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Where Are They Now? Diseases That Killed You in Oregon Trail

You have died of dysentery.

These are five words familiar to anyone who has attempted to caulk a wagon and ford rivers en route to the Willamette Valley. Oregon Trail not only taught generations of kids about Western migration in 19th-century America, it also familiarized them with various strange-sounding diseases. Let’s catch up with some of those diseases and find out if they're just as nasty today.

1. Everyone Has Cholera

Then: The number one killer of the actual Oregon Trail, cholera is an infection of the intestines caused by ingesting the bacteria Vibrio cholerae. Spread through contaminated food or water, cholera released an enterotoxin that effectively flooded the intestines with excess water. This led to continual watery diarrhea, causing severe dehydration and often death. The worst outbreaks occurred on the Oregon Trail in 1849, 1850 and 1852. The only available treatment in the game was a medicine known as laudanum—understood today to be pure opium.

Now: According to the Centers for Disease Control, cholera remains a global pandemic. Though there is still no vaccine for the disease (in the U.S.), it can be treated with a regimen of fluids and electrolytes, as well as antibiotics. The best defense remains stringent sanitation regulations, a luxury afforded primarily to industrialized countries. The World Health Organization has recorded recent outbreaks in Mexico (November 2013), Sierra Leone (August 2012), Democratic Republic of Congo (July 2011), Haiti (November 2010, October 2010), Pakistan (October 2010) and a severe outbreak in Zimbabwe (June 2009, March 2009, February 2009, January 2009, December 2008).

2. Joseph Has Diphtheria

Then: Caused by Corynebacterium diphtheriae, diphtheria is an airborne bacterial disease. It usually showed up first in the nose and throat, but could also surface as skin lesions. A gray, fibrous material would grow over airways, causing difficulty breathing and sometimes uncontrollable drooling, as well as a deep cough and chills. Diphtheria was most common on the Trail during the winter months.

Now: Routine childhood immunizations have nearly erased diphtheria in the U.S. According to the U.S. National Library of Medicine, there are less than five cases here a year. Though it is still a problem in crowded nations with poor hygiene, diphtheria is now rarely fatal.

3. You Have Dysentery

Then: Dysentery, a.k.a. shigellosis, was not as widespread on the trails as its peer cholera. During the 19th century, dysentery was a bigger problem on the Civil War battlefields. Like cholera, dysentery spread via contaminated water and food, thriving in hot and humid weather. Unlike cholera, dysentery lived in the colon and caused bloody, loose excrement. The rise of dysentery in the 1800s was partially due to infected warm cow’s milk, an ideal incubator for shigellosis.

Now: Dysentery is still a major threat to the developing world. Not only is there no effective vaccine, recent strains are increasingly resistant to antibiotics—the only proven line of defense in tandem with fluids. 

4. Sally Has Measles

Then: Evolved from the rinderpest virus, the highly contagious measles ravaged the United States in the 19th century. It was not measles, but complications like bronchitis and pneumonia, that made it life threatening. Measles was spread through contaminated droplets—coughing, sneezing, wiping one’s nose and then touching anything. It caused nasty rashes, fever, and conjunctivitis.

Now: A vaccine was discovered in the mid-20th century, virtually eradicating measles from the developed world. It is now part of the trifecta inoculation MMR (Measles-Mumps-Rubella) most American children receive in infancy and again at age 6. Though relatively contained, measles is still endemic: In 2009, there was an outbreak in Johannesburg and other parts of South Africa. New Zealand saw a small spike in August 2011, with nearly 100 cases popping up in Auckland. And as of May 16, 2014, there have been 15 outbreaks in the U.S., resulting in 216 cases of measles in 18 states, "the highest number of cases reported in the United States during this time period in 18 years," Dr. Greg Wallace, head of measles activities at the Centers for Disease Control and Prevention, told CNN. (Notably, that number doesn't include the latest cases from an outbreak in Ohio.) Most of the people who got measles were unvaccinated and got the disease while traveling; measles then spread among unvaccinated members of the community when the travelers returned home.

