Brian Altonen, MPH, MS

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Article Reviewed: A concise description of Marietta, in the State of Ohio ; with an enumeration of some Vegetable and Mineral productions in its neighbourhood. Communicated by Dr. S. P. Hildreth to Dr. Mitchill, from Marietta, January 17, 1809.

Thomas Jefferson set up plans to lay claim to the Northwest and drew up his map for the “Great Northwest” in 1784. Three years later, in 1787, the Northwest Ordinance of 1787 was signed, ceding the “Northwest Territory” to the United States government.  This treaty allowed for the formation of up to 5 states, which were ultimately Ohio, Indiana, Illinois, Michigan and Wisconsin.

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On April 7, 1788,  General Rufus Putnam and the Ohio Company of Associates headed out to lay claim to these lands.  They settled at the junction of Muskingum River with Ohio River and formed a small community which they named Mariette, after Marie Antoinette. 

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To secure some safety for this part of the country, two treaties were made and signed with the neighboring American Indians–the first in 1785, the second in 1795.  By the end of the first year 1788, 137 people were residing here.

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Alfred Meyer’s Sequent Occupancy

Sequent Occupancy in Marietta

The settlement of Campus Martius provides an example of the first stages in sequent occupancy, which are slightly different between Benjamin Rush’s version of 1786 and the more recent geographical theories.  According to Rush, development begins with the establishment of pioneer, frontier settings.  Rush excludes the American Indian living patterns from his rendering of changes in land use over time.  The more contemporary renderings of this philosophy include the indigenous group in their models, making the settlement of Campus Martius a second stage event followed by the establishment of a more permanent building setting due to the construction of a fortified, defensive wall, a church and the necessities of a rural Euro-american community, such as a mercantile business.  This model applies to the chronology of this region in the following manner:

• Stage 1: Indigenous – up until ca. 1782/8, eliminated by infectious disease induced disease patterns
• Stage 2: Pioneer – ca. 1788 to ca.1795, superseded by the development of the more robust community absent of many of the wilderness survival methods for food gathering.
• Stage 3:  Villages – The early development of village settings with churches, etc. according to Rush; according to later geographers, indicated by the addition of small businesses and early factories (tannins, shoes, bow-benders, farrier wares, livestock products, etc.). Signs of early industrialization.
• Stage 4:  Industrialization – Not yet developed for the above setting.  Industrialization  of the region become heavily industrialized and has outlying communities that are of the two or three earlier stages in this occupancy pattern (a Theissen polygon-Cristaller-like effect). 

With these stages defined, we can now better understand the disease patterns of each setting and period of time in local history.  The original indigenous-settler contact effects result in the diffusion of human contact related infectious disease patterns such as small pox, measles, and perhaps mumps.  Tuberculosis (consumption) is an endemic disease and possibly has indigenous  origins as much as Euro-american origins.  Likewise, disease introduced to Euro-america by indigenous people include the sexually transmitted diseases, especially syphilis.  Other well localized diseases may occasionally make their way into the Euro-americas setting as well, like the local animalcule-waterborn diseases and certain wildlife-based diseases.

Stage 2 consists of group-close proximity related disease patterns such as mumps, roseola, rose fever, rubella, influenza diseases of the common “cold” (thus the name origin), certain forms of diarrhea and non-amoebic dysentery.

This method of interpreting disease patterns can also be applied to occupational disease patterns, the manners in which “filth” and filth-related diseases are developed (early farming practices with poor sanitation in close proximity to groups of people), etc.  The tannier or slaughterhouse employee of a small domestic cabin or farmhouse building setting experiences different risks than tanniers working in an early factory setting.  The family farmer has different set of diseases to contend with than the community farmer (the development of “St. Anthony’s Fire” as a community event related to ergotism).

