In addition, the plains farmers of the mid-19th century still lived in a state of medical superstition, The germ theory was as yet unknown, and they thought many ailments were caused by miasmas rising from the mists or even the early morning dew. The sod huts and their privies were unhealthy--they were dark, damp, crowded, and unsanitary and had dirt floors. Contaminated food, dust-covered belongings, and bedbugs, fleas, and flies were constant aggravations. In home, school, and village, common drinking cups spread infection. Water supplies often were tainted, and the frontiersman's poor diet frequently caused scurvy and an intestinal malady dubbed bilious fever.

For most plainsmen, however, calling the doctor was a last resort. The nearest physician might live far away, and his fee could come to 50 cents a mile, plus a dollar for consultation and additional sums for medicines. This was far too expensive for many, well aware that the professional remedies were often no better than the folk medicines of the farmer's wife with her herbs and poultices.

Sometimes the cures the prairie wife claimed left doubt about the accuracy of the diagnosis. Typical was Mrs. Edith Wheeler of Texas, who reported: "Old Man Rufe Harper sprouted a skin cancer that the doctor swore would spread till it ate up his face. Uncle Rufe came to me...I remembered how my mother used to take warts off our hands with an ointment made from the crushed leaves of a weed called sheep sorrel. I didn't know how it would work on cancer, but I figured it wouldn't kill Uncle Rufe...To make the medicine extra strong, I mixed in gunpowder...and smeared that cancer with fresh applications every day. Uncle Rufe swore it burned 'worse than hell.'...But [after] five days that cancer slid off his face like a dried scab."

For their families' more ordinary ailments plainswomen used homemade remedies: for rheumatism, wahoo-root tea or poke root; as a physic, slippery elm; for ague, sulfur and molasses; to trigger sweating, snakeroot tea; to stanch bleeding, cobwebs. Oddly enough, for childbirth--one of the most natural of human trials--the frontier woman generally sought a doctor's help, perhaps because, due to lack of antiseptics, "childbirth fever" killed so many young women. Often, though, distances and storms prevented the physician's timely arrival, and thousands of children were born with only their fathers in attendance. Whether mother or baby survived was mostly a matter of luck. Indeed, until modern medicine got to the plains in [the 20th] century, everyone's survival depended almost exclusively on good fortune.

The paucity of medical practitioners on the frontier was particularly acute on the plains. Towns that grew around army posts had military doctors, some remarkably good. But many other communities either had no doctors at all or else mediocrities who held degrees from diploma mills, had only a year's apprenticeship with an older doctor, or were merely self-proclaimed physicians with no training. The territories initially had no medical standards, and it was not until 1880 that Nebraska passed the first law requiring that physicians register with the county clerk and be graduates of a reputable medical school--which meant a two-year course.

The most dedicated of the professionals found the career exhausting. A country doctor's office was a tent, a prairie cabin, or a room in his village home. Unable to make a living by medicine alone, he often doubled as a pharmacist or dentist or supported himself through other businesses. When a patient called, the doctor's wife would ring a bell whose special tone would summon her husband from his downstreet business office. For house calls he had to travel long distances at any hour, in all weathers. He might ride by horseback or drive his buggy 30 miles to a soddy, sit up for hours with a patient, then sleep on the return trip while his horse found the way home. He acted as nurse and clergyman too, and his care was a mixture of folk remedy, medieval practise, and shrewd improvisation. He bled his patients for most ills, and for diphtheria he boiled sulfur or powdered brimstone in limewater and dripped it with a quill into the victim's nostrils. He used calomel as a cathartic, opium for diarrhea, tartar emetic to induce vomiting, Spanish fly (a drug from a beetle) to produce counterirritant blisters, and--ignorant of its true efficacy--quinine for the ague. One doctor successfully treated a severely burned man with poultices of sour milk and clay. Another reduced the irritation of bad poison ivy by immersing the child in a mudhole. The frontier doctor's forte, however, was surgery: he performed amazing amputations with a Bowie knife and carpenter's saw. One did an appendectomy on a kitchen table by kerosene lamp and with no anesthetic. The long hours and rugged conditions must have driven many doctors to drink, however, for the Dakota Territory ruled it a misdemeanor if a doctor poisoned his patient while intoxicated.

