Most people think of diseases in US history, such as cholera, malaria, and smallpox as maladies only afflicting southern states along the Gulf and to have happened in a time far removed from our own. New Orleans, in particular, has been known to have been a mecca for all of these maladies. After all, some describe the city as a concrete façade floating on a swamp (apologies, New Orleans. I love you!). When in truth, many states far north of the Big Easy, as far northeast as Ohio and beyond, and as northwest as California have suffered from these scourges. 

For the purposes of this article, I have selected Ohio as an example, as anyone familiar with its vast farmlands, scattered sand dunes across the Lake Erie shoreline, and mostly low-lying landscape dotted by a few isolated hills would have a hard time imagining these diseases having any real impact there. But, in fact, truth generally always is stranger than fiction!  

CHOLERA

A bacterium called Vibrio cholerae is the culprit behind cholera. It affects the intestines, causing mild, moderate, or severe symptoms and in some cases, none at all. When severe, it is characterized by copious, watery diarrhea, vomiting, and leg cramps. Rapid dehydration from loss of body fluids leads to shock and death can occur within hours. Usually found in contaminated water or food sources (by feces from a cholera-infected person). These water sources spread the bacterium due to poor sanitation, lack of proper water treatment, and insufficient hygiene. It can also survive in saliferous rivers and coastal waters. Shellfish eaten raw have also been a source of cholera.

Cholera affected most parts of Ohio at one point or another during the course of the 19th century. Traveling through the state’s canal system, it migrated from city to city. In Cleveland, it arrived on a military ship. As one city would have a cholera outbreak, its residents would flee, taking the disease with them. No one knew that contaminated water was causing the disease.

 In 1826, the Cincinnati Water Company laid a system of pipes to bring water to various locations around the city from the Ohio River but without a proper sewer system to keep dirty runoff from contaminating the river, the company was essentially pumping infected drinking water into homes. Families that did not have water service from the water companies and used wells were at risk too.

In 1832 Henry Boyd, determined that water was spreading cholera. Boyd’s recommendation to boil all drinking water was published in Cincinnati newspapers, and had it been widely implemented, would have saved thousands of lives in the waves of cholera outbreaks in the 19th century. Henry Boyd was a free black man who ran his own successful furniture store in Cincinnati and was ignored by the white community that monitored Cincinnati’s response to the disease.

Around the same time, a geologist, John Lea believed cholera had geologic origins, and created a map of victims of the 1849 cholera epidemic in Cincinnati. This early mapping of a disease outbreak was years before London physician John Snow created his famous Broad Street Pump Map. Although both men are credited now with their pioneering hypotheses concerning the source of cholera and their recommendations on how to stop its spread, they were ignored at the time and the devastation continued.

Although cholera spread throughout the state, the city worst hit was always Cincinnati. During the 1849 Cholera Pandemic, Cincinnati suffered more deaths than both New York and London. In 1850, the convention for updating Ohio’s constitution had to be rescheduled and moved due to a cholera outbreak. During an 1854 cholera epidemic, British physician, John Snow tracked the disease to a water pump. Once the pump was removed, the disease slowed down in the area. After about a decade the world started to take notice of Snow’s ideas about waterborne bacteria, but eventually, large-scale sanitation came into practice, helping fight off cholera outbreaks more permanently.

In the Northwest Ohio area, History of the City of Toledo and Lucas County, Ohio Copyright 1888 Munsell, NY is probably the most reliable. This was published in 1888 to try to lure more commerce to the area by telling how Toledo had grown by leaps and bounds. It's fascinating reading. The following is from the chapter "The Medical Professions" pgs. 541 and 542. It's unclear as to what years they are referring to, but since this book is actually from 1888, it has to mean prior to.

 ".....so few and scattered were the homes of the frontier settlers that the demands for medical assistance often came from 30 or more miles distant. It was no uncommon thing for a call to come from Defiance or other places equally remote to the first settlers at Maumee. At this time there was, perhaps, no unhealthier place upon the whole continent than at this point of Wood and Lucas Counties. The River, from its headwaters at Fort Wayne, ran slowly through the marshes of the Black Swamp. The land being flat and covered with forests, with no drainage, was a hot-bed of miasm, and was as uninviting as possible to the frontiersman. As land was redeemed from its primitive condition, after the plow-furrow followed the malaria, until whole communities were prostrated with the dread fever and ague."

Referring to the year 1834 on pg. 543 --- "The same year the small-pox broke out among the Indians, and made fearful inroads, many dying of the scourge. Fearing the disease would spread to other tribes, the Government ordered the Ottawas vaccinated and Dr. White was appointed to do the work."

