Larry McMurtry’s attempt to depict a classic, 1870s cowboy Texas, in the film, Lonesome Dove, also ironically re-creates a non-hygienic status not too far from the mark of what early Texas was like. In the opening scene, rancher Gus McCrae watches his front porch pigs tear up a rattle snake. Rotting flesh is like an Epicurean Feast for bacteria who secure their claim by secreting toxic chemicals all over it. As Gus laughs, one can imagine the porch being smeared with poisonous clostridium, E. Coli, Staph, salmonella, and other families of toxic microbes. In the film, cowboys of Gus’ Hat Creek Cattle Company ranch are constantly around pathogen-bearing big animals, and it is the job of Newt Dobbs to shovel manure. Later, we learn that Jake Spoon, an old comrade of Gus, has killed one of the lone representatives of good 19th century hygiene, a dentist. On the trail, cowboys are attacked by water moccasins. Their snake venom is filled with microbes. And nearly every sexual interchange in the film includes highly active sexual people--we know that STDs too, result from exposure to dangerous pathogens such as Chlamydia trachomatis, Treponema pallidum, and Neisseria gonorrhoeae.

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The film is hardly a composite history, but it does graphically portray some of the unhygienic realities of early Texas. In fact, forget Yankees, and Nazis. Microbes, invisible-to-the-eye bacteria and viruses, have been the most long-term, lethal enemies of the Lone Star State. But despite the danger, Texas has retained a kind of obliviousness known to the characters of Lonesome Dove. The state exemplifies a tradition of naiveté. It exudes the complacency modern authors such as M. Zaman, and M. Blazer decry as the prelude to a major plague, even a Second Black Death.  Despite the danger of bacterial and viral killers, early Texas was unimaginably vile.  Though Texas did sponsor a brief hygiene upgrade after 1920, Texas has done little as a state to study or to stop its greatest adversary.

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The Dismal Era in Texas history from 1836 to 1919 was a notable hygiene flop. Texas suffered from yearly epidemics of Yellow Fever, an insidious viral infection that struck continuously from 1836 to 1867, and remained a major pest until the early-twentieth century. Texas had an ideal environment for the spread of Yellow Fever. It was a warm state with meandering rivers, and a fair-amount of flooding.  Yellow Fever was disseminated by blood sucking female mosquitos that spread the contagion from victim to victim. Such mosquitos thrived amidst unsanitary conditions and unfilled marshes. After being bitten, the disease at first affected the body with headaches, body aches, fever, dizziness, and nausea. After three days, the initial symptoms would weaken, and the infected patient would feel relieved. However, the deadly stage of the Yellow Fever Virus was yet to come.  Days after the apparent recovery, the final onset of the disease appeared, and it was terrifying.  Fevers spiked.  The skin turned yellow.  Pain and nausea reached unprecedented levels. Sufferers would vomit black blood clots.  The virus attacked the liver, and patients slid into a coma and died. The mortality rate for those catching the disease in some areas of Texas was staggering.  In 1867 alone, 5 percent of Galveston’s population and 8 percent of Houston’s population died of Yellow Fever.  Richard Dowling, the likable red-headed hero of the Battle of the Sabine Pass in the Civil War, and a resident of Houston was one of them. In Corpus Christi people died so frequently from the Yellow Fever, that two to four bodies were wrapped together to be buried. The wood designed to build caskets ran out so fast that it was even necessary to tear down wooden fences to use that wood. The lumber that was delivered to build a church was also used to build caskets. This situation was also true for cities from Beaumont to Brownsville, Texas.  It took progressive action over thirty years later--draining marshes, and preventing exposure--to finally mitigate the losses of this terrible war against the Yellow Fever Virus. 

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Bad water helped make the Dismal Era what it was. Before modern plumbing and water filtration systems in the 1920s, Texans often drank villainous concoctions that passed for nature’s most natural drink.  Water was very difficult to obtain and unprivileged Texans did not have the luxurious sinks and the convenience of obtaining water with ease. In the Trans-Pecos region, settlers in the mid-19th century described water as a fusion of “slimy saltiness” and an evident bitter taste followed by a touch of sweetness and lye.  In Galveston, citizens received their drinking water from their roofs as it rained and then stored what they accumulated in wooden barrels. Collecting water from the roof is dangerous because the lead and copper from the roof material, as well as dirt, and wastes from animals are mixed with the rainwater. Additionally, dust and smoke from the air is dissolved with the rainwater before reaching the roofs, affecting people with weak immune systems the most. 