--From The Story of the Great American West, by the editors of Reader's Digest

Lacking knowledge, many people feared being cut by the surgeon's knife, and believed that a person went to a hospital only to die. Quacks were widely patronized by those too poor, too ignorant, or too frightened to consult a doctor or a druggist. Faced with cures that often failed, or at least felt worse than the ailments, country people especially, instead of going to professional doctors, depended a good deal on "patent" medicines and on folk-medicine advice passed on by word of mouth: "If you get a nail in your foot, wrap the foot in a rag soaked in coal oil to prevent lockjaw." "Put snuff on red-ant bites." "Turpentine will heal almost any sore." Many were likely to obtain home-brewed medicines from a neighbor who specialized in herbalism. In the early Midwest, cold and sore throat was treated with a piece of peppered fat meat fastened about the neck, fever broken with a bag of pounded slippery elm set over the sufferer's eye. If an eruptive disease was slow to break out, the wife fed a dose of "nanny tea," which was composed of sheep dung. Stomachache was reduced with internal doses of whiskey and external rubs of cayenne pepper dissolved in spirits. Other remedies were made from brimstone, sulphur, tobacco juice, bitters derived from roots and barks, and scrapings from pewter spoons.

Many people made their own cures; every "receipt" book, both family and for-profit, included a section on home medications, and every drugstore featured herb cases with dozens of drawers, like boxes in a shoestore, around the walls, containing such things as snakeroot, rutabaga seed, dogwood bark, horehound, pennyroyal, camphor, alum, gum arabic, and caraway seed. A healing salve--always to be made in the spring--was produced by heating in an earthen dish a pound of leaf lard, as much of mutton tallow, and a nickel's worth each of yellow beeswax and raw linseed oil; let get cold, and add a large handful of elder bark with all the gray scraped off. Then boil for 20 minutes, strain through a cloth, and stir until cold. Cough syrup could be made by mixing two tablespoons each of whiskey, lemon juice, and honey (with perhaps a little butter), or by combining a pound of loaf sugar, half a pound of flaxseed, four sliced lemons, and two quarts of water, boiling and straining, and adding a pint of whiskey or brandy to preserve it. As a wash for inflamed feet, an ounce of spirits of camphor and as much of ammonia was combined with a coffee cup full of ocean salt, put into a quart bottle which was then topped off with water, and shaken well; for use as needed, three or four teaspoons of it would be added to a bowl of water. Sunflower seeds soaked in a pint of spirits and let stand 12 hours were taken internally for rheumatism. Wild cherry and bloodroot were brewed into a heart stimulant. Dandelion roots were boiled up in water, strained, and combined with maple syrup for stomach trouble. Pills made of flour mixed with the boiled inner bark of the ash tree were administered for action on the liver and bowels; willow bark was prepared the same way for a tonic. A brew prepared from green gourds was used as an emetic. A soothing syrup for a child's or infant's cold or stomachache could be made of a cup of tallow lard, melted and mixed with half a cup of blackjack sorghum (molasses) and a dash of powdered alum, the whole cooled a bit and taken internally. Folk medicine prescribed swamp-cabbage root mixed with honey for whooping cough, cold water wraps for scarlet fever, beef's gall sliced in alcohol and rubbed on the limbs for polio, quinine or port wine for ague, salt pork and boric acid for canker of the mouth, lard and sulfur ointment for scabies, and asafetida bags to ward off whatever contagious disease was going around the neighborhood. It held that for ague the body of a fresh-killed chicken should be placed against the bare feet of the patient while he swallowed a cobweb rolled into a ball. For scarlet fever, the sufferer should be fed an onion, with a piece of saffron put in it, baked till juicy. For croup, the feet should be rubbed with a mixture of garlic, oil from pigs' feet, and, if available, skunk oil. For cough and sore throat, people were advised to simmer a piece of salt pork in hot vinegar, let cool, and fasten around the patient's neck with a piece of red flannel. A common home remedy for fevers and "summer complaints" was to bind the patient's head in a cold cloth, the feet in cabbage leaves, and administer sage tea, rhubarb, and soda. Antidotes for snakebite included gunpowder and vinegar; brandy and salt; alum; a drink made from the bark of the black ash tree; tobacco juice; and application of the fleshy part of the tail of the killed snake to the bite to draw out the poison. Sweet oil, jalap, or essence of peppermint helped relieve acute nausea. A tea made from sage (the spice, not the bush) was given for headache. Mud poultices took the pain out of insect bites, and wet chewing tobacco eased the swelling. Powdered witch-hazel leaves were inhaled for nosebleed. When children suffered earaches, mothers administered a poultice of mashed potato, and if that failed to work, the blistering-hot heart of a baked onion. Common treatments for colds included coal oil with sugar, asafetida and hot dandelion wine, catnip tea, a syrup of onions and sugar, bitter horehound tea (sometimes made more palatable with honey), or a course of boiled raw onions, mustard plasters, and a concoction of whiskey, honey, and butter. Another country remedy for a severe cold was to take a pitcher of hard cider, mix it with a powerful dose of cayenne pepper and a generous quantity of rock candy, and simmer until bedtime, when, with your feet in a pail of hot mustard water, you sipped it till it was gone. Soaked tea leaves were used as a poultice for burns and their blisters. Horehound was given for coughs, onions boiled in molasses or juice of boiled horehound for sore throat. Hops and motherwort could substitute for laudanum, cotton root for ergot, dandelion, butterfly weed, and pleurisy root for calomel. Derivatives of blackberry, willow, and sweetgum made suitable astringents, and various vegetable compounds took the place of castor oil and salts. If quinine was unavailable, sufferers from malaria could be dosed with a compound of dogwood, poplar, and willow barks mixed with whiskey.

