Doctors and Diseases on the Oregon Trail

“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 what medicine is and how diseases work. We all know about germs, antibiotics, and vaccines. We watch surgeons replace internal organs on cable television. The medical professionals who keep us healthy are among the most respected men and women in the world.

Forget everything you know, because to understand medicine in the mid-1800s you will need to accept a completely different way of looking at disease. The doctors of that time had no idea that infection and disease were caused by microscopic organisms such as bacteria and viruses, and they had only recently realized, thanks to French battlefield physicians treating soldiers during the Napoleonic Wars, that wounds contaminated with dirt, bullet fragments, or other foreign matter would fester, turn gangrenous, and ultimately kill their patients.

Doctors and medical students often unknowingly infected their own patients by spreading germs from one person to another, as they did not change clothes, clean their instruments, or even wash their hands after treating one patient and before moving on to another. Hospitals were not places of healing — they were for the poor, the dying, and the insane. Anyone in a hospital with an open wound or sore would almost certainly contract an infection and die within two weeks.

As a result, some of the best-selling books of the Nineteenth Century were home medical references such as Gunn’s Domestic Medicine, or the Poor Man’s Friend and the Family Hand Book. The last thing most people wanted when they were sick was to be treated by a doctor, because it was more or less an open secret by then that the medical professionals had no 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 and mid-1800s that several states stopped certifying and licensing doctors — anybody could put up a sign and call themselves a doctor, and a lot of folks did.

Predictably, the 1800s became a golden age for medical quackery. Some of the bizarre treatments prescribed by Nineteenth Century quacks included placing patients in bathtubs full of cold water or wrapping them in wet sheets for hours at a time, restricting patients to narrow vegetarian diets such as only eating apples or bread, using hypnotism to relieve pain (which did sometimes offer temporary relief but did nothing to treat the cause of the pain), and, later in the century, delivering electric shocks. The current popularity of allopathic and naturopathic medicine has its roots in the 1800s, as do some familiar soft drinks, including Coca-Cola and Dr. Pepper, that were originally sold as patent medicines. There were even “Indian Doctors” who claimed to have learned the medical properties of the native plants of North America from the Indians.

The mainstream medical treatments of the time were hardly better, and in some cases they were clearly worse. The most common way of treating a high fever, for example, was to cut open a vein and drain blood from the patient — and not in a small way: a good doctor was expected to cut deep enough that the patient’s blood would spurt into the air with every heartbeat! To make matters worse, the most commonly prescribed “drug” of the time was the toxic element mercury, usually in the form of mercuric chloride. Mercury was the active ingredient in many medicines of the period, including calomel, the “blue pill” or “blue mass” which was thought by many to be a safe alternative to calomel, and a patent medicine sold by one of America’s most prominent early physicians, Dr. Benjamin Rush. These medicines were typically administered until the patient began to drool uncontrollably — a classic sign of mercury poisoning which was mistaken for evidence that the medicine was working.

In addition to mercury in its various forms, a good pharmacy in the 1800s stocked drugs such as Dover’s Powder (a mixture of opium and ipecac meant to relieve pain and induce sweating), Black Drops (a solution of opium in vinegar), laudanum (a mixture of opium in alcohol, often sweetened with 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 the ancient Greeks) alongside things we still see in drug stores today, such as glue, soap, castor oil, and carbonate (milk) of magnesia. The ready availability of opium in different forms — there were even opium knockout drops marketed to women who wanted to keep their wayward husbands home at night — reflects the fact that relieving pain was the one helpful thing that a doctor could reliably do for all of his patients. Pharmacies also sold medicinal plants like lobelia, juniper berries, and different kinds of tree bark along with crops that today we only think of as food, such as chili peppers and garlic.

The reason mainstream medicine was so ineffective in the 1800s was that it was all based on an idea that was over a thousand years old. The basic concept was first described in the Second Century and had been updated only slightly in the Sixteenth and Seventeenth Centuries to take into account improved knowledge of human anatomy, the discovery that blood circulates continuously through the body, and primitive theories to explain why we breathe.

