Brian Altonen, MPH, MS

On the head waters of the Great Miami, and in some of the adjoining parts of Kentucky, a disease called by the people the Sick-stomach, has prevailed more or less for several years. Its prominent symptoms are, a vomiting upon taking exercise, with chronic debility, lassitude and soreness of the extremities. Sometimes it continues for months, in the same individual; and frequently affects whole families. It is supposed to extend to horses, cows, sheep and dogs, varying in several of its symptoms. It does not often prove fatal, and the people, where it is endemic, seem to have learned by experience an efficacious method of treatment. It has been ascribed to some noxious impregnation of the water ; to the use, by the animals whose milk and flesh are eaten, of some deleterious plant, and to marsh exhalation — the last of which is the most plausible. For two or three years past, its occurrence has been more infrequent, and it cannot be regarded as constituting any serious objection to the districts in which it prevails.

Daniel Drake’s PICTURE OF CINCINNATI. . . 1810, p. 183 (see my page with readings on medical topography for the link to this reference)

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One group of diseases that mapped very well during the mid-1800s were those induced by an ecological cause and were axenotic in nature. Axenotic diseases required limited ecological interaction, avoiding the requirement of animals as hosts and carriers of disease, or the involvement of disease vectors like microscopic organisms later found to be pathogens. Axenotic diseases were usually chemical in nature, and included such afflictions as upaism, poison ivy rash, hives due to nettles, bufotoxin or puffer fish poisoning, veratrum-induced cyclopia, equine hind leg paralysis, bovine bloating, flatulence and finally death.

Sick-Stomach was the first well documented axenotic disease with well defined regions. It was later known as milk sickness due to its cause, the intoxication of milk produced by cattle that ate the plants responsible for this disease.

The first time I came across the importance of this disease in American history was during my Overland trail studies. A very young child by the name of Josephine Bristow died at just several months of age on the trail following the death of her breast-feeding mother from Asiatic cholera just west of Fort Kearney. Josephine was passed over to a relative whose mother had at least one other children that she was breastfeeding. Less than six weeks later, Josephine died; according to family records she died to to infant’s cholera.

One possibility for this death I realized was the narrow band of vegetation that the family was passing through during the days just prior to Josephine’s death. I was then mapping medical plants and plants toxic to livestock along the trail, when I realized that one such plant was also capable of killing children due to a transfer of its poison to any milk produced by the livestock that ate this plant. Then it occured to me that perhaps this is why the aunt of Suzannah feared for the life of her own infants. I knew I was onto something. To Josephine’s aunt, her kids, some of whom were also breastfeeding, appeared vulnerable to the same disease that the young girl might carry. Back then this would have been due to a belief that Josephine was potentially carrying and/or being infected by the same miasm that just killed her mother. Instead of putting her own children at risk of contact with Suzannah, thereby causing them to catch the same infection or breathe in the miasma or effluvium emitted by a possibly sick body, the aunt turned to the family cow or oxen for her niece’s milk instead of her own breast. Because of where they were on the trail, mid to west Nebraska just before Steamboat Rock and Fort Laramie, these animals fed in part on one of two potential local causes for milk poisoning, which in the end had detrimental effects on Susannah. Due to the social beliefs for the time, Suzannah’s name is never mentioned by her father or immediate next of kin; only by the aunt. For this reason, no genealogists investigating the Bristow family or historians investigating trail history would learn about this fact involving John Bristow and Suzannah. (John’s family history related documents told us the likelihood was there, but perhaps in the decision to move west so quickly once cholera struck Illinois in 1852, it seemed possible that for whatever reason, John and Josephine got married, but for whatever reason did not have a baby yet or had lost the first pregnancy.) We only learn about the fact that Josephine and John began their journey with a newborn through these aunt’s letters sent to relatives back east once the journey was over. Dr. John Kennedy Bristow, Suzannah’s father, never mentions her existence on the trail or her death in any of his writings. But the aunt provided all the details about the loss of the wife right after they passed Fort Kearney, followed by the child four of five weeks later. The place and timing of young Suzannah’s death told me it was not due to Asiatic cholera. Too much time had passed for her to suddenly become infected by such in an area where it just didn’t thrive in the water from makeshift wells, and where everyone infected by this disease at the fort had either died off or totally recovered were they so lucky. Old time historians probably felt that anyone who died at the place and in the way Suzannah did was probably due to “infant cholera”, as did I, until I began mapping the trail plants.

Since then, I have noticed during my studies that this problem with milk sickness resurfaces repeatedly in the pre-1850 medical journals. At the time, it was very hard for physicians to assign a specific cause or poison for a problem with a well defined geography. This is one example of a very early rendering of this disease and its history, and the questions that existed regarding its cause in relation to the ongoing theories for the time for disease. One could easily imagine a miasma-like cause for the disease, but isolating the exact cause for this miasma within the environment was a major problem for ecologically observant physicians during the first quarter of the nineteenth century. Miasma was most often attributed to local topographical features related to water bodies, swamps, and stream edges. But these geographical requirements could not be used to explain they very limited distribution of milk sickness to a narrow longitude range within the Great Plains. However, miasm was often attributed to the chemistry of the rocks and soil found in a region as well, and so too could milk-sickness speculated be linked to some local geology or soil features. But this too did not suffice for the author of this article. The author rightfully mentions “poison plants” as a part of his discussion. Poison Ivy, a known toxic plant with a very well understood cause and effect relationship, was theorized to be the cause by famous mid-west medical geographer Daniel Drake, one of several embarrassments he experienced during his very active professional life as a field epidemiologist and self-motivated ‘jack-of-all-trades’ in the field of medicine. (His two volume book on the medical geography of the Midwest is extensive, but often lacking in much new philosophy.)

The following article is an example of how the knowledge about this disease was evolving as it was rediscovered as pioneers made their way westward into Ohio Territory. Its cause was still not known when this article was published in the late 1820s. Such a dilemma continued for several more decades unfortunately. Until the physiology of the body could be better understood, many explanations for mysterious diseases often divert back to the most primitive fears about disease causes in early American medicine–illness is either the result of the weather and climate, in particular with regard to place, temperatures and humidity, and/or it may be related to that catch-all phrase for pathogens common throughout medical history–the miasma of nature or the miasma emitted by the sick and decaying body.

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