathic medicine has itsroots in the 1800s, as do some familiar soft drinks, including Coca-Cola andDr. Pepper, that were originally sold as patent medicines. There were even“Indian Doctors” who claimed to have learned the medical propertiesof the native plants of North America from the Indians.
The mainstream medical treatments of the time werehardly better, and in some cases they were clearly worse. The most common wayof treating a high fever, for example, was to cut open a vein and drain bloodfrom the patient — and not in a small way: a good doctor was expected to cutdeep enough that the patient’s blood would spurt into the air with everyheartbeat! To make matters worse, the most commonly prescribed “drug”of the time was the toxic element mercury, usually in the form of mercuricchloride. Mercury was the active ingredient in many medicines of the period,including calomel, the “blue pill” or “blue mass” which wasthought by many to be a safe alternative to calomel, and a patent medicine soldby one of America’s most prominent early physicians, Dr. Benjamin Rush. Thesemedicines were typically administered until the patient began to drooluncontrollably — a classic sign of mercury poisoning which was mistaken forevidence that the medicine was working.
In addition to mercury in its various forms, a goodpharmacy in the 1800s stocked drugs such as Dover’s Powder (a mixture of opiumand ipecac meant to relieve pain and induce sweating), Black Drops (a solutionof opium in vinegar), laudanum (a mixture of opium in alcohol, often sweetenedwith sugar), and Dragon’s Blood (a bright red plant resin used to treat“morbid impressions in the blood” and the like since the time of theancient Greeks) alongside things we still see in drug stores today, such asglue, soap, castor oil, and carbonate (milk) of magnesia. The ready availabilityof opium in different forms — there were even opium knockout drops marketed towomen who wanted to keep their wayward husbands home at night — reflects thefact that relieving pain was the one helpful thing that a doctor could reliablydo for all of his patients. Pharmacies also sold medicinal plants like lobelia,juniper berries, and different kinds of tree bark along with crops that todaywe only think of as food, such as chili peppers and garlic.
The reason mainstream medicine was so ineffectivein the 1800s was that it was all based on an idea that was over a thousandyears old. The basic concept was first described in the Second Century and hadbeen updated only slightly in the Sixteenth and Seventeenth Centuries to takeinto account improved knowledge of human anatomy, the discovery that bloodcirculates continuously through the body, and primitive theories to explain whywe breathe.
The theory of the Four Humors was part of theancient belief that the world was made of four elements: air, earth, fire, andwater. Each element was represented by one of the Four Humors: choler, blackbile, blood, and phlegm. Good health was the result of the elements being inbalance within the body; illness, as well as insanity and failings of one’smoral character, was believed to result from the Four Humors being out ofbalance. It’s important to recognize that the theory of the Four Humors was notmerely a tool to diagnose sick people — it was an effort to explain all theillness, madness, and evil in the world.
Under this way of thinking, doctors did not reallysee separate, distinct diseases the way they do today. There was just onemalady: the Humors being out of balance. The patient’s symptoms indicated thenature of that imbalance, suggesting which Humor(s) the patient had too much ortoo little of. For example, blood was associated with fire and was believed tobe the source of the body’s heat. Thus, it was common to bleed patients whowere running a high fever, as described in The State of the Art section.
In addition to bleeding, doctors would try to bringa patient’s Humors into balance by giving a laxative to cause diarrhea or anemetic to induce vomiting. Doctors also attempted to draw off excess Humors byraising blisters on the skin with poultices of ground chili peppers or cayennepepper. Another technique, called “cupping,” involved placing heatedglass cups upside-down on the patient’s skin. As the cups cooled, the airpressure inside them dropped, and the partial vacuum raised large, red welts whichwere thought to concentrate and draw off toxins in the body. Cupping was alsosometimes used in combination with bleeding: after one or two aggressivebleeding treatments, a patient’s blood pressure would drop to the point whereblood would no longer spurt out, so heated cups were placed over incisions tohelp draw more blood.
Most responsible doctors — as opposed to the manyquacks plaguing the profession — learned how to ply their trade either byattending medical school for a few months or by serving as an apprentice to apracticing physician for perhaps two or three years. Different teachers oftenpassed on very different lessons about how to treat disease, however, as theycould do no more than teach their students what they believed had worked forthem in the past.
Medicine was slow to accept the basic scientificmethod of advancing knowledge by observing and experimenting, and as a resultthere were no verified, accepted, concrete facts to compare when two doctorsdisagreed about something in the mid-1800s. Many doctors taught that mercurywas a useful laxative that had been used successfully for centuries, forexample, while others believed it was poisonous and advised their students toprescribe lobelia or aloe, instead.
