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Doctors and Diseases on the Oregon Trail
Diseases of the Nineteenth Century
Not all of these diseases were common on the Oregon Trail, but we provide the following information in response to popular demand.
Cholera
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.
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 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.
Influenza
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.
Malaria
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.
Typhus
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.
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