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Texas was unimaginably vile in the Dismal Era. The environment and surroundings were extremely unsanitary and unhygienic. The photograph shown above shows the town of Taylor, Texas in 1883, located forty miles northeast of Austin. The conditions around the Womack and Sturgis business block, the First National Bank, a furniture store, a saloon, and the city’s main street suggest that the town had no pavement of note. The city streets are covered completely by dirt and mud. Horse-drawn wagons dominate the roads. Pedestrians had to look twice, not just for the horses, but for the carryover of privies, cesspools, chamber pots, trash, and slaughterhouse waste that were carelessly dumped into streets. Alleys and streams also served as receptacles of personal waste. 

                                

These conditions did not improve for some time. Unimaginably vile streets persisted in several cities at the end of the Dismal Era. The photograph shown above from 1919 portrays a muddy street in Ranger city of Eastland County. There are several wagons and antique cars that appear to be stuck in the mud, with citizens walking by with boots and some of them attempting to free their wheels out of the mud road. The photograph also shows a mule or horse.  Each day, a horse excretes about twenty pounds of manure. Hundreds of horse wagons drove down the major drags of a Houston or Austin in one morning, and there was no one to stop the traffic. The odiferous droppings were everywhere. The churning mud attracted flies by the millions, and such flies were themselves vectors for over 100 pathogens, including Shigella, Campylobacter, Salmonella, enterohemorrhagic E. coli, Bacillus anthracis, and Vibrio cholerae.

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Flying insects bequeathed to Texans yet another feared adversary in this most unhygienic era—Typhus.  This was a flea-borne disease caused by Rickettsia typhi.  Fleas came in contact with infected dogs, cats, opossums, rats, and similar mammals, and spread the dangerous pathogen to humans. Fever, headache, chills, weakness, nausea/vomiting, body aches, and rashes were a few possible symptoms. Many bodies gave out entirely because of the stress, and elderly people were especially in danger of death through Typhus. Typhus was less feared than Yellow Fever, but there were major political ramifications from the disease once its link with fleas was suspected. In 1916, Tom Lea Jr. was elected mayor in El Paso, Texas. Lea was passionate about cleanliness, law, and order. He opposed the presence of Mexican immigrants who crossed the U.S.-Mexican border. In 1917 The United States Public Health Service helped the mayor develop his agenda.  Their notice stated that because of the spread of Typhus in Mexico, the port in El Paso would be closed from 7 pm to 7 am. In addition to this rule, the notice stated that immigrants crossing the border had to be inspected closely to see if they were vermin-infested. They had to go through the process of quarantine and their bodies and personal belongings sanitized. By 1917 Lea had developed a fumigating facility.  These baths were not with soap and water but rather with toxic chemicals such as gasoline and vinegar. This obviously worried the immigrants. Would a stray match set them on fire?  Would they be poisoned?   Mexicans were also forced to take their clothes off to be sterilized and then they were forced to stand without any clothes on in front of federal agents to be inspected. Thereafter, immigrants needed a card showing proof that they had been bathed in a fumigating facility. Rather than rid the environment of the real carriers- fleas and rodents, Texans endangered the lives of immigrants.  As a result of the misplaced emphasis, Texas was regularly a Typhus stronghold thereafter, reporting more cases than any other state.

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In the years of Yellow Fever and Typhus, Unhygienic Texas even had its own disease.  The malady was known as Texas fever, and it was caused by ticks bearing protozoans known as babesiosis. A very insidious and extremely lethal sickness suddenly struck cattle in Illinois in June 1868. It was known to be connected to Texas cattle. Farmers in the Midwest discovered that it was related to the movement of Longhorn cattle north by ranchers in South Texas. The Texas cattle appeared healthy, but cattle from the Midwest who were allowed to interact with them or use a pasture that had previously been used by the Longhorns fell ill and frequently perished. Texas Fever became the worst disease known to American cattle of the nineteenth century and it caused cattle from other states to drop dead. Texas cattle were inundated by evil microbes and the unfortunate effects of this condition diffused and penetrated to various states. Thousands of cattle perished in the 1800s from tick sickness. 