It was perhaps a blessing in disguise that doctorswere few and far between on the frontier. Most folks only called on a doctor inan emergency, such as to treat a gunshot wound or set a broken bone. Inste ad,settlers relied on “granny medicine” — home remedies passed from motherto daughter over the years — though some families also put their faith inbooks such as The Family Nurse and Gunn’s Domestic Medicine, or the Poor Man’sFriend.
Granny medicine was no more effective thanmainstream, or “heroic” medicine, but it is at least easier for us tounderstand today. There was a certain amount of common sense in grannymedicine. For example, one basic rule was that anything that had some sort ofnoticable effect on the body must have medicinal value: peppermint oil was usedto treat all manner of aches and pains because it causes a sensation of warmthwhen applied to the skin, and asparagus was widely thought to be good for thekidneys because it makes urine smell odd. Granny medicine also followed whatmodern anthropologists call the “Rule of Similars” — for example,snakebites were often treated with extracts made from plants with long, stringyroots that looked sort of snake-like.
But the grannies and the doctors were on the samepage when it came to the Four Humors. Granny medicine and heroic medicine evenused many of the same medicinal plants to prepare “purgatives” todrain excess humors from their patients. As strange as the Four Humors seem tous today, they were entirely real to our ancestors. They worried just as muchabout acrimonious humors and disorderly movement of the blood as we worry aboutthe ebola virus and antibiotic-resistant bacteria.
We pitched our tents but soon found we were in a distressed crowd. Many Oregon families. One woman & two men lay dead on the grass & some more ready to die of cholra, measels & small pocks. A few men were digging graves, others tending the sick. Women & children crying, some hunting medicine & none to be found scarcely; those that had were loathe to spare. With heartfelt sorrow we looked around for some time until I felt unwell myself. Ordered the teams got up & move forward one mile so as to be out of hearing of crying & suffering.
John Clark
The idea that microscopic creatures we call “germs” cause disease did not gain scientific credibility until 1861, when the French physician Louis Pasteur published Memoire sur les corpuscles qui existent dans l’atmosphere. Before Pasteur, the idea that diseases could be contracted from the environment had gone in and out of fashion over the centuries. It was in fashion during the 1800s, and people believed that damp, foul-smelling air, often called “miasma,” was the cause of disease and epidemics. The scent of mold in a dank basem*nt, a reeking cesspool or pile of rubbish, or even the mist rising off a swamp were among the potential sources of bad, disease-causing air — in fact, the word “malaria” literally means “bad air.”
Thus, the Oregon Trail emigrants had no realunderstanding of the nature of disease. They did, however, appreciate itseffects. Epidemics tore through the country every few years, aided in theirspread by improvements in transportation — every new road, canal, steamboat,clipper ship, and railroad line was a potential route for a local outbreak tospread into an epidemic. Children were at risk from illnesses such as scarletfever and diptheria which are all but forgotten in the United States today.Tuberculosis, known as “consumption” for the way it slowly wore downits victims over the course of many years, was so common that a deep, hackingcough was almost a badge of old age, like wrinkles or gray hair. Malaria wassuch a major barrier to settlers along the upper Mississippi that some medicalexperts of the day declared that parts of Illinois, Iowa, and Missouri wouldprobably never be permanently settled.
“There was an old German doctor in our train. I don’t know why I call him old — he was only 34 years of age — but he seemed old to me then. … When Father died, Dr. Dagon volunteered to drive the wagon and help us to Oregon. After Mother’s death, Dr. Dagon took care of us children and was both father and mother to us.” -Elizabeth Sager Helm
Not many wagon trains had doctors traveling with them, and it was common for trains without doctors to try to stay close to a train that did have one. Although doctors generally had a low reputation in the United States of the mid-1800s, there are many stories of physicians on the Oregon and California Trails giving generously of their time, energy, and limited stocks of medicine. These men were fondly remembered by their fellow emigrants.
Unfortunately, in addition to trained doctors,quacks also came West.