...Doctors were too scarce and too expensive to be summoned to a country farm without grave reason. Every woman needed to know how to care for the sick in her own household. Grandmothers and maiden aunts were in great demand when illness struck. Some elderly ladies from large families, lacking men to provide for them, moved from one relative's home to another, spending all their days at bedsides. They earned their keep, certainly, but they would have been insulted to be offered money. Their patients were their own kith and kin, however remote, and it was only decent for family members to "help out where there was sickness." Neighbor women "helped out," too, as a matter of Christian duty; so did the family hired girl, if there was one--a maidservant who was "a good hand with the sick" could always be sure of finding a job. People became used to coming to certain neighborhood women for advice when a baby fretted with "summer complaint" or Grandma's rheumatism was bad.

--From A Thunder at Dawn, novel in progress, by Christine Jeffords

Staple Western medicines included castor oil, peppermint essence, sulfur, calomel, quinine, laudanum, carbolic, carbolic salve, powdered alum, liniment, cholagogue, witch hazel, talcum powder, axle grease, coal oil, vinegar, dry mustard, copperas, bluestone, baking soda (for gas pains, dyspepsia, sour stomach, heartburn, and, when dampened to a paste, rashes and insect bites), alcohol, and assorted laxatives, salts, and pills. Every chuck wagon carried these, together with cotton and gauze, bandages, tape, tweezers, scissors, and at least one small and very sharp knife; every well-equipped farm- and ranchhouse owned them. Turpentine was applied to bruises and aching joints, mixed with lard and rubbed on a sore throat or chest, and used for cuts, worms, backaches, kidney troubles, croup, pneumonia, toothache, and earache; whiskey was employed for snakebite, sore throat, burns, rheumatism, and "female complaints;" kerosene was rubbed on bruises or strained muscles to relieve the pain, and also for burns, scalds and sores, head lice, ringworm, and horse mange; vinegar was sponged on a fevered body and employed for ringworm, scab, and mange. One recommended pioneer treatment for soreness of the chest was to apply a plaster of kerosene, oil, syrup, vinegar, axle grease, and red pepper under a piece of red flannel. Other range medicines included: for diphtheria, kerosene poured on a cloth and bound about the neck; for hiccups, a few drops of strong vinegar on half a teaspoon of sugar, held in the mouth till dissolved; for bladder infection, a tablespoon of red cider vinegar three times a day till no longer needed; for hay fever and other sneezing afflictions, the vapor of salt and hot vinegar, breathed for 10 minutes four or five times a day; for diarrhea (and for scours in calves and foals), well-scorched flour mixed with milk or boiled water and drunk; for slivers, cactus thorns, boils and the like, a poultice made by pouring boiled water over dry bread crumbs, boiled till soft and made pliable with a little sweet oil; for ringworm, a copper penny soaked in vinegar and placed on the afflicted part, still wet, for a short time each day, or placed in butter to make a kind of green salve which was then rubbed on; for headache, a hot toddy taken while hot water was applied to the feet and the back of the neck; and for nosebleed, a folded piece of paper or cardboard placed under the upper lip, a cold cloth applied to the back of the neck, a nickel held in the mouth, or nostril plugs of small pellets made from cigarette papers. Mountain men believed that a slightly used chew of tobacco, applied to a wound and bound in place, would draw out the poison; on many occasions it was observed to be of help. Peroxide or tallow was applied to blisters, a salve of pine gum, mutton tallow, and turpentine to bruises. Camomile tea was a sort of universal cure, said to be good for "what ails you." The usual sedatives were opium, chloroform, laudanum (tincture of opium), and paregoric ( camphorated tincture of opium); laudanum pills were used as tranquilizers.

