Washington University
 
 
Lewis and Clark:  Doctors in the Wilderness
 
By:
Tracy K. Nondorf
 
 
  
 
 
A Research Paper and Final Examination
Presented to:  Dr. Robert Moore
Lewis and Clark:  Encounter, Culture, and Discovery
AMCS / MLA 5163
 
 
 
 
May 12, 2004

 
 
Contents
 
1.  Introduction      . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                   3
 
2.  Meriwether Lewis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                  4
 
3.  Benjamin Rush and the State of Medicine in 1803     . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                  7
 
4.  Lewis in Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                   13
 
5.  Lewis and Clark:  Doctors in the Wilderness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                  16
 
Reference List / Works Cited. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                  22
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
Introduction
 
Americans will hear a great deal about Lewis and Clark in 2004 as they commemorate the 200th anniversary of this history making expedition.  Indeed, there is already a great deal of excitement surrounding the anniversary, with countless books being published, museum exhibitions opening, re-creations of the journey getting underway, even university courses being taught!  As Americans we seem to revel in the story of how the Corps of Discovery opened the West.  We are awed by all that the expedition accomplished.  On their two year and nine month journey, Lewis and Clark catalogued hundreds of new plant and animal species, made political and commercial contact with numerous native tribes, and created maps that would encourage later exploration and settlement of the Louisiana Territory and beyond.  Yet, as we glory in the heroic exploits of the Corps, we may forget the daily challenges and dangers that they faced, and the many times that they came close to death or failure.
                  “One of the things most difficult to understand is that an expedition as well equipped as this one . . . should have gone out upon a journey of eight thousand miles, to be absent from civilization for two years and a half, without a physician as a member of the party.”[1]  Elliot Coues, writing in 1893, referred to the lack of a doctor as the expedition’s “most serious defect.”[2]   Olin Wheeler, in The Trail of Lewis and Clark added, that “of the soldiers, hunters, rowers or watermen, interpreters, there were enough, but not one man of the medical profession to bind up the wounds, mend broken limbs, or cure fevers. . .”[3]  Was this a grave omission?  Was the expedition poorly planned?  Had President Thomas Jefferson, who seemed to think of everything in his long list of instructions to the explorers, forgotten this important detail?  Or was there a reason for the exclusion of a professional physician on the Lewis and Clark expedition?
                  Historian Gary Moulton, in his edition of The Journals of Lewis and Clark, noted that in the spring of 1803 Thomas Jefferson sent Meriwether Lewis to Philadelphia to purchase supplies, and to “complete training in astronomy, natural history, health, and ethnology by consulting with the leading lights of the American Philosophical Society.”[4]  Instead of hiring a physician to accompany the expedition, Jefferson opted to have Lewis take a “crash course” in medicine from Dr. Benjamin Rush, a member of the American Philosophical Society, his friend, and the “most eminent physician of the day.”[5]   Modern Americans might wonder at the wisdom of this choice.  Could Meriwether Lewis, a soldier and personal secretary to the President, possibly have learned enough in a few weeks to enable him to care for the men (and woman) of the expedition?  Historians and doctors today seem to agree with physician / historian Eldon Chuinard that “. . . the generally non –scientific basis of medical practice at the time permitted these two men [Lewis and Clark] of natural ability to care for their men as well as a graduate physician of the day might have done.”[6]  What was the status of American medicine in 1804?  Would the education that Dr. Rush provided on the common medical practices of the day, contribute significantly to the Lewis and Clark expedition? Or, would Lewis’ lack of medical education be more likely to insure that the expedition would return home in relatively good health in 1806?
Meriwether Lewis
                  Born in 1774, Meriwether Lewis lived in Virginia, the state of his birth and his home for the first eight or nine years of his life.  He was an independent child, who enjoyed hunting and the outdoors.  After his father’s death in 1779, Lewis’ mother Lucy remarried and the family moved to Georgia.  By the time Lewis was thirteen or fourteen he returned to Virginia and began his formal education.  He started his studies in 1788 under the tutelage of Parson James Maury.  In 1789, he gained a new tutor, Dr. Charles Everett, and finished his education with Dr. James Waddell from 1790 to1792.  At the age of twenty Lewis joined the army where he met William Clark, his future partner in exploration.  In 1801, Thomas Jefferson hired Lewis (who had been a neighbor in Virginia) to be his personal secretary; Lewis was then twenty-seven years of age.[7]
Lewis’ education and background were typical of a man of means in the early 19th century, but did this instruction prepare him to act as a “doctor” for the Corps of Discovery?  Though it may not be apparent, Lewis received some training in the medical arts prior to his formal preparation with Dr. Rush.  His first “medical instructor” was his mother, Lucy Lewis Marks.  Historian Stephen Ambrose noted in Undaunted Courage, that Lucy had a “strong constitution” and that she was “stern, Spartan, and a devoted Christian” who lived to the ripe old age of eighty-six.[8]    Lucy Marks was “known far and wide for medicinal remedies [or simples], [and] she grew a special crop of herbs which she dispersed to her children, her slaves, and her neighbors.”[9]  Dr. Chuinard in his book Only One Man Died remarked that Lucy “rode horseback with her medicines to serve the countryside.”[10]  Lewis learned the medicinal value of local plants from his mother, and showed his propensity for using natural remedies on the Lewis and Clark expedition.  On June 11, 1805 for instance, Lewis wrote in his journal that he “experimented” with the chokecherry plant and that he “. . . resolved to try an experiment with some simples, and the Choke cherry which grew abundantly.”[11]  On the day of the experiment, Lewis cut some “twigs” off a chokecherry tree, removed the leaves and brewed a “strong black decoction of an astringent bitter taste” which he took to combat the ravages of fever and a “violent pain in the intestines.” [12]   Chokecherry was, according to physician/historian David J. Peck, “a well known herbal medication on the frontier for the treatment of diarrhea and other ailments” and the experiment seems to have worked well for Lewis who noted that “by 10 in the evening I was entirely relieved from pain . . . and every symptom of the disorder forsook me.”[13]   It should be noted, however, that chokecherry seeds contain a poisonous element, amygdalin.   If crushed the seeds can cause a toxic reaction that can produce deadly results, Lewis avoided the use of the seed bearing berries in his decoction, perhaps because he had been taught that they were potentially poisonous, or perhaps because he was lucky! 
                  In addition to learning about herbal remedies in his home, Lewis received basic medical training in the army, as would his future partner William Clark.  In 1793, prior to the expedition, Clark wrote in his journal that “he was equipped with a lancet and bled men on several occasions.”[14]  Dr. James Tilton, who wrote about medical practices during the Revolutionary Era, noted that it was the responsibility of every “commanding officer to be equipped with medicines and supplies to care for the illness and trauma of their men.”[15]  Though military hospitals in that period were probably the cause of more deaths than battle, there was a growing understanding of the importance of cleanliness and good nutrition which led military camps to develop “rules” to insure better sanitation.  Dr. Tilton noted that there were “means by which military officers have it in their power to prevent and alleviate the ordinary sicknesses and distress of the army.”[16]  Tilton noted that to insure health on an army post the following things should be done:

 
Tilton and many others of his age understood that cleanliness was a factor in health.  Though people of the colonial era had little understanding of the causes of disease, common thought dictated that “miasma” or the “smell of decaying food, foliage, bodies, or the smell of excrement” promoted and spread illness.[18]  Thus, by cleaning up military outposts to eliminate odors, camp commanders were able to curb the spread of disease.  By the time Lewis set out for Philadelphia to begin his formal “scientific” training for the expedition in 1803, he had already acquired a vast amount of basic, “common sense” medical
 know-how!  What then would the eminent Dr. Rush, a well-known and highly trained physician, have to teach him?
Benjamin Rush and the State of Medicine in 1803
                  The state of American medicine in 1803 was deplorable by modern standards.  According to Dr. Chuinard, “Bacteriology, hygiene, and preventative medicine were unknown sciences.”[19]  To this, Dr. Peck adds that the “concepts of germs, contagious diseases, and parasites”, of which we are familiar today, were unheard of.[20]  “Infectious illness in various forms took staggering numbers of people into early graves, often with a helpful push from their learned physicians.  The viral diseases of smallpox, measles, influenza, and yellow fever mercilessly” killed millions, while parasitic diseases like malaria and typhoid infected millions more.[21]  There was little that the average colonist could do to combat disease, and it was unlikely that most would ever see old age.  Ailments such as cancer, diabetes, and heart disease which we associate with the aged, were virtually unknown in the 18th and 19th centuries. 
                  By the early 1700’s there were no guilds or professional associations to standardize or regulate medicine, which meant that anyone could call himself a doctor.[22]  By 1775, there were only 400 doctors with medical degrees practicing in the American colonies, all of them residing on the Eastern seaboard.[23]   By 1805, only one in five doctors in America had any formal training.  Frontier doctors and colonial moms (like Lucy Lewis Marks) used a combination of herbal cures or simples, animal based remedies, and a healthy dose of superstition to cure their patients and loved ones.  Settlers brought European herbal remedy books with them to the colonies.  Bancke’s Herbal (1525) and Culpepper’s Complete (1625) were two of the favorites, both offering lists of beneficial herbs and plants, as well as recipes for inevitably foul tasting cures.[24]  Unfortunately for colonists, American plants differed from those commonly found in England and Europe.  Herbs and medicines were available by import, but purchasing them was expensive.  English herbs could also be grown in the colonies, but climatic differences often made results uncertain.  So American colonists were forced to develop new pharmacopeias and collect and experiment with “new world” plants.  They often turned to native peoples for help.  Though native medicine varied from tribe to tribe and had a strong spiritual element that colonists did not understand, there were things to learn from the natives, of whom one colonist remarked were a “well-fashioned people, strong and sound of body.”[25]  Most native tribes used “splinting, traction, and immobilization to treat fractures.”[26]  They treated burns, skin ulcers, and infections with a combination of remedies which included the use of herbal poultices, the use of heat and sweats, the washing and dressing of wounds, and the opening of wounds to drain (via an incision).[27]  Natives also made use of extensive pharmacopeias which included plants that are commonly found in modern medicines.   Insulin, cocaine, quinine, ipecac, and witch hazel, were all derived from Native American plants.[28] 
                  For those living in cities, there was the potential for hiring a professional doctor.  After receiving a basic education in grammar school or from a private tutor, the future doctor might go to a university, and then participate in an apprenticeship program with an experienced physician for one to five years.  Such was the path of Lewis’s medical mentor Dr. BenjaminRush.  To understand the medical treatments and methods taught by Dr. Rush it is important to note his training, and the methods by which he developed his theories of disease and treatment.
                  Dr. Rush was born in Pennsylvania in 1745.  Though the family had some financial difficulties after the death of his father, his mother’s remarriage bought financial stability and made it possible for Rush to pursue a formal education.  He attended a Presbyterian boarding school in Nottingham, Maryland where he was taught by Reverend Samuel Finley.   In his autobiography, Rush noted that in 1759 he was “removed from Dr. Finley’s School to the Jersey College” or the University of New Jersey (later Princeton) where he was admitted as a junior and studied a standard curriculum of science, math, English literature, Latin and Greek.[29]  “In the month of September 1760 [Rush] was admitted to the degree of Batchelor of Arts.”[30]  Benjamin Rush was fifteen years old when he graduated college, and had planned to pursue a legal career.  Upon the advice of his former teacher Reverend Finley, he decided to become a physician instead.  In later life, Rush said of his choice, “I now rejoice that I followed Dr. Finley’s advice.  I have seen the hand of heaven clearly in it . . . I may have acquired more fortune and rank in life in the profession of law, and probably have escaped much of the vexation and distress that are connected with the practice of medicine, but I am sure I have been more useful in the latter profession. . .”[31]
Rush began his medical career as an apprentice to Dr. John Redman of Philadelphia in February of 1761.  He worked with Dr. Redman for five years.  In his autobiography, Rush described his daily duties as an apprentice “In addition to preparing and compounding medicines, visiting the sick and performing many little offices of a nurse to them, I took the exclusive charge of his [Redman’s] books and accompts [accounts.]”[32]  Redman made his library available to his young apprentice, and through his readings Rush encountered the lectures of Dutch doctor Hermann Boerhave, whose teaching had a profound effect on the young physician (Boerhave’s theories will be discussed later in the paper). 
Rush was also able to attend some of the first anatomy lectures ever held in the American colonies.   These were conducted in Philadelphia by Drs William Shippen and John Morgan, also major influences on the young Rush.  Shippen and Morgan were the founders of America’s first medical school.  They approached the College of Philadelphia in 1765 with an idea for adding a medical school to their program.  This was accomplished in November of the same year, with Morgan teaching the theory and practice of medicine, and Shippen teaching anatomy.[33]  Shippen had an especially hard task, since it was nearly impossible to find cadavers on which the medical students practiced.  In order to obtain specimens, Shippen was forced to steal corpses and was formally accused of grave robbing in 1765.  He admitted to stealing dead bodies, and noted that they were “unclaimed, or the bodies of the executed or suicide victims.”[34]  Though grave robbing was met with repugnance and hostility, it was tolerated, as long as would- be doctors used the bodies of “unwanted” or African American persons, and did not flaunt their activities.[35]  