“A boy eight or nine years of age had had his leg crushed by falling from the tongue of the wagon and being run over by its wheels… When I reached the tent of the unfortunate family to which the boy belonged, I found him stretched out upon a bench made of plank ready for the operation which they expected I would perform. I soon learned…that the accident occasioning the fracture had occurred nine days previously. That a person professing to be a doctor, had wrapped some linen loosely about the leg and made a sort of trough, or plank box, in which it had been confined. In this condition the child remained without any dressing of his wounded limb, until last night, when he called to his mother that he could feel worms crawling in his leg!… An examination of the wound for the first time was made, and it was discovered that gangrene had taken place, and the limb of the child was swarming with maggots!… I made an examination… The limb had been badly fractured, and had never been bandaged; and from neglect gangrene had supervened, the childs leg from his foot to his knee was in a state of putrefication. …
“The [surgical] instruments to be used were a common butcher knife, a carpenters handsaw, and a shoemakers awl to take up the arteries. The man commenced sawing; but before he had completed the amputation of the bone, he concluded that the operation should be performed above the knee. During these demonstrations the boy never uttered a groan or a complaint, but I saw…that he was dying. The operator, without noticing this, proceeded to sever the leg above the knee. A cord was drawn around the limb…so tight that it cut through the skin into the flesh. The knife and saw were then applied and the limb amputated. A few drops of blood only oozed from the stump; the child was dead — his miseries were over!”
-Edwin Bryant
Most of the overland emigrants took responsibility for looking after themselves; as at home, doctors on the Trail were only called upon in the event of an emergency. The Oregon Trail emigrants were mostly farm families and could take care of themselves reasonably well, as the women brought their granny medicine with them. When the women got sick, however, the men had to improvise.
“Mrs. Knapp, one of the members of the wagon train, died of cholera, and Mother laid her out. Mother took the cholera. Father didn’t know what to do, so he had her drink a cupful of spirits of camphor. The other people thought it would kill her or cure her. It cured her.” -Abigail Hathaway King
Traffic on the California Trail, on the other hand, was dominated by unattached men who tried to treat their own illnesses as best they could.
“June 25 Somewhat indisposed this morning for the first time on the trip. Prompted by the advice of an Illinois friend, I had brought with me a pint of brandy and some quinine for cases of sickness. Feeling that this was such a case, I prepared a dose according to directions, but found it so excessively-bitter I could not swallow it. Not being acquainted with either of the ingredients, I attributed the bitterness to the brandy. After adding quantities of sugar and coffee with the vain hope of making it palatable I threw the whole mess away in despair and disgust.” -William Smedley
The most dangerous period of the emigration was the early 1850s, when cholera broke out in the jumping-off towns along the Missouri River. The emigrants and Gold Rushers headed for Oregon and California picked up the disease while outfitting for the journey and carried it west along the Platte and North Platte Rivers. The cholera epidemic on the Trail certainly killed hundreds and may have killed as many as a few thousand overlanders, but it was rarely mentioned in the emigrants’ diaries and journals once they passed Fort Laramie. No one knows if the epidemic simply ran its course and burned out at about the same time every year or if some environmental factor stopped it once the wagon trains were past a certain point on the Trail.
“Dear Uncle, I find here a station for the purpose of conveyinga letter to the States and I hasten to inform you of our travels and theincidents pertaining thereto. First of all I would mention the sickness we havehad and I am sorry to say the deaths. First of all Francis Freel died June 4,1852 and Maria Freel followed the 6th, next came Polly Casner who died the 9thand LaFayette Freel soon followed, he died the 11th, and her baby died the17th. So you see we have had a sad affliction on our short journey. You see wehave lost 7 persons in a few short days, all died of cholera. Although I knowit will be a sad epistle of news to send you, still, I feel it a duty to letyou know how matters are progressing, but thank God we are all well and likelyto do well for we have had no sickness since the baby died. Please let SophiaParkinson read this letter when you have perused it and let all of our friendsknow about our sad afflictions. We have had very good luck with our teams andhave prospered well except sickness and deaths.
“And I would say here a word about traveling and tell it to all of your friends that think of coming on this vast prairie, it is this, do not, as you value your lives, ever drink water out of springs and sunken wells on the side of the road or any where else. Always use the Platte River water and you will have no sickness. Even if you do have to go a mile or two miles, do it rather than to drink out of those cursed pittholes of deaths. For it is nothing less than that caused all of our sickness.
“We didn’t know anything about it, and as the water is generally good and pleasant to drink, we thought we were using the best water. So remember this, and as I said before, advise your friends to do the same. I have not time to write more at present, for we are stopping our teams in the middle of the road for the purpose of writing this. So good bye for the present. I will write to you again the next opportunity and believe me yours as ever
“Your affectionate nephew
George Kiser
Ann Kiser”
While cholera was the most widely feared disease among the overlanders, tens of thousands of people emigrated to Oregon and California over the course of a generation, and they brought along virtually every disease and chronic medical condition known to science short of leprosy and the Black Death. Dysentery, smallpox, measles, mumps, and influenza were among the diseases named in diaries and journals, but cholera, mountain fever, and scurvy were probably the biggest killers.