From History of Medical Practice in Toledo and the Maumee Valley Area 1600-1990 by Walter H. Hartung, Jr., MD. Page 1: With the swamps, there were insects, wild animals, including bears and panthers, and epidemics, especially cholera, "flu," malaria, measles, and smallpox. Cholera epidemics in 1849, 1852, and 1854 were severe. Treatment of this disease took on many forms. Dr. Jacob Clark's most successful method was bloodletting. He urged the practitioner to "bleed until you think you are killing the patient, and he will get well."

 From Maumee River 1835 by Louis A. Simonis, 1979. pgs. 33-34: "A sad narrative weaves its way through the stories of the old settlers; a saga of ague or malaria was part of the fabric. It entangled all but one out of six with chills, fever, the shakes, and sometimes death. The afflicted lay low and awaited the cleansing crystals of white autumn frost which killed the unsuspected carrier - the mosquito. The months of August and September were the months of harvest for the physicians, as during these months the bilious fever and ague took full possession of the county and few, very few indeed, escaped one or the other. Malaria strikes in three forms, some classed as dumb ague which struck the person daily; chills and fevers that affected the person every other day; and hard chills and fever which occurred every third day. The cause of malaria was unknown to the world in which they lived. The malaria parasite, transmitted by the mosquito was yet to be discovered. Both the mosquito and the gnat were especially troublesome; in combating them, the settlers unwittingly were fighting malaria. In the cabins alone the Maumee, meals were frequently taken in the smoke of a smudge pot placed under the table to discourage the insects..........Clearing the land and draining the swamps eventually destroyed the extensive breeding grounds of the mosquito and broke the life cycle of the malaria parasite. The pioneers realized that swampland was the key to the problem, but believed 'the constant opening of new and old land to the action of the sun purified the air' which they thought transmitted the disease.

There's quite a bit more on the topic and a photo of a patent medicine-looking quinine bottle from a log farm home along the Maumee River. The label says it's for Ague & Fever "chill or Intermittent Fever and the various form of Bilious Disease permanently cured by Dr. Colin's Mackenzie's Tonic Febrifuge".

Maumee Valley USA by Downes and Simonds, published by the Toledo Historical Society 1956. Pg 60 states: The greatest danger was from disease, especially malaria which came from the swarms of mosquitoes which infested the swamps.

SMALLPOX

The initial symptoms of the disease included fever and vomiting, followed by the formation of ulcers in the mouth and a skin rash. Over a few days, the skin rash turned into fluid-filled blisters with a dent in the center, scabbed over, and fell off, leaving scars. The disease was spread between people or via contaminated objects. Prevention was achieved mainly through the smallpox vaccine. The risk of death is about 30%, with higher rates among infants. Often, those who survived had extensive scarring of their skin, and some were left blind.

I was introduced to smallpox by way of childhood vaccination when it was still required to travel abroad from the USA in the 1950s. I still remember the shard of broken glass my pediatrician jabbed in my upper left arm. Didn’t seem very “modern” to me at the time. I think this requirement was lifted around 1980 as WHO decided there was enough herd immunity. My parents and brother, who had traveled extensively, even before my birth, still bore the circular, dimpled scars from their previous vaccinations.

While perusing Ohio history records at the library, I was surprised to find an early record of smallpox disease in Toledo, OH. Not too far from, but not affiliated with other nearby hospitals was: Toledo City Isolation Hospital, Upton Ave., Toledo, 0. Established 1883 ; public ; contagious ; smallpox only ; 40 beds ; Rhea Anderson R. N. , superintendent

From WTOL, a Toledo broadcasting web page, notes: 1907  The City of Toledo opened a house at 220 Erie Street where 14 smallpox victims are being held and quarantined. Newspaper report said the men were very "sour" and didn't want to be cooped up.

OK, you may say, this happened in the last two centuries but in a local newspaper article from 2003: Smallpox vaccinations begin in Toledo Public health workers across Ohio began receiving smallpox vaccinations yesterday as part of a nationwide effort to vaccinate up to 500,000 healthcare workers in case terrorists ever use smallpox in a biological attack. So smallpox, although now forgotten and eradicated still follows us into this century, if only recognizing it as a possible life-threatening plague. According to the NIH, “Currently, there is no evidence of naturally occurring smallpox transmission anywhere in the world. Although a worldwide immunization program eradicated smallpox disease decades ago, small quantities of smallpox virus officially still exist in two research laboratories in Atlanta, Georgia, and in Russia”.

 © 2003 Guiomar Goransson