The theory of the Four Humors was part of the ancient belief that the world was made of four elements: air, earth, fire, and water. Each element was represented by one of the Four Humors: choler, black bile, blood, and phlegm. Good health was the result of the elements being in balance within the body; illness, as well as insanity and failings of one’s moral character, was believed to result from the Four Humors being out of balance. It’s important to recognize that the theory of the Four Humors was not merely a tool to diagnose sick people — it was an effort to explain all the illness, madness, and evil in the world.

Under this way of thinking, doctors did not really see separate, distinct diseases the way they do today. There was just one malady: the Humors being out of balance. The patient’s symptoms indicated the nature of that imbalance, suggesting which Humor(s) the patient had too much or too little of. For example, blood was associated with fire and was believed to be the source of the body’s heat. Thus, it was common to bleed patients who were running a high fever, as described in The State of the Art section.

In addition to bleeding, doctors would try to bring a patient’s Humors into balance by giving a laxative to cause diarrhea or an emetic to induce vomiting. Doctors also attempted to draw off excess Humors by raising blisters on the skin with poultices of ground chili peppers or cayenne pepper. Another technique, called “cupping,” involved placing heated glass cups upside-down on the patient’s skin. As the cups cooled, the air pressure inside them dropped, and the partial vacuum raised large, red welts which were thought to concentrate and draw off toxins in the body. Cupping was also sometimes used in combination with bleeding: after one or two aggressive bleeding treatments, a patient’s blood pressure would drop to the point where blood would no longer spurt out, so heated cups were placed over incisions to help draw more blood.

Most responsible doctors — as opposed to the many quacks plaguing the profession — learned how to ply their trade either by attending medical school for a few months or by serving as an apprentice to a practicing physician for perhaps two or three years. Different teachers often passed on very different lessons about how to treat disease, however, as they could do no more than teach their students what they believed had worked for them in the past.

Medicine was slow to accept the basic scientific method of advancing knowledge by observing and experimenting, and as a result there were no verified, accepted, concrete facts to compare when two doctors disagreed about something in the mid-1800s. Many doctors taught that mercury was a useful laxative that had been used successfully for centuries, for example, while others believed it was poisonous and advised their students to prescribe lobelia or aloe, instead.

It was perhaps a blessing in disguise that doctors were few and far between on the frontier. Most folks only called on a doctor in an emergency, such as to treat a gunshot wound or set a broken bone. Inste ad, settlers relied on “granny medicine” — home remedies passed from mother to daughter over the years — though some families also put their faith in books such as The Family Nurse and Gunn’s Domestic Medicine, or the Poor Man’s Friend.

Granny medicine was no more effective than mainstream, or “heroic” medicine, but it is at least easier for us to understand today. There was a certain amount of common sense in granny medicine. For example, one basic rule was that anything that had some sort of noticable effect on the body must have medicinal value: peppermint oil was used to treat all manner of aches and pains because it causes a sensation of warmth when applied to the skin, and asparagus was widely thought to be good for the kidneys because it makes urine smell odd. Granny medicine also followed what modern anthropologists call the “Rule of Similars” — for example, snakebites were often treated with extracts made from plants with long, stringy roots that looked sort of snake-like.

