Thursday, September 27, 2018


The Doctor's Bag

The blog about Medicine and Surgery in the Old West 

By Keith Souter aka CLAY MORE

War is a time when medicine and surgery often advance. Physicians and surgeons are forced to find ways of treating patients in new ways, simply because of increased cases of trauma and increased incidence of disease. This month on the blog I would like to introduce you to Dr James Henry Salisbury, who I believe invented what would become an American institution - the Salisbury Steak!

First a stark fact

Over 620,000 soldiers died during the Civil War. Two thirds of that figure were not from enemy fire, but from disease. Although the diseases were broken down by type, yet the diagnoses did not have the specificity that we would expect today. This is not at all surprising, since the causes of most of the infectious diseases was not then known and diagnoses were made almost purely on clinical grounds. 

There was confusion about diseases and the statistics often refer to such diagnoses as typho-malarial disease, or diarrhoea-dysentery. The clinical pictures of diseases can be very similar, yet the causes may be completely different. Typhoid is a bacterial disease and malaria is a  protozoal infection. 


This condition is caused by a virus. Such infecting organisms were not even suspected back in the 1860s. The microscope was just coming into medical use, but it had its limitations. Only the larger infecting organisms could be seen and even then, their significance was not appreciated until the development of the science of bacteriology. 

Measles was a real problem. It is a condition a occurs in epidemics and it is not a trivial disease. It has both mortality and  complication rates that are significant. It can affect anyone who is not immunized. And of course, back in  the 1860s no one was immunized as there were no vaccines. Affected individuals feel unwell and miserable with a characteristic blotchy rash.

During the Civil War one in twenty soldiers who contracted Measles died, accounting for 11,000 deaths.   

In the 1860s it was a mystery how this condition spread. 

Dr J. H Salisbury and his Straw Hypothesis

John Henry Salisbury (1823-1905) was born in New York and graduated in medicine from Albany in 1850. He had a definite scientific  approach and was an experimenter and medical innovator. 

In July 1862 he wrote an article in the American Journal of the Medical Sciences about his observations on Measles in his practice.  He believed that Camp Measles, as the condition that affected institutions and orphanages was due to fungi that thrived on straw bedding.  It was an ingenious piece of reasoning.

To begin with he had made a study of fungi and in his article  he describes the conditions that they grow in and the odour that they emit during decay.  This he thought made them likely to be causative infecting agents. 

He began his article with a description of one case:

" ....of Newark, Ohio, came to my office on the evening of the 9th December last, and stated that he was just recovering  from what he believed to be an attack of measles. It was his opinion he had caught them from pitching straw from an old stack. "

He then goes on to describe a measles outbreak at the military Camp Sherman, Newark, Ohio. He described the tents and the bedding at the camp, which at that time had between six and seven hundred men.  The weather had been cold, wet and with sleet and snow. Bedding got wet and the straw became rank. 

" Bearing upon this may be mentioned the circumstance that in almost every instance (of the disease), where our soldiers have gone into camp; in a short time after - the disease - called camp measles, has made its appearance, without any previous exposure to the measles. It should be stated that their beds have usually been straw."

The article then goes on to describe the various types of fungi found in wheat and rye straw and their microscopic appearance, which he shows in 20 different diagrams. 

Straw inoculations

Dr Salisbury then outlines several experiments that he made. He inoculated himself twice and his wife once with spores and cells from the fungi found in straw that had started to decay. He described the symptoms they developed and his conclusion that they were like measles in miniature, albeit there was not a rash, other than slight blotchiness. Nevertheless, he felt that there was sufficient evidence for him to conclude that the fungi in decaying straw caused measles.

Next he started inoculating people who had been exposed to cases of measles in their families. He found that of the thirteen  people that he inoculated none of them  developed measles after the inoculation.  

Later, he wrote a further article after inoculating a further 27 individuals who were living on a state farm. There were four buildings, each of which was inhabited by a large, extended family. Each family had diagnosed measles cases within them. As none of the inoculated individuals developed measles he concluded that the fungi in the straw was the infecting agent and that inoculation of straw fungi protected against measles. 

Reasonable, but incorrect

We now know that measles is cased by a virus,  but Dr Salisbury's conclusions seemed reasonable. It was not until 1954 that the measles virus was isolated. 

The four principles of bacteriology are known as Koch's postulates. Had Dr Salisbury known about them he would have found that the straw hypothesis would collapse. 

Koch's postulates

These are 4 criteria that must be met to demonstrate a cause and effect between an organism and a disease:

1. The organism must always be present, in every case of the disease.

2. The organism must be isolated from a host containing the disease and grown in pure culture.

3. Samples of the organism taken from pure culture must cause the same disease when inoculated into a healthy, susceptible animal in the laboratory.