Westerners also made great use of the natural drugs available to them. Sphagnum moss, which is naturally sterile, made a good surgical dressing. The poison of Spanish dagger was reputed to counteract rattlesnake venom if jabbed into the flesh around the bite. A tea made by steeping the leaves of the purple-flowered cinquefoil was found useful for fevers brought on by infection, and tea made from huisache bark eased internal bruising. Open bleeding could be stopped by washing and the application of gum from a balsam fir. Pepperwood-tree bark could be chewed to ease pain. Slippery-elm bark was used to draw pus and poison from a cut, and the tree also provided a poultice that soothed a lanced carbuncle. The ground bark of native holly was used for ague, black elder for skin infections. Dysentery ("bloody flux") was treated with bayberry or a strong tea brewed up of snakeroot or the inside bark of a cottonwood tree. Ground aspen bark could substitute for quinine. Catnip was good for colic, mullein leaf for asthma, sage tea for fever and chills and sassafrass tea for either. Peppermint leaves crushed in boiling water and breathed deeply relieved congestion. A brew of blackberry root and leaves was the standard for dysentery and similar afflictions of the bowels, and goldenseal root stirred up in a spoon of molasses was also used for flux. Senna weed provided a laxative for cases of bilious colic, and swamp laurel or snake-root astringent proved efficacious when diarrhea struck. Bearberry tea was good for stomachache, butterfly-weed tea for pleurisy, hop or peppermint tea for indigestion, buttercup tea for asthma, celery seed for rheumatism, ginger tea for chills, snakeroot tea to bring on a sweat, spignet root for cough syrup, bitter willow-bark tea (loaded with salicylic acid, the chief ingredient of aspirin) for headache; the inner bark of willow was chewed for fever. Effective laxatives included stewed pepper grass, pokeberries, senna leaves, or the inner bark of the ash tree. For severe indigestion and abdominal cramps, a pioneer would gather an armful of the smaller limbs of the chokecherry, strip off the leaves, cut the limbs into small pieces, and boil them to a thick black tea about the consistency of molasses. He would then drink a pint at a time an hour apart. It was horribly bitter, and would bring on heavy sweats and severe weakness, but eventually he would feel steadily better.

A healing poultice for a wound could be made by shaving bark from a young live-oak, boiling it down to a syrupy mix, adding pounded-up charcoal, thickening the compound with a little cornmeal, and keeping it tied to the wound for four or five days. Another wilderness treatment involved crushing the dry leaves of yerba del pescado and yerba de San Pedro together and placing them on the bathed wound. Dry spectacle pod, crushed to powder and sprinkled on a wound, was a treatment the Hopi and Tewa Indians swore by; the former also employed cliff rose, or quinine bush--a resinous, strong-smelling plant important as winter browse for livestock and deer alike--to make a wash for wounds, boiling the bark, leaves, and smaller twigs together, then bathing the wound with the water. Bathing the wound with hot water and binding it up with the matadura herb was another desert treatment. Other tribes used a compress of split and slightly roasted prickly-pear leaves, bandaged tightly over the wound, to remove inflammation (the root of this cactus was also mashed to make a poultice for cuts), while Mexicans favored the boiled pads of the nopay cactus. The Plains peoples highly esteemed the purple cone-plant (a type of echinacea): the root was chewed until a darkish paste was produced, and this was applied to the wound, preventing infection, reducing pain, and eliminating stiffness. Yellow dogwood plant was a favorite Indian remedy for fevers; so was fire root, which was also used for "'most everything else as well." Dried roots of sedge grass, another Indian cure, were eaten for nervousness; dried roots of the bitterroot plant were chewed for sore throat, and boiled pentstemon flowers applied to sores and burns.

Southerners, who made up a large percentage of the Western population, brought their own region's materia medica, chiefly rural and heavily Negro,with them. Among those Nathan would almost certainly know were: barefoot root, cooked down and combined with pyro lard and salt to make a salve for rheumatism; may-apple root, good to work the bowels; black halls and cherry root, a good tea to strengthen the appetite; Jerusalem oats or Jerusalem-weed candy or tea for worms; pulsey or ripe pomegranate hulls for diarrhea and dysentery; tansy tea, red shank, and hazel roots for "womanhood" and childbirth troubles; Samson snake root for cramps and pains in the stomach; plantain leaf or marshmallow leaves for stubs and bruises; hot onion poultices on the chest for a cough; slippery-elm bark, chewed till sweetish, rubbery, and mushy to soothe a cough-sore throat; Jamaica ginger for colic; wild-raspberry wine or boiled sassafrass for "drying up of joint water" (rheumatism?); blister-the-stomach for tuberculosis; horehound and mullein tea, or molasses, cottonseed oil, and a little bourbon, for a cold; goldenseal (a.k.a. yaller-root) for stomach trouble, heartburn, or sore mouth; flaxweed tea for infants' "summer complaint;" ginseng for chills and fever; mullein boiled up and drunk hot to bring out the rash in chicken pox and measles; asafoetida bags to ward off measles, smallpox, and the like; peppermint or pennyroyal for beneficial teas.