Mountain fever was not described well enough to pindown exactly what it was. Some speculate that it was typhoid fever, whileothers believe that it was an insect-borne disease such as Rocky Mountainspotted fever. Camp fever was almost certainly scurvy — which is not actuallya contagious disease, but the result of a vitamin deficiency — as bleedinggums were described as the first symptom of a fatal case.
Disease was the single biggest threat to theemigrants on the overland trails, but doctors were often called upon to dealwith accidental injuries, as well. Horses and oxen sometimes bit or kickedtheir owners, people occasionally slipped as they were climbing on or off theirwagons and were run over, and there were even a handful of people struck bylightning over the years. Among the most difficult injuries to treat weregunshot wounds, as doctors could do little beyond bandaging the wound andrelieving pain. If a bullet or musket ball remained within the body, doctorsused slim rods of metal or bone to probe the entry wound, poking around untilthey found the bullet by touch, and then tried to reach in (often with theirbare fingers) and pull it out through the wound it made on the way in. Mostgunshot wounds on the emigrant trails were the result of somebody’scarelessness or lack of experience with firearms.
“Some stir in camp this morning in consequence of a sentinel’s gun going off accidentally, which killed a mule belonging to James Williams, the bullet breaking the mule’s neck. This is the most serious accident which has yet occurred from carelessness in the use of firearms, though, judging from the carelessness of the men, I have anticipated more serious accidents before this time, and if they do not occur, they will be avoided by great good luck, not by precaution.” -James W. Nesmith
There was no telling where illness or injury might strike, and it was common for doctors to ride miles out of their way to reach patients in distant wagon trains. Overland trails historian John Unruh, Jr., observed that, “…it is evident that physicians were among the heroes of the migrations, especially during the Gold Rush.”
Burns
The most effective traditional approach to treating burns was to coat theburned skin with egg white, as this provided a sterile seal for the skin andhelped keep the wound from drying out. Some folks on the Oregon Trail had touse axle grease, instead, which was made of rendered animal fat and perhaps abit of beeswax thinned with turpentine.
The Common Cold
A few drops of camphor in a glass of water (as hot as the patient can stand)was recommended, and for a sore throat tie a piece of bacon sprinkled withblack pepper around the patient’s neck.
Cough Syrup
“Take of poplar bark and bethroot, each 1 lb.; water, 9 quarts; boil gently in a covered vessel 15 or 20 minutes; strain through a coarse cloth; add 7 lbs. loaf sugar, and simmer till the scum ceases to rise.” – from The Family Hand Book, 1855
Diarrhea
A standard treatment was an hourly spoonful of water in which blackberry roothad been boiled. Some folks didn’t treat diarrhea unless it was very severe,however, as they thought it was helping to cleanse the patient of unhealthyHumors.
Snakebite
Rattlesnake bites were often treated just like you see in old westerns:somebody would slice open the bite wound and suck the poison out. This wasactually fairly effective if done right away. In one case we have record of,the victim (who was a child, incidentally) was given a shot of whiskey and atobacco poultice to bandage the wound.
Syphilis
The standard heroic treatment for centuries was mercury, usually in the form ofcalomel. Long-term use was thought to be dangerous by many people, however, andgrannies (and by the mid-1800s, some doctors as well) often recommended arsenicas a safer alternative.
Tuberculosis
The settlers had many treatments for consumption, none of which were effective.Among them were smoking tobacco, drinking cod liver oil, and eating a thick,boiled-down onion stew.
Cholera
The disease that had the worst reputation in the Nineteenth Century wascholera, which raged across the planet every few years in a series of outbreaksthat killed millions. Our present-day anxiety about some horrible disease beingspread rapidly around the world by modern transportation technology has alreadyhappened to devastating effect in relatively recent history — instead of ebolabeing spread from Africa aboard jet aircraft, it was cholera that journeyedaround the world aboard sailing ships. Cholera cut like a scythe wherever itstruck, with a mortality rate of 20% or higher among the infected populationbeing commonplace. The real horror, however, was the speed with which itkilled: a person could be healthy in the morning, crippled by agonizing crampsand diarrhea at noon, and dead of dehydration by nightfall. If cholera didn’tprove lethal in the first 24 hours after the onset of fever, it would typicallyrun its course in 5-7 days.
Dengue Fever
Commonly known as “breakbone fever,” dengue is a tropical diseasethat is uncommon in the United States but periodically gets imported fromwarmer climes. Though rarely fatal, dengue was widely dreaded for theincredible pain its victims suffered — the folk name “breakbonefever” was a reference to the immobilizing joint pain the disease broughton, leaving people bedridden for days as if all their limbs had been broken.This pain could recur weeks or even months after the initial period ofinfection and fever, and immunity to the infection was only conferred afterrepeated exposure. Dengue fever is spread by mosquitos — the host for thedengue virus is the Aedes aegypti mosquito, while the malaria parasite isspread by the Anopheles mosquito.