Texas fever also led to bans on Texas cattle outside the state. Some states established quarantine laws. Kansas in 1885 made it illegal for Texas cattle to be within its borders. In 1893, scientists Theobald and Fred Lucius Kilborne discovered that Texas fever was spread through ticks with the protozoa named Babesia bigemina and Babesia bovis. The state subsequently mandated dipping vats filled with arsenic for the cattle to pass through, and thus eliminate the ticks. But many Texans resisted the expensive procedure.  Dairy farmers thought that cows subjected to arsenic gave less milk.  Driving cows long distances to reach the vats in Texas was a major issue. In time, “night raiders” retaliated against the offensive, mandatory vats in Burnet, Cass, Cameron, Llano, and Tarrant counties, blowing up the bathing devices.

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There was one final disease that showed how vulnerable Texans were to microbes in the Dismal Era. The Spanish Flu outbreak of 1918 not only came on with full force, but encountered a population that treated it as nothing more than the customary yearly “grippe.” Texas neglected the menace and was notoriously unprepared to deal with the Spanish Flu. A large portion of the world was impacted by the Spanish influenza epidemic during the fall and winter of 1918–1919. With the Spanish Flu, the first wave in 1918 was not highly fatal but people did experience chills, mild cough, fatigue, and fever. Healthy people were affected by the Spanish Flu on the second and third waves later that year. Instead of the elderly, this flu struck the young. With no warning, within a few hours, patients were unable to walk and had to be put to bed. It was often fatal and the stricken rarely lasted more than three days after being infected.  Family members of this flu’s invalids were horrified. As the lungs failed, victims began bleeding from their ears, eyes, and nose. They also turned blue or black from a lack of oxygen. Additionally, patients would have severe pain in their joints. Even though patients were instructed to call for a doctor as soon as they developed the Spanish Flu, there was nothing a doctor could do once they arrived. 

Compared to the later COVID shutdown of 2020, Texans in 1918 refused to give the disease prolonged attention.  In October 1918, Galveston schools, churches, and business closed, but only for about two weeks. By that time 5,000 people had the disease. El Paso too shut down for less than a month after 400 had died. In some towns, however, students still attended classes and if they needed to cough, sneeze or just spit, they needed to do it in a handkerchief. Between September and October of 1918, the Spanish Flu claimed a large number of lives in Texas. The ban on meetings at the time only applied to Houston and other areas of Texas for a short period of time. After that, it was reported that everything had returned to normal. Dr. A. W. Carnes, the lead health officer of Dallas at the time was clearly more concerned about war readiness during World War I than the flu. Carnes allowed Dallas to have a parade during the deadliest phase of the pandemic, on September 28, 1918, in the city streets in which thousands gathered in honor of a Liberty Loan Campaign. Between September 24 and November 2, 1918, at least 9,000 people in Dallas acquired the illness, and 250 of them died. Several strains of the Spanish Flu stayed on the scene after 1920. In 1944, Texas experienced about twenty percent of the total cases reported in the United States. 

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Better water treatment, better medical facilities, better education and cleaner roads led Texas to a hygiene upgrade from 1920-1980. However, in all of these areas, Texas was a follower rather than a leader. From Germany came Robert Koch’s “germ theory of disease,” that pathogens were at the heart of most maladies. Ronald Ross of England discovered the pathogenic basis of Malaria, while doctors at Johns Hopkins in Maryland were the first to use rubber gloves.  Due to the persuasiveness of outside experts, cities for the first time were obeying the Texas Legislature that in 1913 ordered all communities with more than 50,000 residents to stop disposing of raw sewage into streams. Cities were finally able to design and set proper or basic sewage sources or systems. Though started earlier, Houston was compelled to build a sewage disposal system by the United States Army Corps of Engineers in 1900. Alexander Potter was an exceptional consulting engineer that developed a sophisticated disposal system in the early 1900s. His procedure involved collecting city sewage, pumping it, and then filtering it using materials like coke and rough stone. In 1902 Alexander was so confident about his advanced project that he even drank some effluent, declaring it wholesome. The U.S. Government was pleased with the new advanced system and as a result the city of Houston, Texas was granted financial aid to build a deep-water port. The invention of Alexander Potter’s system influenced several towns around Texas. As a result, there was an improvement in sewage systems in Texas during the first half of the twentieth century. 