In 1830-60, deaths from degenerative and malignant diseases remained constant, while deaths from infectious and epidemic disease, especially among children, rose enormously. Scarlet fever, measles, croup, whooping cough, and diphtheria killed children by the thousands; pulmonary tuberculosis ("consumption") killed young and old alike; enteritis, malaria, typhus, typhoid, asthma, Asiatic cholera, rheumatism, yellow fever, gonorrhea, and various fevers were endemic, though vaccination did seem to be reducing smallpox. The nation's greatest medical problems lay in the growing cities, where substandard housing, inadequate sanitation, infectious food supplies, and few effective health regulations provided nearly perfect conditions for the spread of disease, but even the country was not entirely healthful: an Illinois country doctor in the '50's could (and one did) predict more or less what his seasonal practise would be--pneumonia ("winter fever"), colds, coughs, and diphtheria in winter; dysentery, "summer complaint" (a diarrhea that struck infants), and various cuts, bruises, and accidents in spring and summer; and in autumn, "chills and fever," the "ager" or the "shakes." Diphtheria was not believed communicable, nor tuberculosis communicable or curable. Malnutrition and hookworm, neither yet recognized by doctors, were widespread in the West and South. The most dreaded epidemic diseases were cholera, typhoid, and yellow fever; the first swept most of the nation's major cities in 1832, 1849, 1850, 1854, and 1866, the third in 1841, 1850, 1853, and 1855 (for reasons never understood it lessened in Northern cities after 1825 but increased in virulence in the South). Nevertheless, some progress was made: the fact that Boston's mortality rate began to decline after the city began regular street-cleaning seemed to indicate some relationship between filth and disease, while physicians noted that typhoid epidemics hit hardest at those areas of New York City where "waste water drained into yards and alleys..., and broke into cellars and foundations."

Infant mortality was especially high in large cities, where nearly half of all pre-War deaths were of children under five. (In New York City in 1850, 25% of all deaths were of infants under a year old, 50% of children younger than six.) On the frontier, some 25-30% of babies born died in their first five years, chiefly of influenza, pneumonia, and intestinal disorders within a few months of birth. (However, pregnant women were generally well fed, so premature births were less frequent than they are today.) Personal narratives of the Oregon Trail suggest that at least 20% of pregnancies "failed" and at least as many infants died before their fifth year, while in 1847 the Hannibal (Mo.) Gazette reported that a quarter of all children died before they were a year old, 50% before they were 21, and not 25% reached 40. Over 54% of all child mortalities in 1870 were of infants in their first year. (Still, it's important to keep in mind that our common phrase "threescore and ten," used to describe the lifespan of a man, comes from the Bible, and the ancient Hebrews would hardly have used it if they considered it remarkable for a man to live to that age.) Causes of these early deaths included the drugging of the mother in childbirth, colic, cholera, diarrhea, dysentery, and convulsions, often brought on by "soothing syrups," sleeping draughts, and anodyne nostrums, usually of molasses and water with opium and brandy added. Infants died in the summer of "bowel complaint" or "cholera infantum" (this seems to have been the term used for almost anything that produced diarrhea and vomiting among them, but the disease probably most associated with it was a milk-borne infection that killed thousands of city children every season), older children of "cholera morbus" (gastroenteritis, which also killed President Zachary Taylor).