Botanicals

A number of American botanicals, well-known by the time Marietta was settled, were noted in Hildreth’s 1809 letter (descriptive essay) published in the Medical Repository.  This is a very pivotal moment in American political and medical history.  Thomas Jefferson has just succeeded in one of his early attempts to expand the United States in a way that would more strongly define its boundaries, and avoid too many attempts by other countries to lay claim to the unsettled parts of the continent.  The issue settlers and those designing settlement plans had to deal with was the answer to the important question–how inhabitable were these regions?

Late 18th century writers had already provided evidence suggesting these wilderness settings were inhabitable and politically and economically “manageable” by people and government.  These regions weren’t as deadly as the tropical torrid parts of the world, but they did on occasion suffer the consequences of epidemic arising from other torrid regions, especially if commercial adventures were important to both the newly settled community and the providers of goods, wares, peoples and slaves located in the tropics.  This relationship alone made it likely that new diseases would come to the regions as briefly lived epidemics from time to time.  According to local epidemiologists like David Hosack, these “epidemic” diseases were events that occur “upon the people” (epis + demos), brought in by merchant vessels and the people and supplied on board.  Natural products like ebony wood (haematoxylon), assorted plant fibers, baleen whale oil and food “gills” or filters (used to make corsets), various fruits and vegetables, dried or seasoned animal parts and pelts, kegged beverages and dry foodwares, caffea “beans” were all capable of producing the effluvium and miasma associated with new disease in these settings.  Due to the events of the 1790s, yellow fever was the major concern these early examples of environmental epidemiologists had.

Fortunately, the philosophy of medicine and defining the best drugs for treating diseases had taken several new avenues of change.  There was a certain amount of perfection taking place when it came to understanding, chemically extracting, and thereby strengthening certain foreign-derived plant medicines, like the opium  needed from Turkish plants.  This same research approach was taken towards the development of strong mineral remedies, many of which were natural consequences of the local environmental setting, like the mineral springs and their dried and purified equivalents for epsom and glauber’s salts.   Their very powerful renderings of the highly medicinal mineral waters like the local saratoga springs and New Lebanon Springs, each considered natural sources for Chalybeates (see Chancellor Livingston’s study of Saratoga chemicals for more on this).  Further west, there was Seneca Oil, a new chemical with uses as of yet to be decided upon and described.    Then there were the various ores and metal salts, the more important of which were the natural ferrous containing rocks and stones, used to produce iron-based beverages and tonics for treating the blood, and to produce alkaline, acidic and even nitrogen-enriched (ammoniated) agents use to treat disease and cleanse the local environmental settings of any substances known to be related to miasmatic formation and diffusion (According to Samuel Mitchell’s writings, and his sepsis/septon theory so heavily promoted in the Medical Repository, surfaces were typically treated with the nitrogen-rich waters by this time, to prevent fever and dysentery epidemic onsets).

For this reason, the focus on local plants that were medicinal was a priority of the physicians by the early to mid-first decade of the 1800s.  What took government and regular medicine a few more years to develop an understanding of, enough to add to their treatment protocols, was already heavily used by individual interested in and in need of, through necessity, the knowledge of how to use the Indian remedies.  This meant that in several ways, learning the local plants was a presumptive part of domestic and professional medical practices during the very early 12800s, and so too became one of the most important parts of early midwestern settlement medical geography studies that was developed and then reported in the medical literature.   Hildreth’s work not only exemplifies this phase in American medical history, but also details in is a fairly succinct fashion.