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During the era of the hygiene upgrade, 1920-1980, almost every city gained a respectable water supply system. Austin, El Paso, Houston, Galveston, San Antonio utilized water from rivers, while Dallas, Fort Worth, Corpus Christi, and San Antonio used water wells. To prevent water-borne illnesses, it became a normal practice to use sand filters, chlorination, and artesian water. Texas remained a challenge due to the slow pace of its rivers, and as its most western river, the Pecos, was salty.  The state needed help from the outside, and the career of John B. Hawley is a great illustration of how the information flow from outside the state improved Texan hygiene. Hawley arrived at Fort Worth from Chicago, Illinois where he worked as a sanitary and hydraulic engineer. He came as a project leader to construct a pump house for the artesian water that the city of Fort Worth had discovered. Hawley saw that Dallas used Browder Springs which was at risk of drying up.  He also surveyed the Trinity River and found it polluted with garbage. He portrayed this as a major problem and advised the city to build their first reservoir of water. He persuaded the Dallas City Council to build a dam and a lake named White Rock. With reluctant but ultimate help from the Texas Legislature, the situation in Fort Worth improved as well.  By the time Fort Worth finished its first disposal facility in 1923, it was still discharging packinghouse waste and raw sewage into the West Fork of the Trinity River. After the water filtrations that Hawley built, the Trinity River went from having an average count of 19,000 bacteria per millimeter to having only 200 bacteria per millimeter. Other accomplishments of Hawley in Texas included the design of the first water filtration plant in Austin that was finished in 1925, a final inspection and report in 1927 of the Dallas Garza Dam, and the planned Lake Crook of Paris, Texas. If it wasn’t for the advice and efforts by John B. Hawley from Illinois, it is likely that Texas would have lagged even more in the development of better water.  

                                 

Ideas from the outside also helped clean Texas streets.  New York City initiated a streetcar system, alleviating some congestion, in 1832.  Dallas gained its first streetcar system only fifty years later. Dallas’ system started with animal-drawn carriages, but in the 1920s, trains became the preferred method of transportation. In the 1930s automobiles triggered a decline in all other modes of transportation. The picture above from 1930 shows a street of downtown Fort Worth. Model-T Fords and other cars now dominate. The streets were no longer muddy or full of manure. However, this would not have been possible without the invention of cheap automobiles by Henry Ford in Michigan. By 1929, one in every four Texans owned an automobile. As a result, the problem of animal manure in the streets decreased.  

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The era of the hygiene upgrade featured attempts at greater degrees of immaculateness. A photograph taken in 1935 shows a hygiene class taking place in Our Lady of Guadalupe Catholic Church in Houston, Texas. At a very early age, thirteen students await a hygiene examination, issued by nuns. The nuns are the instructors for the course in hygiene. They assess the children’s teeth for any cavities, look for appropriate trimmed nails, clean clothing, and hair without lice.  As the instructors demonstrate a procedure on a student, all the class carefully learns methods for improved personal hygiene. State health departments recommended training kids to "dry brush" in schools and dental offices because they believed toothpaste's ingredients to be inconsequential. This idea quickly underwent a radical shift. The American Dental Association conveyed a pervading message that “healthy teeth in children are equal to fluoride plus sealants.” 

 

Countless rivers and creeks remained in a state of disgrace even during the years of the hygiene upgrade. Many were diverted from the cause of better hygiene by the Great Depression of the 1930s, the terrible effects of the Dust Bowl, and the great challenges of World War II. Despite the efforts to modernize Houston’s sewage division, for example, various waterways remained contaminated. One was the Buffalo Bayou located near Houston that had a severe case of prospering prokaryotes. The total bacteria count reached almost 200,000 per cubic centimeter, when an acceptable count was 500. It wasn’t until 1947 that an investigator in Harris County named Frank J. Metyko noticed that the Buffalo Bayou was eighty percent polluted, and that its treatment plants were not working. In 1964, Dr. Walter A. Quebedeaux observed that Houston's "sewage-treatment plants worked poorly; twenty-two were operating at near capacity, and twenty-one generated objectionable aromas." Buffalo Bayou remained a health menace. The bayou was reportedly so filthy that the Ship Channel caught fire in 1966, killing a shipyard worker.