Many children died of illness (especially whooping cough, measles, diphtheria, polio, scarlet fever, and rickets) before they were five. On the Midwestern frontier, "lung fever," diphtheria, pneumonia, measles, smallpox, rheumatism, influenza, bronchitis, tuberculosis, typhoid (sometimes called "putrid") fever (what Vin's mother died of, alternately known as "brain fever," "bilious fever," or "the flux"), meningitis, cholera, trichinosis, and appendicitis were well known, along with prickly heat and goiter. (Farm children, however, seem to have often escaped the ordinary childhood diseases such as measles, to judge by the remarkable rate at which they killed young Civil War soldiers suddenly thrown into contact with more people than they had probably ever seen before: it was in the towns and villages that contagion was likeliest to run rampant.) Malarial fevers were so common in the Midwest that people would say that so-and-so "wasn't sick, he only had the aguer." Beyond the Missouri River, the disease was most widespread in parts of Iowa, Kansas, and Texas swarming with mosquitoes and settled by people already shivering with "the quakes," but hardly a person living in the valleys or marshy lands of Nebraska and the Dakotas escaped it either, and it was common over much of the country, as generations of pioneers took it westward in their bloodstreams. West of the malaria belt, on the high plains and in the mountains, pulmonary diseases, especially pneumonia, were among the biggest killers of the young; the latter, both viral and bacterial, was commonest in winter and early spring, especially in wetter regions (like the mountains) and among families huddled in dank, crowded dugouts from November to April. Fevers of undefined nature and origin killed many infants, especially on prairie farmsteads.

As with most other diseases, the pulmonary and intestinal ones found most of their victims among children under five, but diphtheria attacked those up to 10 and even sometimes older; it was somewhat less common south of the 37th parallel (the southern border of Utah, Colorado, and Kansas), but struck at seeming random--in 1880 it killed three Arizonians and 808 Utahans (though Utah had only three times Arizona's population); two California mining counties of approximately equal population reported respectively one death and 45. Much of this may have stemmed from an upsurge of the disease about mid-century, which struck hardest in the cities of the Atlantic coast; many victims gained immunity from a small dose of the bacillus, but could still carry it to others never exposed to it: heading West to be scrambled in among the many thousands from Europe and rural America, they did just that. Tetanus (better known as lockjaw), blood poisoning, erysipelas, and the usual run of childhood diseases endangered family health. Pleurisy, cholera, and typhoid felled many settlers, as did smallpox, which was the most dreaded scourge of frontier towns--bad sanitary conditions and a dearth of nursing and hospital facilities caused rapid contagion and many deaths, and those who recovered generally came out with marred faces. Though vaccination against it had been introduced to the frontier before 1800 by Dr. Samuel Brown of Kentucky, and accepted by doctors all over the world as early as 1823, it still posed a threat, and all people knew to do was establish a quarantine in some isolated cabin and send for the doctor. It had been almost banished from the Eastern states by the 1840's thanks to vaccination programs, and was extremely rare among pioneers (but not in the Hispanic Southwest, where it accounted for 70 of Tucson's 83 child deaths--84.3%--in 1870). Scarlet fever, meningitis, and the frontier's greatest child killer, laryngeal diphtheria, passed easily through the air or by touch, including handling of toys or clothes. Mumps, measles, scarlet fever, and diphtheria struck many, while numbers, weakened by head colds and fevers, died of measles and dysentery. Whooping cough was especially dangerous to infants, but one siege of it usually caused immunity. Small ailments caused endless discomfort: festering sores from running in bare feet on the burnt-over prairie, chilblains, sunstroke, puncture wounds from stray pitchforks, bruises and broken bones from kicking livestock and falls into wells or from haylofts, horses, trees, wagons, and threshing machines. Catarrh was the common name for a chronic irritation of the sinuses resulting in postnasal drip; many people living in the damp Ohio and Mississippi River valleys suffered from it. Placer miners (i.e., those who panned for their gold, as in early California) were often killed by pulmonary disorders, and diarrhea, dysentery, typhoid, chills, fever, malaria, scurvy, periodic outbreaks of cholera (which slew many), rheumatism, sciatica, and numerous skin diseases could all be traced to poor diet and sanitation, the abundance of mosquitoes, sleeping in wet clothes, and long hours standing shin-deep in cold rivers without adequate protection from the scorching sun. Cowboys, on the other hand, were a fairly healthy lot, except for boils, carbucles, hoof cuts, bad blood, running sores on the hands, dyspepsia, heartburn, stiff joints, broken bones, and, as they aged, rheumatism.

