If you believed the old Western movies, you’d think that First Nation people were the greatest danger to pioneers setting out for the West. “Circle the wagons!” somebody yells in the movie. The pioneers rush to get the wagons in a circle so they can shoot the hoard of screaming Indians hurling toward them on horseback. It is a scene enacted in games of cowboys and Indians all around the world. But the truth is, wagon trains were much more threatened by disease than by attack. Pioneers had very few encounters with tribes who lived in the lands they passed through. And if they circled the wagons, it was to make a pen for livestock.

Diseases such as cholera and smallpox were deadly and could wipe out an entire wagon train. Unfortunately, wagon trains carried diseases with them to a native population that had not been exposed to them. Smallpox killed hundreds of First Nation people. Wagons, like the Willis wagon, pulled out of the train when someone became too sick to travel. If another wagon train came upon a wagon where owners had all died from the pox or cholera, they set fire to it, hoping to prevent spread of the disease. In other cases, the train waited for the sick person to die and buried them in the middle of the trail so that wagons passing over them could pack the earth down and protect the grave from animals. Some people estimate that are were ten graves per mile along the Oregon/California trail. Click the link to see other dangers going west.

Cholera is still a danger in some parts of the world. It is a severe stomach condition caused by a bacteria—usually in drinking water contaminated by the bacteria. Extreme diarrhea and vomiting leads to dehydration. Death can occur in a matter of hours.

Smallpox can be deadly, too. It had been around for thousands of years before Grace’s family started West. It is a disease that is highly contagious. There is no cure for it, even today. It begins with a rash in the mouth and spreads to face and hands. The flat red spots become blisters that later dry up and scab over, leaving people with disfiguring marks all over their body. It often leads to death.

Fortunately for us, smallpox has been completely eradicated all over the world by 1980. When Grace’s family set out for California, researchers were already experimenting with how to improve smallpox vaccine. Her father probably knew a great deal about vaccinating people using live smallpox virus and how to prevent its spread. But vaccination was controversial and still is.

In the book, Mr. Swathmore and Dr. Willis have both survived smallpox as children. The result was immunity. Mr. Swathmore was left with terrible marks on his face. Dr. Willis had a much more mild case, but it left him with immunity. By studying people who had mild cases of the disease or showed natural immunity, researchers were able to learn more about how to prevent the disease.

Being around somebody with smallpox didn’t mean a person would catch it. Precautions such as washing hands and keeping hands away from nose and mouth went a long way to curb its spread. But the disease was also spread by coughing and sneezing. It was sometimes spread by handling clothing or bed linens of the sick person, but this was more rare.

If there were ever an outbreak of smallpox, people who have been exposed to it could get a vaccination within four days. The vaccination prevents the disease or makes it much less dangerous.

The vaccine is kept ready in case we ever need it. Samples of smallpox virus are used for research purposes. Some people fear that smallpox could be used as a biological warfare agent. The World Health Organization and other health organizations have emergency plans for how to react were that to happen. In the US, the Center for Disease Control and National Institutes of Health are some of the facilities where research on treatment and prevention of smallpox occurs. They have emergency plans for protection of citizens in cooperation with all of the state health organizations.