But the grannies and the doctors were on the same page when it came to the Four Humors. Granny medicine and heroic medicine even used many of the same medicinal plants to prepare “purgatives” to drain excess humors from their patients. As strange as the Four Humors seem to us today, they were entirely real to our ancestors. They worried just as much about acrimonious humors and disorderly movement of the blood as we worry about the 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 basement, 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 real understanding of the nature of disease. They did, however, appreciate its effects. Epidemics tore through the country every few years, aided in their spread by improvements in transportation — every new road, canal, steamboat, clipper ship, and railroad line was a potential route for a local outbreak to spread into an epidemic. Children were at risk from illnesses such as scarlet fever and diptheria which are all but forgotten in the United States today. Tuberculosis, known as “consumption” for the way it slowly wore down its victims over the course of many years, was so common that a deep, hacking cough was almost a badge of old age, like wrinkles or gray hair. Malaria was such a major barrier to settlers along the upper Mississippi that some medical experts of the day declared that parts of Illinois, Iowa, and Missouri would probably 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 conveying a letter to the States and I hasten to inform you of our travels and the incidents pertaining thereto. First of all I would mention the sickness we have had 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 9th and LaFayette Freel soon followed, he died the 11th, and her baby died the 17th. So you see we have had a sad affliction on our short journey. You see we have lost 7 persons in a few short days, all died of cholera. Although I know it will be a sad epistle of news to send you, still, I feel it a duty to let you know how matters are progressing, but thank God we are all well and likely to do well for we have had no sickness since the baby died. Please let Sophia Parkinson read this letter when you have perused it and let all of our friends know about our sad afflictions. We have had very good luck with our teams and have 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 pin down exactly what it was. Some speculate that it was typhoid fever, while others believe that it was an insect-borne disease such as Rocky Mountain spotted fever. Camp fever was almost certainly scurvy — which is not actually a contagious disease, but the result of a vitamin deficiency — as bleeding gums were described as the first symptom of a fatal case.

Disease was the single biggest threat to the emigrants on the overland trails, but doctors were often called upon to deal with accidental injuries, as well. Horses and oxen sometimes bit or kicked their owners, people occasionally slipped as they were climbing on or off their wagons and were run over, and there were even a handful of people struck by lightning over the years. Among the most difficult injuries to treat were gunshot wounds, as doctors could do little beyond bandaging the wound and relieving pain. If a bullet or musket ball remained within the body, doctors used slim rods of metal or bone to probe the entry wound, poking around until they found the bullet by touch, and then tried to reach in (often with their bare fingers) and pull it out through the wound it made on the way in. Most gunshot wounds on the emigrant trails were the result of somebody’s carelessness 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.”

The most effective traditional approach to treating burns was to coat the burned skin with egg white, as this provided a sterile seal for the skin and helped keep the wound from drying out. Some folks on the Oregon Trail had to use axle grease, instead, which was made of rendered animal fat and perhaps a bit 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 with black 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

A standard treatment was an hourly spoonful of water in which blackberry root had 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 unhealthy Humors.

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 was actually 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 a tobacco poultice to bandage the wound.

The standard heroic treatment for centuries was mercury, usually in the form of calomel. Long-term use was thought to be dangerous by many people, however, and grannies (and by the mid-1800s, some doctors as well) often recommended arsenic as a safer alternative.

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.

The disease that had the worst reputation in the Nineteenth Century was cholera, which raged across the planet every few years in a series of outbreaks that killed millions. Our present-day anxiety about some horrible disease being spread rapidly around the world by modern transportation technology has already happened to devastating effect in relatively recent history — instead of ebola being spread from Africa aboard jet aircraft, it was cholera that journeyed around the world aboard sailing ships. Cholera cut like a scythe wherever it struck, with a mortality rate of 20% or higher among the infected population being commonplace. The real horror, however, was the speed with which it killed: a person could be healthy in the morning, crippled by agonizing cramps and diarrhea at noon, and dead of dehydration by nightfall. If cholera didn’t prove lethal in the first 24 hours after the onset of fever, it would typically run its course in 5-7 days.

Dengue Fever
Commonly known as “breakbone fever,” dengue is a tropical disease that is uncommon in the United States but periodically gets imported from warmer climes. Though rarely fatal, dengue was widely dreaded for the incredible pain its victims suffered — the folk name “breakbone fever” was a reference to the immobilizing joint pain the disease brought on, 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 of infection and fever, and immunity to the infection was only conferred after repeated exposure. Dengue fever is spread by mosquitos — the host for the dengue virus is the Aedes aegypti mosquito, while the malaria parasite is spread by the Anopheles mosquito.