A disease as dreaded in that day as cancer in ours was cholera (generally Asiatic). It was one of the most severe and lethal of sicknesses, more to be feared than yellow fever; it ran through a community like a prairie fire, and doctors could do little save administer opiates to dull the pain. It literally swept the world in successive waves, first appearing in the U. S. in 1832-4 (this visitation was particularly rough in Texas), dissipating, returning briefly in 1837, and then bursting forth again in the winter of 1848-9 as an element of a pandemic that had begun in 1840 and continued for 22 years. (It was this contagion which proved so perilous to the overland emigrants of '49; by May of that year it had killed 5000 in New York City and spread as far as Wisconsin, while St. Louis lost 10% of its people, Cincinnati almost as much, Sandusky more, and in the Rio Grande Valley an Army surgeon estimated that fully that much of the population sickened.) From then till 1854, there was no period when it didn't appear somewhere in the country. Another such pandemic raged from 1863-75; 50,000 Americans died of it in 1865 alone, 2000 of them in New York City, which had also suffered recurring outbreaks of scarlet fever, smallpox, typhoid fever, typhus, and yellow fever. In the West cholera was spread chiefly by contaminated water: the slow-moving prairie rivers were unsafe to drink, while the disease was never found in the mountains above the Sweetwater River. About 50% of victims died, some in a day, some taking closer to a week of terrible retching agony, fever, and chills; children, whose smaller bodies dehydrated more rapidly, could go in four hours, though one 12-year-old lasted four days. Yet it was a tricky illness: half the people in a place might be down with it and half not, though all consumed the same bad food or water. At first it wasn't believed to be caused by the intemperance, dissolution, and filth on which it usually began, but to be a scourge sent by God to punish them. By '49, when it spread from the "vicious poor" to the "industrious poor" and the upper classes, some people began to admit the possibility that it was the disease itself that killed, not sin. A dual cause was now suspected: imperfect ventilation, impure water, crowded conditions, damp or even flooded living quarters, garbage undisposed of, lack of warm clothing and proper diet, and also "evil...and sensual pleasures [which] corrupt the morals, and enfeeble the intellect..." By 1866, advances had been made in medical knowledge and social conscience alike; the pathology of the disease was unknown, but few doctors doubted that it was contagious (in '49 few had thought so), and Americans, once convinced that the effort might be worthwhile, earnestly undertook to clean streets, disinfect privies, eliminate damp and flooded cellars, institute garbage collection, and bar pigs from urban areas. (Some had tried to reform slum conditions in '49, but had been discouraged by the lack of response from the poor; now they did it themselves.) The AMA had backed slum clearance from its beginnings. In February of '66 New York City's Metropolitan Health Bill provided for a nine-man Board of Health (three of them physicians), whose energetic clean-up measures were instrumental in keeping that year's visitation from assuming epidemic proportions. Wherever citizens worked conscientiously to make their cities sanitary, cholera deaths were fewer: New York, despite a vast increase in overall population, reported only 10% the 1849 figure. This was the last of the national epidemics, but localized ones continued: a severe regional outbreak swept the Mississippi Valley in 1873. The gospel quickly caught on in the North, but the prostrate South was unable to follow suit, and cholera, malaria, and yellow fever were epidemic in its hot, moist, mosquito-y weather: up until 1900 or so, when Walter Reed discovered its cause, the last of these was a perpetual curse in the Gulf States region, though it also ravaged Philadelphia and New York early in the century, and in 1878 it struck its regular haunts with unusual fury, hitting hardest in Memphis, New Orleans, and Vicksburg.

Diphtheria (which, until antitoxin was first employed in 1891, was a dangerous affliction) was especially prevalent in 1863, '64, '74-'82, and '89; typhoid (which, like cholera, isn't contagious in the normal sense, but proceeds from a common source of infection, usually contaminated food or water, though this wasn't proven till 1873) ravaged the Northeast in the mid-'60's and in '72. These, with cholera, beset Westerners grievously, thanks chiefly to poor sanitation and tainted water, while along with scarlet fever and typhus the trio were seldom absent from the cities. 1872 and '73 saw especially virulent waves of smallpox (though it killed less than either diphtheria or typhoid) and exceptionally lethal outbreaks of measles. Periodic outbreaks of typhus, scarlet fever, and mumps were also common. Tuberculosis, not yet considered contagious, caused roughly 400 deaths per 100,000 population (0.4%) in 1857; called "consumption" ("galloping" if it was the quick kind), it killed more young people than anything else, most of them getting it from drinking infected (unpasteurized) milk. With pneumonia, it was one of the main causes of death throughout the century. Raw milk was also liable to carry typhoid fever, scarlet fever, diphtheria, and the "summer complaint."