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Aristolochia and Polygala

The two most famous plant medicines for this period in American history are probably the Virginia Snakeroot (Aristolochia serpentaria) and Senega Snakeroot (Polygala senega).  These are the first medicines explorers and readers of explorers’ reports like to read about in this sort of literature.  These plants “ground us” as we begin to learn about the other plants of the region that is covered.  These plants we know the history of and the various uses for,  even though at times we are now learning that newer uses for these same plants are becoming more defined, as they are researched and applied methodically by the best trained physicians.  In this way a snakebite remedy becomes a fever remedy (aristolochia and wild ginger), “cancer” remedy (podophyllum), seizure remedy (scullcap), or feminine nerve and menstrual tonic (the cohoshes).  The snakebite remedies are the first plants heavily promoted by botanists, beginning with the strong support provided to them by Carl Linne (see Colden history coverage on this).   The first example, aristolochia, has New Spain and Virginia history as its origins, due to the numerous species found to be residing throughout the Americas.  The latter, Seneca snakeroot, is of Iroquois tradition and has a history pertinent to New York medical history in association with Lt.-Gov. Cadwallader Colden and his daughter Jane Colden.

Also popular around this time was the Carolina Pink (Spigelia), now becoming very popular as an ipecac substitute.   We find one east coast major plant medicine distributor circulating an advertisement about this plant as part of his numerous other “antient” and modern medicines.  This advertisement appeared in many of the east coast papers published in the major urban settings.

American (False) Sarsaparilla and allies

There were also a number of local remedies yet to be heavily popularized by pharmacal merchants.  The two “sarsaparillas” are examples of this.  Noted by Hildreth as part of the Ohio flora, these two species he noted are most likely Aralia nudicaulis and Aralia racemosa (Aralia spinosa is more southern, Aralia hispida had yet to be identified by botanists).  

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Mezereon is also noted, although the European Daphne mezereon is not expected to be found here.   A. B. Lyons Plant Names identifies this as Dirca palustris (Leatherwood or Leatherbark), a very strong blistering agent.   This plant has a long history of use in American herbal medicine (see Cornelius Osborn’s 1762 New York/Hudson Valley-Dutchess County manuscript  for example).

A similar history exists for Valerian.  The species noted by Hildreth is probably Greek Valerian (Polemonium reptans) due to the distributions of the expected American Valerian species (Valeriana sp.). 

These last two examples of an early “misidentification” are actually based upon  resemblances between the European and American species.  The former heavily marketed, and very expensive following the Revolution.  The Embargo Act prior to the war of 1812 did little to help with the matter of expensive medicines.  For this reason, local remedies were favored, once their credibility was better managed and popularized.  For this reason, the old habit of equating Old Time European plants with newly discovered American remedies continually results in assigning improper common names to some of these plants.  In some cases its was simply resemblances that resulted in the name, in spite of obvious toxicological and medical differences.  It did not help to see that many herbal medicine are hard to differentiate except by a skilled pharmacist.  The gross morphology of the powdered, crumbled, or cut and sectioned radices, leaves, barks, seeds and rhizomes did little to help in this differentiation, as noted by Hildreth’s comment about root or rhizome the similar appearances.  These resemblances had little to do with the medicinal value, but appear throughout the early history of documenting North American herbal medicines.  A plant’s natural, environmental setting and even gross morphology in situ did little to help as well.  Like Hildreth states, there were a number of snakebite remedies in this Ohio setting, but he couldn’t identify or differentiate them from the rest of the flora.

Gillenia trifoliata

Another expensive herb, from South America and New Spain no less, was Ipecacuanha (Cephaelis sp.)or Ipecac, a plant that induced vomiting chemically through a neurochemical mechanism.  The ipecac Hildreth notes is not at all like the imported medicine.  Its local abundance however made it a more effective plant medicine for such uses.  The American Ipecac, “the hills are covered with it in many places” according to Hildreth, most likely refers to Gillenia trifoliata.

Colombo root (Jatropha sp.) was probably one of the wild cucumber vines (for example, Echinocystis lobata).   Since the major use of Colombo root was as an emetic and drastic (produced a watery diarrhea), there is possibility that many of the wild cucurbits could have been interpreted as such.  The herbs in Texas-Arkansas area documented a decade or two later were also considered effective colombo substitutes, such as the Buffalo Gourd (Marah oregansis).  [Reviewed elsewhere.]