Though generally thought of as a childhood disease, diptheria infected adults, as well, and used to be infamous for killing doctors. The bacteria that causes diptheria can survive outside the body for days, allowing the disease to be transmitted in droplets of saliva and mucous blown into the air by coughs and sneezes as well as by contact with contaminated clothing, handkerchiefs, pens and pencils, and other objects long after they were handled by an infected individual. The mortality rate was 5-10%, but children under five and the elderly were more vulnerable.

The flu (often known in the 1800s as “the grippe”) is today considered to be little more than a bad cold, but the influenza virus was a feared killer for centuries. The last major flu pandemic struck in 1918 and killed over 21 million people worldwide — about one percent of the human population at the time — and prior to that it flared up in lesser, though still quite deadly, outbreaks every few years throughout modern history. The mortality rate of influenza is very low today, but past outbreaks have killed up to 7-8% of the infected population. Recent research suggests that the high death rate of major historic outbreaks may have been the result of widespread tuberculosis infection, as people already sick with consumption became highly vulnerable to pneumonia when struck by a bad case of the flu.

Known as “the ague” or “fever and ague” in the 1800s, malaria had a reputation for sudden, widespread outbreaks. It struck down entire families and communities at the same time, transmitted across wide areas by mosquito bites. As malaria has a low mortality rate, most victims survived and lived with it as a chronic condition causing occasional bouts of weakness, chills, and fever. Today, malaria is considered a tropical disease, but in the mid-1800s it was a significant barrier to the rapid settlement of the prime farmland available in the Mississippi River basin. Settlements along the Missouri, Illinois, and upper Mississippi Rivers collapsed when they became known 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 of refrigeration and ignorance of the existence of germs, nobody gave much thought to handling food (especially meat) safely. Little wonder that food poisoning was so common during the warm months of the year that it was thought of as a seasonal disease.

Typhoid Fever
Typhoid is a bacterial disease characterized by high fever and diarrhea lasting about three weeks. The appearance of rose-colored spots on the abdomen was the tell-tale sign of typhoid, which also commonly caused patients to lapse into delirium during the second week of the fever. Most commonly spread by contaminated water, typhoid was also known as “cess-pool fever” in the late 1800s because of its association with poor sanitation. Typhoid fever was highly contagious and had a mortality rate of 10-20%, though the mortality rate was closely tied to age — it usually wasn’t fatal for children. In rare cases, known as “walking typhoid,” the symptoms were very mild and patients were able to go about their business more or less normally. However, some of these cases ended in perforated bowels, causing death by peritonitis if the tears were small or, in a worst case, massive bleeding which killed in minutes.

Not to be confused with typhoid fever, typhus was distinguished by a dark red or purplish, mottled rash that appeared over the entire body of the patient, and where typhoid caused diarrhea, typhus usually caused constipation. The mortality rate of typhus was comparable to typhoid fever, about 15%, as was the period of fever, and indeed they were not clearly identified as two different illnesses until the 1850s. Also known as ship or jail fever, typhus is spread by body lice and does well in crowded, unsanitary conditions. Historically, typhus never became entrenched in the United States, while it was a chronic problem through the centuries in Europe.

Yellow Fever
The rapid development of trade along the Mississippi, Ohio, and other rivers brought yellow fever to the heartland. Yellow fever is an unpredictable tropical disease which historically struck hardest in the port cities of southern states, but it often struck the Atlantic coast, as well, and occasionally reached as far inland as St. Louis and Chicago. It sometimes appeared in virulent, potentially lethal forms and at other times inflicted only mild symptoms. It was well known for inflicting two bouts of fever separated by a brief, partial recovery — the second fever either killed or it didn’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 for the discoloration of the skin common in varying degrees to its victims. Internal bleeding sometimes caused “black vomit,” which usually indicated a fatal case of the disease.