Mass-produced soaps strengthened the hygiene cause in the twentieth century, and Texas was full of natural resources for soap.  Hardwood ashes provide the best in lye, and Texas has over thirty species of oak, the largest oak forest in the United States, in Monahans, and many types of maples and magnolias.  But Texas was a soap outsider. Ajax and Palmolive originated from Wisconsin and Kansas City. Ajax was introduced in the 1940s. Mr. Clean was founded in the 1950s in Illinois. Safeguard was founded in 1963 by the Proctor and Gamble corporation, which was founded in Ohio over 100 years prior, using just ivory soap.  Suave and Dove were brands based on Chicago, Illinois and were founded in 1937 and 1957 respectively. The most modern liquid antimicrobial soap is Soft Soap that was founded in Minnesota in 1980. Instead of focusing on the antimicrobial soap industry, Texans leveraged their proclivity for raising animals by building huge feedlots in the panhandle, and giant chicken slaughterhouses in Northeast Texas.  Problems with excessive manure re-emerged, and chicken blood began to clog water treatment plants. 

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The most recent epoch of Texas’ battles with microbes is the Era of Miscalculation from the 1980 to the present. Rather than giving pathogens their due as our number-one enemy, Texans overinvested in cancer and heart research.  In a sense, Texans were more concerned to cover for vices such as over-eating, and smoking, than face the mysterious enemy they could not see. At the University of Texas Southwestern Medical School in Dallas, Red Duke earned his M.D. in 1960. President John F. Kennedy and Texas Governor John Connally received emergency medical care from Duke while he was a resident at Parkland Memorial Hospital. Duke spent fifteen years appearing on Dr. Red Duke's Health Reports, a nationally syndicated television program that was popular in the 1980s and 1990s. He gave tips on a good mental health, exercise, and appropriate foods but not on cleanliness or hygiene. For instance, on one of his health reports he acknowledged that we burn out from the “unhealthy concrete jungle” that includes stress we get from society, traffic, and problems. Duke ignored the enemy from without and treated human beings as their own worst enemy.  One agenda was to eliminate stress, to relax and calm down souls. Nutrition was another priority of Red Duke. He stated that people blame potatoes for being fattening, but claimed that potatoes are excellent as they are low in calories, but contain complex carbohydrates, and good vitamins. The problem was the way Americans added butter and cheese to potatoes, as this led to obesity. Red Duke revolutionized the use of media communications to disseminate both realistic and cutting-edge health information. However, Dr. Red Duke had a feebleness feature in that he failed to convey information on how to prevent influenza, sepsis, colds and other microbial diseases. 

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Modern Texas has dealt with mosquitos, but its own material abundance has led to new, unhygienic realities.  Texas has a major problem with littering, and it plays a role in assisting with the spread of diseases. In fact, on Texas roadways, there are an estimated 362 million pieces of garbage per year. Litter refers to trash that is not disposed correctly into a trash can and can vary from small items like fruit peels, plastics, cardboard, cans, bottles, and wrappers, to big items like car parts and unwanted furniture. The amounts of accumulated litter contain significant degrees of bacteria and viruses. Multiple harmful germs and viruses can grow when organic litter decomposes. and spread both directly and indirectly. Bacteria, such as Salmonella, becomes active, which leads to the development of several serious illnesses, such as typhoid fever, gastroenteritis, and food poisoning. The unclean nature of Texans can be well seen in a 2001 study that studied 868 residents of Texas. Despite the fact that it is against the law and carries a fine of up to $500 and more than 5 pounds of trash might result in a $2,000 fine, 40% of Texans admitted to having a littering habit in the last three years since 2001. In a 2017 study, 50 percent of participants admitted to littering. Some evidence indicates that residents of Texas have some of the worst littering habits in the nation. Thus, the state had to issue harsh reprisals in its “Don’t Mess with Texas” campaign after 1986. 