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Chinese and American Ginseng

The American Ginseng (Panax quinquifolia) is a colonial item used for trade with the Orient (Panax ginseng).  By 1800, Oriental physicians were less convinced that it would serve as an adequate substitute.  Still, the marketing of the American species led to over harvesting as early as the 1830s

Hildreth also notes Dogwoods (Cornus florida was most popular back east) and Yellow Poplar (Tulip tree – Liriodendron tulipifera).  This use of Dogwood tree (Cornus spp.) as a cinchona substitute was first attempted in such a way that it would become public knowledge soon after during the Revolutionary War at the hospital in Fishkill, NY.  Tulip Tree is indigenous to the New York region, but is probably first noted by botanists further south in the Carolinas.

“Tumeric” – identified using A.B.Lyons, Plant Names Scientific and Popular . . . (1900/1907),  p. 411 entry 1918. 

Two other related plants (Celandine, more turmeric-like based on color, and is related to Sanguinaria, but is introduced; Curcuma is the true Tumeric)

“Roots of tumeric” probably refers to Bloodroot (Sanguinaria canadensis) with its fleshy, rhizomatous roots that produce a red latex and but barely resemble tumeric (the close relative Celandine appears more like Tumeric, but is introduced species).  Sanguinaria lacks many of the features of true tumeric (curcuma), including its highly aromatic nature (turmeric is like its relative Oriental ginger, only much hotter).   Sanguinaria is more toxic that true turmeric and can work as an emetic due to their highly toxic chemistry (although Sanguinaria and Chelidonium are truly anti-cancer due to their biq alkaloids, such as zeta-sanguinarine and the homochelidonines).

Disease Ecology and Geography

“The diseases of this climate are generally of the bilious class” according to Hildreth. 

Regarding the first of January, 1808 [p. 360] he writes “this was the season in which bilious fever and influenza ravaged the country.”  Bilious fever was a name originally attributed to fever that cause biliary symptoms or in some way are related to bilious problems in the body.  However, yellow fever changes the meaning of this earlier use of the word.  Its fatality made it necessary to redefine the fevers, which had been an ongoing process now since the Revolutionary war.

Common fever names had focused on the cyclicity of fever patterns, resulting in the terms intermittent, remittent, constant and ague fevers.  Ague fevers had periods of fever interspersed with periods of chills.  There were also the “Lake fever” identified by western New York land investor Watkins, of Watkins Glen located in the southern Finger Lakes regions of New York.  Marsh fevers were typical of wetlands settings.  “Hill” and “Mountain” fevers were still being defined.  The Spotted fever is so named for the appearance of the skin related to it.  Yellow fever was also known as the Black death or plague due to the vomiting spell it produced (black bile-like), normally preceding death.

A number of other disease mentioned are not necessarily bilious in nature.  These diseases are “phthisis pulmonalis” (consumption or tuberculosis), rheumatism, and “asthmatic cases”.  The latter could relate to the phthisis due to its impacts on the lungs, but it probably also included numerous other fairly common respiratory problems such as allergies, bronchitis, bronchiectasis, alveolitis, and other respiratory inflammatory syndromes.  

The “bowels complaints” and cholera infantum of the region infer simple diarrhea and dysentery, the latter a sign of a developing village according to sequent occupancy theory as expressed by Benjamin Rush about this time, as well as a century later by the more contemporary medical geographers.

The only endemic disease Hildreth noted is “membraneous ophthalmia”, an eye condition for which the name has not really changed.  Modern diagnoses of this infer the common bacterial forms of ophthalmia, but there were several other forms that may have developed due to disease history, such as gonococcal ophthalmia impacting newborns.

“Endemic” Ophthalmia membranous

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Statistical Epidemiology

According to the philosophy for the time, there were diseases of human cause and origin, and diseases of environmental cause and origin.  Different takes on this philosophy define diseases as being endemic or epidemic in nature, a belief that Hosack added a third category to–diseases that express a little of both of these forms of behavior.  There was also the ongoing argument that diseases were either infectious and due to contagion, or that they were due to some environmental causes, such as miasma, effluvium, or according to Mitchell, the missing natural element likened to phlogiston–septon.