Even nonfatal experiences of disease could have lasting repercussions. Many children, weakened by colds and fever, died of measles and other complications: hence Mother was likely to roll out the big guns at the first sign of a sniffle--rub the chest with coal oil and lard or goose grease and turpentine and cover it with a piece of old flannel; rub the throat with camphorated oil, which smelled like moth crystals; plunge the feet into a mustard foot-bath with water as hot as the victim could stand, "to draw the cold downward;" and administer castor oil (which in those days was thick, oily, and not tasteless as it is now), syrup of cherry bark every hour and syrup of alum and honey in between (for hoarseness), and various "infusions" (teas of boiled herbs, barks, and leaves), usually pretty horrible to the taste. Malaria (also called intermittent fever, remittent fever, bilious fever, summer ague, or simply "the aguer"), though rarely fatal, had debilitating effects that could weaken a person enough for other diseases to kill him; typhoid was one dangerous complication. Measles weren't ordinarily anything to worry about, but in a delicate child they could go inward, settle on the lungs, and cause lung fever, and sometimes they caused blindness. Scarlet fever often left a child blind, deaf, mute, deaf-mute, or infertile; it could also result in loss of control of the vocal cords (which made for very indistinct speech), a damaged heart or kidneys, or rheumatic fever, which in turn could bring on crippling arthritis or a bad heart, and even after the first spell passed off, recurrence was always possible--even likely: the victim must never get overtired or overexposed to cold or damp. The latter disease could also infect the throat and appendix, resulting in a long, painful, and ultimately fatal illness. Spotted fever could also destroy the hearing or produce a deaf-mute. Smallpox left many of its victims crippled or totally blind, especially if sunlight had been mixed with the pussy matter in the victim's eyes. Some survivors of yellow fever were left with damaged hearts. Diphtheria could also bring on temporary paralysis, or weaken the heart, which often led to death. Spinal tuberculosis could affect the lungs, spine, and bones; special shoes, with braces and built-up soles, helped victims to walk. Infant meningitis could result in blindness, mumps in an inability to father children. The swelling of chronic pleurisy could compress the internal organs and lead to curvature of the spine and a slight rearrangement of the inner workings.

Since no entirely convincing explanation for illness existed before the articulation of the germ theory in 1883, most people stressed a link between morality and good health, bolstered by the fact that the teeming city centers, where the incidence of disease was higher, were notorious for crime, immorality, and debauchery. Meanwhile most sicknesses had to be dealt with symptomatically since there were no antibiotics to cure them. To treat pneumonia, people would keep the victim quiet and wrapped in quilts, sponge him frequently, poultice his chest well, keep a cold compress on his head and direct light from his inflamed eyes, and feed him raw eggs, juice squeezed from baked onions, sassafrass tea, and tea made from a boiled hog hoof. The poultice was made of powdered mustard stirred with vinegar and flour, red pepper and turpentine, or a square of brown paper buttered with lard and turpentine; to prevent blistering of the skin, axle grease was spread on the chest before its application. Another country remedy was to mix vinegar, bran, and catnip leaves in boiling water, crumble a little charcoal in, boil the whole down to the consistency of mud, and use it as a hot poultice on the chest; when it cooled, they replaced it with a piece of flannel sprinkled with turpentine while reheating the other mixture. Or they wilted cabbage leaves over a fire till soft, fastened them all over the sufferer's chest, sides, and back with a thin cloth wrapping, and poured on vinegar as hot as he could stand it to bring on a sweat. Onion poultices, "Indian Primp" tea, and boiled corn next to the body were also employed. For cholera, they forced finely powdered sulfur-and-charcoal, quantities of red-pepper tea, or cinnamon stirred in brandy down the patient's throat, kept him warm and full of fluids (preferably ice water), applied mustard and turpentine plasters to the abdomen, rubbed his flesh, and used laudanum and turpentine to relieve the pain. A case of typhus was treated by blistering the length of the spine with ammonia and mustard. Treatment for diphtheria consisted largely of swabbing the throat every four hours with 20 grains of nitrate of silver in an ounce of water, in which a sponge, attached to a whalebone for easier handling, had been dipped. Recommended for consumption were lots of fresh milk and eggs, dry, open air both day and night (hence the popularity of Colorado and New Mexico as resorts for "lungers"), sunlight, plenty of sleep, and no worrying, excitement, or heavy physical exertion. Lay remedies for yellow fever were wine, bark (quinine?), and hot vinegar baths to supplement the doctor's bleeding and purges. Attempts at prevention were made too. When diphtheria was epidemic, mothers used asafoetida, blew sulfur down their children's throats two or three times a day, kept their bowels open with lukewarm cassia tea, rubbed their chests with grease every day and kept chest protectors of soft old woollen securely pinned on, and kept the house warm as toast. To ward off yellow fever, people drank limewater, ate garlic, took big doses of quinine, or sprinkled sulfur in their boots; cities put chlorinated lime in the streets, burned tar to sweeten the air, and fired off cannon "to stop the spread of the disease in the air." Fires of tar and pitch were burned in the streets to combat cholera.