Texas developed the world’s largest medical center after 1980, but it did not prioritize the battle against pathogens. It went after cancer and heart diseases. The Texas Medical Center is in Houston and recently, in one year, the TMC saw over 10 million patients, undertook over 180,000 operations, over 750,000 ER visits, close to 14,000 cardiac operations, and gave birth to over 25,000 children. The Texas Medical Center is a unique city that consists of many hospitals such as the MD Anderson which is the world's largest cancer hospital in terms of the number of patients treated each year. It receives over 46,000 new cases each year and has one of the highest cancer treatment success rates. It also has ranks second in the nation with its Texas Children’s Hospital. The Children’s hospital has all their ten specialties ranked in the top ten by the U.S. News & World Report such as neurology, cardiology, urology, woman’s health, and general surgery. The TMC is also the home of the Texas Heart Institute, an internationally recognized center for cardiovascular care.  Research into the behavior of pathogens, treatment and immunology goes after other the major specializations; in other words, microbiology is a weakness among its strengths. The extreme miscalculation in allotments has been costly. Since the start of the current COVID-19 pandemic, approximately 89,505 Texans have lost their lives. These statistics are immense compared to 8,000 victims of the Galveston Hurricane, 600 deaths of the Texas City Disaster, and the 4,000 deaths by the Yellow Fever Epidemic. 

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The Texas Medical Center is not the only medical center in Texas weak in their understanding of microbes. Parkland Memorial Hospital in Dallas, Texas was opened in 1984. It is internationally known for its burn center and Level 1 trauma center. The hospital also excels with the largest-level Neonatal Intensive Care Unit (NICU) in the area. Other major specializations include woman’s health, cardiology, arrhythmia management, and epilepsy. Just like the Texas Medical Center, microbiology has gone by the wayside. Thus, Dallas County on July 1, 2020, was the second county in the state with the most confirmed COVID cases, which was 20,737. The Texas Health Harris Methodist Hospital in Fort Worth provides another case. It has important certifications in stroke care. The hospital received the highest level of advanced certification from the Joint Commission as a Comprehensive Stroke Center. The hospital is the first in the nation to receive this designation as a Primary Heart Attack Center from the Joint Commission. It was also the second hospital in the country to earn a Gold Seal Approval for Brain Tumor Certification. But like Dallas, when the pandemic entered the picture in 2020, Fort Worth was relatively unprepared.  

 

In fact, throughout the state, Texas showed a lackluster response to the COVID-19 pandemic. In the week on November 12, 2020, Texas became the first state in the United States to surpass one million COVID-19 cases. To compare, more people than the total population in Austin had been infected. Even though Texas had reported the highest number of cases, more than 11,5000, since the peak of July of 2020, Texas decided to shift back to normal life very early.  An investigation found that Texas had been warned ahead of time about future pandemics, but the state lacked the necessary sources such as sufficient epidemiologists and testing infrastructure. Texas was the first large state in the United States to eliminate the COVID-19 mask requirements. Governor Greg Abbott declared that the state would eliminate all dining capacity restrictions and get rid of obligatory mask policies, both of which would take effect on March 10, 2021. The Governor decided to take these actions without consulting the guidelines of the health experts. In a Monday press conference at the White House, Dr. Rochelle Walensky, director of the Center for Disease Control (CDC), remarked. "At this rate of instances with spreading variations, we risk losing all of the hard-won ground we have made”. An epidemiologist, Diana Cervantes at the University of North Texas also said that Texas was at a critical condition where the situation could shift into to a wicked direction.As a result of Texan obliviousness toward pathogens, there has been a little over 7 million total cases reported and almost 90 thousand deaths.  

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Overall, Texas can be best described as a dirty state. Compared to other states, Texas has waited until there was a critical or major situation to try to fix what has already been covered with filth. Texas waited until manure flooded the streets and personal waste created unpleasant conditions to bring in technology from other states to fix their hygienic deficiencies. Texas only lost about 15,000 in the Civil War, but over 80,000 to COVID-19. Through the years, bacterial killers such as tuberculosis, cholera, typhus, pneumonia, syphilis, and gonorrhea, as well as viral killers such as yellow fever, and smallpox have killed millions. Throughout history, Texas has suffered from a significant defeat at the hands of its bacterial and viral adversaries. Texas has been hygiene weak and should in the future reconsider this part of its medical tradition.