5. Mary Has Died of Typhoid Fever

Then: Unfamiliar with the virtues of boiling water first, Oregon Trail pioneers contracted typhoid like many other diseases—from contaminated water. Caused by Salmonella Typhi, typhoid was spread when an infected person “sheds” the bacteria. Sparing you the gross details, let’s just say the bacteria lived in a person’s blood and intestines. The major symptom was high fever, followed by weakness and loss of appetite. In the warmer months, typhoid was a real killer.

Now: Still a killer, though not in the Western world. The CDC says it’s preventable with good sanitation and antibiotics, but even Westerners are not immune when traveling in developing countries. The CDC strongly recommends anyone planning travel to a "non-industrialized" nation get vaccinated—and avoid any tap water or food cooked in unclean water.

This story originally appeared in 2011.

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Health
People With Type A Blood Are More Prone to Severe Diarrhea
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Bad news for people with type A blood who also love to eat at buffets: A new study spotted by Science News reveals that people with this particular blood type have a significantly higher risk of contracting severe diarrhea from a common bacterial pathogen.

Researchers at the Washington University School of Medicine discovered that a protein secreted by a strain of Escherichia coli latches onto sugar molecules that are only found within the blood cells and intestinal lining of people with type A blood.

For the study, 106 healthy volunteers drank water that contained a strain of the bacterium E. coli—one of the major causes of infectious diarrhea around the world. Only 56 percent of volunteers with blood types O and B contracted moderate to severe diarrhea, but 81 percent of volunteers with blood types A or AB fell ill. All participants were later given antibiotics.

Researchers say these findings, which were published in the Journal of Clinical Investigation, could aid the development of an effective vaccine. Developing parts of the world are particularly susceptible to E. coli contamination, which causes millions of infections and hundreds of thousands of deaths each year, researchers note.

As anyone who has ever had "Delhi belly" can attest, this is also a concern for people who travel to developing regions. The main causes of E. coli infection are contaminated food and water, so it's wise to regularly wash your hands and avoid eating raw produce and undercooked beef while traveling.

[h/t Science News]

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Essential Science
What Is Death?
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The only thing you can be certain about in life is death. Or is it? Merriam-Webster defines death as "a permanent cessation of all vital functions." The Oxford English dictionary refines that to "the permanent ending of vital processes in a cell or tissue." But determining when someone is dead is surprisingly complicated—the medical definition has changed over the centuries and, in many ways, is still evolving.

DEATH, DEFINED

For most of human history, doctors relied on basic observations to determine whether or not a person had died. (This may be why so many feared being buried alive and went to great lengths to ensure they wouldn't be.) According to Marion Leary, the director of innovation research for the Center for Resuscitation Science at the University of Pennsylvania, "If a person wasn't visibly breathing, if they were cold and bluish in color, for example, they would be considered dead."

As time went on, the markers for death changed. Before the mid-1700s, for example, people were declared dead when their hearts stopped beating—a conclusion drawn from watching traumatic deaths such as decapitations, where the heart seemed to be the last organ to give up. But as our understanding of the human body grew, other organs, like the lungs and brain, were considered metrics of life—or death.

Today, that remains true to some degree; you can still be declared dead when your heart and lungs cease activity. And yet you can also be declared dead if both organs are still working, but your brain is not.

In most countries, being brain dead—meaning the whole brain has stopped working and cannot return to functionality—is the standard for calling death, says neuroscientist James Bernat, of the Geisel School of Medicine at Dartmouth College in New Hampshire. "A doctor has to show that the loss of brain function is irreversible," he tells Mental Floss. In some cases, a person can appear to be brain dead if they have overdosed on certain drugs or have suffered from hypothermia, for example, but the lack of activity is only temporary—these people aren't truly brain dead.

In the U.S., all states follow some form of the Uniform Determination of Death Act, which in 1981 defined a dead person as "an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem."

But that's not the end of the story. In two states, New York and New Jersey, families can reject the concept of brain death if it goes against their religious beliefs. This makes it possible for someone to be considered alive in some states and dead in others.

