Since the late nineteenth century, the western plains had been a haven for those with respiratory ailments. At time when the complex workings of the lungs were not-yet understood, many with breathing issues were often advised that it wasn’t a problem with their organs; it was a problem with the air. The solution, therefore, was to move from the smoke and pollution smogged atmosphere of the city to the clean, wide-open spaces of the country, where fresh air resided in abundance, ready to cure any and all issues beleaguering the body. And, for many years, it seemed to work.

Until the dust storms started.

What at first seemed like an abnormality soon became the norm, the once-crystal air soon mired with dust so thick it clouded people’s vision and covered their belongings. The rolling fields of green were reduced dunes of brown. No matter what the precautions–taping doors with strips of flour paste-covered paper, stuffing wet bedsheets in the cracks in the walls, draping damp gunnysacks over the windows–fine particles of sand seeped into every home, hanging in the air and coating beds, dishes, and furniture. In the first few years of the Dust Bowl, dirt destroyed crops, suffocated livestock, shorted out machinery, and decimated towns.

But the worst was yet to come.

Around 1935, doctors in the hardest hit areas started to notice an influx of patients all beset with the same symptoms. High fever. Raw throat. Body aches. Itchy red eyes. Chest pains and trouble breathing. Many suffered from nausea and were unable to keep food down. Hundreds sought help and, of these, nearly half would die. Facing an overwhelmed system, the Red Cross declared a medical emergency across the High Plains, turning local gymnasiums into the make-shift hospitals. It didn’t take long to figure out the cause of the epidemic.

Dust. People were stuffed with dust.

Many of those admitted showed signs of silicosis, a well-known plague affecting miners and others who work underground, where elevated silica levels contaminate the air. Prolonged exposure tears at the web of air sacs in the lungs and weakens the body’s ability to effectively take in oxygen. In coal miners, it would take years of work to reach a level of silica in the body to create these adverse conditions; due to the high levels of silica in prairie soil, doctors were seeing these same issues inside the lungs of Dust Bowl residents after only a few months.

And it wasn’t just silicosis. Sinusitis, laryngitis, and bronchitis were all common. Tuberculosis–the very thing many had traveled out west hoping to cure–became rampant. But hundreds of more cases showed no definitive tie to these known diseases. Their symptoms were similar to pneumonia, an infection of the lungs, except it wasn’t caused by any bacteria or virus. It was caused simply by inhaling too much dust.

Unable to stop the storms, the Red Cross advised people not to go outside, an unattainable goal for those who made their living out on the land. When that failed, they handed out masks that soon became so clogged, one survivor likened it to slapping a mud pie onto your face. The best solution, the Red Cross suggested, was to leave. But, because of pride, stubbornness, or a lack of better options, this advice, too, was often ignored. Because the disease disproportionately affected children, literally choking their small bodies from the inside out, many desperate parents pleaded with the government to take their children, willing to be separated from their babies if it meant giving them a chance to live.

The exact number of deaths attributed to dust pneumonia is unknown, but researchers put the toll in the thousands. Among those who did survive, long-term medical conditions were common. What is known is that hundreds of people traveled west in search of fresh air to cure their ails, only to soon find themselves poisoned by the very medicine their doctor had prescribed. In a time period marked by poverty and starvation, it was a brown plague perpetuated by man that did the most damage, a product of the storms in which the weakest among us were killed by the dirt beneath their feet.