Statistics was a natural follow-up to the on-going practice of maintaining weather and climate records in order to try to define the behavior of nature itself (himself or herself), as well as the behavior of diseases that related to these temporal changes.  The first medical statistics regular kept are probably those that served as mortality records for the military and public hospitals during the late 1700s.   Following the Revolution, American physicians began to make it a habit to keep these records, and to do the same for weather information with hopes of drawing some important conclusions from this information.  This statistical behavior became somewhat addicting to some physicians, who went that one step further by designing research methodologies for engaged in research about past epidemics.  These retroactive studies were performed rarely in the late 1790s, if at all, at least on a large in American history, that is until Shadrach Ricketson made one of the first such attempts to do this by performing a retrospective study of the influenza epidemic that struck the United States around 1806/7.  Very quickly, Shadrach’s work, its news in the field and medical literature, and the impacts of the results when he published them a few years later, turned this occasional practice into a more regular epidemiological activity in the New York area. 

Hildreth’s inclusion of a mortality table in his report on Marietta, Ohio is another first for the field locally and for the Medical Repository.  It provides us with important insights into the diseases of a Stage 1 to 2 sequent occupancy location.    There are a number of very environmental based diseases noted, but the majority of these diseases are unattended to infectious diseases, unhealthy human behaviors, and lifestyle manners and choices.

The expected infectious disease patterns are worth noting, ranging from intestinal worms (animal and especially livestock-linked and produced, therefore stage 1 or 2), to vermin-induced Typhus Gravior (epidemic typhus; see http://www.antiquusmorbus.com/English/EnglishT.htm). 

The common infected wound-related conditions such as abscesses were probably prevalent, but not necessarily mortal.  This suggests the “Abscess in the Head”  noted in the table to be very different.  This “Abscess” was probably an example of “suppuration of the brain” (http://www.antiquusmorbus.com/English/EnglishA.htm).  But in terms of where the problem occurred and the age of the patient (18 months), it could also be the results of poor fetal developmental problem resulting from an incomplete closure of the neural tube during fetal growth (spinal bifida), a condition commonly induced by malnutrition (folic acid deficiency).  In sum, the possibility of an infectious disease invading neural tissue is the most likely cause for this condition (for example, traumatic, otogenic, rhinogenic and metastatic abscesses, for more on which see http://gluedideas.com/content-collection/diseases-of-children/Brain-Abscess_P1.html).  

Other observations worth noting:

• Pertussis (cough) may have associations with other more deadly conditions like diphtheria, but it is perhaps a little too early for this disease to strike this setting. 
• Apoplexy is commonly associated with stroke, but may also be due to overworking in the farm setting, and/or due to over-exposure to the sun during these work activities. 
• Purpueral fever, which is typically of bacterial cause, is possibly a consequence of a poorly sanitized delivery setting (see http://en.wikipedia.org/wiki/Puerperal_fever).
• The convulsions are not an overly surprising neonatal-infant problem, and could relate to either idiopathic or environmentally induced epilepsy. 
• Iliac Passion is the result of bowel obstruction, due to any of a number of reasons including volvulus and intusussception, abdominal and diaphragmatic hernias, fecal impactions or bezoars, abnormal tissue growth such as benign or cancerous tumors, or the presence of foreign bodies in the intestines (http://www.antiquusmorbus.com/English/EnglishI.htm; http://medical-dictionary.thefreedictionary.com/Iliac+passion).

A concise description of Marietta, in the State of Ohio ; with an enumeration of some Vegetable and Mineral productions in its neighbourhood. Communicated by Dr. S. P. Hildreth to Dr. Mitchill, from Marietta, January 17, 1809.

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