A BLURRED LINE

In the past, if one of a person's three vital systems—circulation, respiration, and brain function—failed, the rest would usually stop within minutes of each other, and there was no coming back from that. But today, thanks to technological advances and medical breakthroughs, that's no longer necessarily the case. CPR can be performed to restart a heartbeat; a person who has suffered cardiac arrest can often be resuscitated within a 20- to 30-minute window (in rare cases, people have been revived after several hours). And since the 1950s, machines have been used to take on the role of many of the body's vital functions. People who stop breathing naturally can be hooked up to ventilators to move air in and out of their lungs, for example.

While remarkable, this life-extending technology has blurred the line between life and death. "A person can now have certain characteristics of being alive and others of being dead," Bernat says.

People with severe, irreversible brain damage fall into this mixed category. Many lie in intensive care units where ventilators breathe for them, but because they have minimal reflexes or movements, they're considered alive, especially by their families. Medical professionals, however, may disagree, leading to painful and complex debates about whether someone is alive.

Take the case of Jahi McMath, whose tonsil surgery in 2013, at age 13, went terribly wrong, leaving her brain dead—or so doctors thought. Her family refused to believe she was dead and moved her from Oakland, California, to New Jersey, where she was provided with feeding tubes in addition to her ventilator. After several months, her mother began recording videos that she said were proof that Jahi could move different parts of her body when asked to. Additional brain scans revealed that although some parts of her brain, like her brain stem, were largely destroyed, the structure of large parts of her cerebrum, which is responsible for consciousness, language, and voluntary movements, was intact. Her heart rate also changed when her mother spoke, leading a neurologist to declare last year, after viewing many of her mother's videos, that she is technically alive—nearly four years after she was pronounced brain dead. By her mother's reckoning, Jahi turned 17 on October 24, 2017.

Organ donation adds another layer of complications. Since an organ needs to be transplanted as quickly as possible to avoid damage, doctors want to declare death as soon as they can after a person has been disconnected from a machine. The protocol is usually to wait for five minutes after a donor's heart and breathing have stopped. However, some believe that's not long enough, since the person could still be resuscitated at that point.

Bernat—whose research interests include brain death and the definition of death, consciousness disorders including coma and vegetative states, and ethical and philosophical issues in neurology—disagrees. "I would argue that breathing and circulation has permanently ceased even if it hasn't irreversibly ceased," he says. "It won't restart by itself."

THE FUTURE OF BRINGING PEOPLE BACK TO LIFE

As resuscitation technology improves, scientists may find new ways to reverse death. One promising approach is therapeutic hypothermia. Sometimes used on heart attack patients who have been revived, the therapy uses cooling devices to lower body temperature, usually for about 24 hours. "It improves a patient's chance of recovering from cardiac arrest and the brain injury [from a lack of oxygen] that can result from it," says Leary, who specializes in research and education relating to cardiac arrest, CPR quality, and therapeutic hypothermia.

One more out-there possibility—which had its heyday in the early 2000s but still has its proponents today—is cryonic freezing, in which dead bodies (and in some cases, just people's heads) are preserved in the hope that they can be brought back once technology advances. Just minutes after death, a cryonaut's body is chilled; a chest compression device called a thumper keeps blood flowing through the body, which is then shot up with anticoagulants to prevent blood clots from forming; and finally, the blood is flushed out and replaced with a kind of antifreeze to halt the cell damage that usually occurs from freezing.

The idea is highly controversial. "It makes a good story for a movie, but it seems crazy to me," Bernat says. "I don't think it's the answer." But even if cryogenics is out, Bernat does believe that certain types of brain damage now thought to be permanent could one day be subject to medical intervention. "There is currently a huge effort in many medical centers to study brain resuscitation," he says.

Genetics provides another potential frontier. Scientists recently found that some genes in mice and fish live on after they die. And even more surprisingly, other genes regulating embryonic development, which switch off when an animal is born, turn on again after death. We don't yet know if the same thing happens in humans.

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