4. The organism must be isolated from the inoculated animal and must be identified as the same original organism first isolated from the originally diseased host

Salisbury Steak

During the Civil War Dr Salisbury became convinced that diarrhoea and dysentery could be cured by diet, specifically coffee and chopped beefsteak.

He continued his observations after the war and became convinced that poor diet was the cause of many diseases and that carbohydrates, vegetables and starches should be restricted  within a diet. He became convinced that chopped beef would prevent many diseases, all of which he wrote about in his 1888 book The Relation of Alimentation and Disease.

He invented the Salisbury Steak in 1897, which he believed could prevent disease. This consisted of finely minced beef, flavoured with onion and formed to look like a steak. This was usually taken with brown sauce or gravy. I am sure that many of you will be familiar with the food item.

Salisbury Steak

Dr Salisbury was, essentially, an advocate of the high protein and low carbohydrate diet, for general health and for weight loss. He was one of the first diet and health gurus.


If you are interested in reading more about medicine and surgery in the frontier days, including the work of Doctor George Goodfellow, then you may find The Doctor's bag useful. It is a collection of my past blog posts, published by Sundown Press.

The novel about Dr George Goodfellow, the Tombstone surgeon to the gunfighters

The novel about Ned Buntline, the King of the Dime Novelists


  1. Fascinating post, Keith, especially his trial-and-error approach to determining the cause of measles. But he was well ahead of his time in embracing high protein and a low carb diet. And, I had no idea - until your article - how the Salisbury Steak was named.

  2. Another interesting post Keith! Thanks for all the good information.

  3. Your post are always interesting and informative, Keith.
    I had the measles at about age l2 (1956). I do not remember what was done in order to aid or speed up the healing. I do remember inoculation at a later date. I think a lot of inoculations may have been given out at schools.
    Salisbury steak is one of my favorites. We have it at home often.
    I enjoyed the post.

    1. Thanks, Jerry. You were possibly given painkillers and something for the itch and maybe a cough remedy, of which there were lots. In 1954 you may have been given aspirin as well, which would never be used now in children, because it can produce a dangerous complication.

      Glad to hear you enjoy Doc Salisbury's steaks!

  4. Thanks, Tom. I thought his reasoning was good and the apparent effectiveness was interesting. I would be less happy, of course, about inoculating fungi into the body.

  5. A lot of kids died of diseases in the small town I lived in. Measles, whooping cough, scarlet fever, chicken pox, polio, etc., they came and went, and on a few ocassions left severe problems for those who survived. I got a few of them and LOOK WHAT HAPPENED TO ME!

    Those with chicken pox are having problems, once again with that HORRIBLE rash thing. Those who got cured with polio are now having recurring problems.

    We all hate disease. Thank goodness for doctors, science, and the medical field. It prolongs life for most of us.

    Thanks, Dr. Keith!

    1. Thanks, Charlie. Looking back at the way doctors strove to find answers is so interesting. Over the years there have been so many wrong turns, blind alleys and roundabouts, yet gradually headway is made.

      Vaccination has been one of the greatest medical discoveries, yet we are faced with increasing numbers of cases of measles and there conditions because insufficient numbers of children are vaccinated. On the other hand, because of overuse of antibiotics we face problems with antibiotic resistance.

  6. Keith, I always love your posts. I think this is fascinating that he related measles to the straw. And Salisbury steak? I love it. I have not had that forever. Here in Oklahoma we tend to eat a lot more "chicken fried steak" --another fave. LOL

    Great post. Really enjoyed it, as always!

  7. Thanks, Cheryl. It was ingenious, albeit incorrect. He kept decent casenotes, which was to be applauded. Very useful and interesting to read them.

  8. Dr. Salisbury sounds like a most interesting man. It takes such patience to go through so much trial and error, even if it's wrong, at least he was trying.

    Having survived having measels and double pneumonia at the same time, I can attest to how miserable a person feels. (And how oxygen tents and hospitals are not my favorite memory)

    Thank you so much for taking the time to share the history of how we have gotten to where we are today. I stive to wrap my head around what it was like in the medical field back then and your posts help me with that. Doris

    1. Thanks, Doris. I had an inkling of what it was like to practice with minimum
      Lab tests while working in an infectious disease hospital in India in 1975. I was a medical student on the cusp of qualifying. I saw all sorts of infectious disease - tetanus, diphtheria typhoid, malaria, cholera and TB. I also assisted at operations for enteric perforation (typhoid fever).