Diptheria
Though generally thought of as a childhood disease, diptheria infected adults,as well, and used to be infamous for killing doctors. The bacteria that causesdiptheria can survive outside the body for days, allowing the disease to betransmitted in droplets of saliva and mucous blown into the air by coughs andsneezes as well as by contact with contaminated clothing, handkerchiefs, pensand pencils, and other objects long after they were handled by an infectedindividual. The mortality rate was 5-10%, but children under five and theelderly were more vulnerable.
Influenza
The flu (often known in the 1800s as “the grippe”) is todayconsidered to be little more than a bad cold, but the influenza virus was afeared killer for centuries. The last major flu pandemic struck in 1918 andkilled over 21 million people worldwide — about one percent of the humanpopulation at the time — and prior to that it flared up in lesser, thoughstill quite deadly, outbreaks every few years throughout modern history. Themortality rate of influenza is very low today, but past outbreaks have killedup to 7-8% of the infected population. Recent research suggests that the highdeath rate of major historic outbreaks may have been the result of widespreadtuberculosis infection, as people already sick with consumption became highlyvulnerable to pneumonia when struck by a bad case of the flu.
Malaria
Known as “the ague” or “fever and ague” in the 1800s,malaria had a reputation for sudden, widespread outbreaks. It struck downentire families and communities at the same time, transmitted across wide areasby mosquito bites. As malaria has a low mortality rate, most victims survivedand lived with it as a chronic condition causing occasional bouts of weakness,chills, and fever. Today, malaria is considered a tropical disease, but in themid-1800s it was a significant barrier to the rapid settlement of the primefarmland available in the Mississippi River basin. Settlements along theMissouri, Illinois, and upper Mississippi Rivers collapsed when they becameknown as centers of plague and steamboat captains refused to stop there.
The Summer Complaint
Though widely believed to be the result of heat interfering with digestion,“the summer complaint” was simply food poisoning. Between the lack ofrefrigeration and ignorance of the existence of germs, nobody gave much thoughtto handling food (especially meat) safely. Little wonder that food poisoningwas so common during the warm months of the year that it was thought of as aseasonal disease.
Typhoid Fever
Typhoid is a bacterial disease characterized by high fever and diarrhea lastingabout three weeks. The appearance of rose-colored spots on the abdomen was thetell-tale sign of typhoid, which also commonly caused patients to lapse intodelirium during the second week of the fever. Most commonly spread bycontaminated water, typhoid was also known as “cess-pool fever” inthe late 1800s because of its association with poor sanitation. Typhoid feverwas highly contagious and had a mortality rate of 10-20%, though the mortalityrate was closely tied to age — it usually wasn’t fatal for children. In rarecases, known as “walking typhoid,” the symptoms were very mild andpatients were able to go about their business more or less normally. However,some of these cases ended in perforated bowels, causing death by peritonitis ifthe tears were small or, in a worst case, massive bleeding which killed inminutes.
Typhus
Not to be confused with typhoid fever, typhus was distinguished by a dark redor purplish, mottled rash that appeared over the entire body of the patient,and where typhoid caused diarrhea, typhus usually caused constipation. Themortality rate of typhus was comparable to typhoid fever, about 15%, as was theperiod of fever, and indeed they were not clearly identified as two differentillnesses until the 1850s. Also known as ship or jail fever, typhus is spreadby body lice and does well in crowded, unsanitary conditions. Historically,typhus never became entrenched in the United States, while it was a chronicproblem through the centuries in Europe.
Yellow Fever
The rapid development of trade along the Mississippi, Ohio, and other riversbrought yellow fever to the heartland. Yellow fever is an unpredictabletropical disease which historically struck hardest in the port cities ofsouthern states, but it often struck the Atlantic coast, as well, andoccasionally reached as far inland as St. Louis and Chicago. It sometimesappeared in virulent, potentially lethal forms and at other times inflictedonly mild symptoms. It was well known for inflicting two bouts of feverseparated by a brief, partial recovery — the second fever either killed or itdidn’t. Bleeding from bodily orifices, and in severe cases from the eyes, ears,and skin, was the most gruesome symptom of yellow fever, which was named forthe discoloration of the skin common in varying degrees to its victims.Internal bleeding sometimes caused “black vomit,” which usuallyindicated a fatal case of the disease.