Rush developed a close relationship with Dr. Morgan, who helped him to learn “materia medica” the study of medications, including the use of herbal remedies, preparation of medicines, and proper dosing.[36]  When Rush finished his apprenticeship in 1766 he could legally have become a practicing physician.  Instead he decided to study abroad, and departed the colonies for the University of Edinburgh in Scotland where he remained until 1768.  This was a common practice for American physicians, who had begun to seek medical degrees by the 1760’s, slowly helping to form a medical “elite” in the colonies.[37] 
Edinburgh Medical School opened in 1726, and graduated 17,000 doctors in its first one hundred years.[38]   The school was popular with would-be American physicians because it was inexpensive; had no religious limitations, taught classes in English (unlike many schools which used Latin), and did not require a specific course of study.[39]  Rush, like the other students, was allowed to pick and choose the classes that he wanted, and only had to pay for those he actually attended. 
At Edinburgh, Rush continued his study of Dr. Boerhave, a professor at the University of Leyden, who promoted a “neat and all embracing system of disease.”[40]  He believed that the body was a hydraulic mechanism full of pumps and pipes.  In a healthy person, this system would work correctly, but if a pipe should clog, it would force the pumps to work harder and faster to push blood around the obstruction.  This caused friction and heat or fever which showed the doctor that a problemexisted.  Boerhave’s “cure” was to bleed his patients, which in turn reduced the friction and fever.   In addition to time spent with Boerhave’s theories, Rush studied under William Cullen, a teacher at Edinburgh who had developed a theory that disease was caused by “nervous excitation” and its effect on bodily solids.[41]   Rush would combine the philosophies of Boerhave and Cullen to develop his own “monistic explanation for disease”, which he felt was caused by a “hyperactive state of the arteries . . . called hypertension (fever – in modern terminology).[42] 
When Rush returned to the colonies in 1769, he opened his own practice, became the medical consultant for the city almshouse in Philadelphia, and was asked to join the College of Philadelphia as a professor of chemistry.  He became a prolific writer, publishing more medical essays by 1773 than any other physician in the colonies.[43]  “He was also the most doctrinaire practitioner of the age, staunchly defending [and teaching] European theories of disease long after his contemporaries began to make clinical observations” which called them into question.[44]  Historian Norman Risjord, noted that because of his writing, lectures, and teaching, Rush had a dramatic impact on American medicine, literally training thousands of doctors in his “hypertension theory”, which may have “caused untold injury and delayed for years the development of clinical pathology in America.”[45]   
Though Rush’s treatments may seem barbaric to the modern American, they were the standard for all medical professionals of his day.  He was best known for his use of copious blood letting and calomel purges.  Rush believed that blood letting was a universal cure for all ills (even mental problems), and felt that a patient could be bled of 6-8 pints over several days (the body only contains 12 pints), with the blood replenishing itself in a day or two.[46]  In reality, a body will not replenish that level of blood loss for weeks.  Dr. Peck writes that Rush “bled virtually all his patients, often repeatedly, [and] often more than once daily.”[47]  To this he added chemical purges, which called for the patient to “evacuate” the toxins that led to disease.  A doctor could purge a patient by inducing vomiting, sweating, or diarrhea.    Rush’s favorite “purge inducer” was calomel, a “profound intestinal irritant which [he] administered in whopping doses.”[48]   Calomel was a white tasteless power which consisted of mercury chloride.  When taken in small doses calomel led to the evacuation of the bowels.  If taken over time or in heavier doses, calomel induced heavy salivation, bleeding gums, mouth sores, tooth loss”, and other serious side effects as the patient succumbed to mercury poisoning.[49]   Rush would eventually patent his own medication, “Dr. Rush’s Pills” or the “bilious pill”, commonly referred to as “Thunder Clappers” which mixed calomel with jalap, a second powerful purgative, and which had “explosive” results.[50]  Calomel was so commonly used in the late 18th century that it inspired verse, “The doctor comes with good free will, but ne’er forgets his calomel.”[51]
By the 1780’s Rush was perhaps the most famous doctor in America, but people had begun to question his methods.  When a yellow fever epidemic struck Philadelphia in 1793, leading to 4,000 deaths, Rush’s patients died in large numbers.  He had used his favorite treatments of blood letting and purges in an attempt to cure them, and had few successes.  When the epidemic ended, Rush’s reputation had suffered.  By 1797 a “backlash against doctors was growing” in the United States.[52]   Rush found himself “ridiculed by his detractors and sarcastically referred to as ‘the bloodletter’ in the press.[53]   As early as 1777 Philadelphia papers criticized his medical tactics publicly; and in 1788, Federalist author William Cobbett called Rush a “potent quack”, whose disciples had slain “tens of thousands” with bloody purges.[54]  Rush sued Cobbett for libel and won in 1799, but “his medical career never [again] reached its former heights.”[55]   By 1813, the year of Rush’s death even Thomas Jefferson admitted to reservations about his friends methods.  He wrote of Rush, “In his theory of bleeding and mercury I was ever opposed to my friend . . . whom I greatly loved; but who had done much harm, in the sincerest persuasion that he was preserving life.”[56]
Lewis in Training
It appears that Jefferson had begun to doubt the efficacy of physicians and their methods by the time of Rush’s death in 1813.  Yet, just ten years earlier he had decided to send Meriwether Lewis to study with one.  But, Jefferson and Rush were good friends, with a longstanding relationship and respect for one another.  This no doubt influenced the president’s decision to have Rush tutor his personal secretary.  Lewis traveled to Philadelphia in the spring of 1803.  His mission was to gather supplies for his upcoming expedition, and to study under a number of members from the American Philosophical Society.  He would study:

 
  Jefferson sent letters of introduction to all of Lewis’s teachers prior to his visit, and on February 8, 1803, he wrote to Dr. Rush stating that, “Captain Lewis is brave, prudent, habituated to the woods, & familiar with Indian manners & character.  He is not regularly educated, but he possesses a great mass of accurate observation on all subject of nature which present themselves here. . .”[58]   In addition to schooling Lewis in the modern medical arts, Jefferson asked Rush to provide him with questions on the natural history of American natives to help guide the expeditions’ collection of information.  He asked the other members of Lewis’s teaching team to do the same.  Rush presented his questions to Lewis on May 17, 1803.  Most of them dealt with medical issues and cures, but Rush also sought information on child rearing, religious and death rituals, sexuality and vice, even diet and “blood letting” among the Indians.
By early June, “the shortest medical apprenticeship in American history – about two weeks” was finished and Dr. Rush wrote to Thomas Jefferson, “I have endeavored to fulfill your wishes by furnishing Mr. Lewis with some inquires relative to the natural history of the Indians . . . a few short directions for the preservation of his health, as well as the health of persons under his command.”[59]  Rush went on to tell the President that Lewis seemed to be “admirably qualified” to lead the expedition. 
                  With Rush’s advice in hand, Lewis purchased the medical supplies needed for the expedition.  He spent $90.60 (of the total $2,324 spent) at the apothecary shop of Gillaspy & Strong in Philadelphia.[60]  Given Rush’s penchant for bleeding and purgatives, Lewis’s medical kit was well stocked with items for performing both functions, but there would be more.  The medical kit contained many different kinds of medicine, which can be categorized by their general uses:

 
Lewis also packed fifty dozen of Dr. Rush’s “caomel and jalap Bilious Pills” which became a favorite treatment on the expedition.[62] Lewis and Clark used calomel as a purgative on many occasions, but they also used it in the treatment of syphilis.  If we look at the medical purchases, we can tell that Lewis was thinking ahead to his men’s sexual exploits.  In addition to the mercury based calomel, he purchased “four pewter penile syringes” which would have been used “to treat gonorrhea by injecting a solution up the penile urethra.[63]  This solution could have been made from the medications that Lewis bought for the expedition; they however had no need of it since the men contracted syphilis and not gonorrhea.  Lewis also purchased tools for blood letting, “three best lancets”, in addition to mosquito netting, material for packing wounds, a tourniquet, bottles for holding his medicines, and two wooden medicine chests.[64] 
                  Dr. David Peck, in his book Or Perish in the Attempt, made it clear that “the lessons from Dr. Rush and his colleagues could not provide Lewis with medical skills equivalent to his naturalist and leadership abilities.  Lewis’ practice would consist of the use of a few herbal and chemical medications, some of his mother’s medical-herb knowledge, and some practical medical skills acquired during his army career.”[65]  Dr Rush added a “pinch of European medical theory” and a “generous dose of blood-letting into the explorer’s medical bag.”[66]  He also provided Lewis with a list of eleven “Rules of Health” which were meant to preserve the health of the Corps. 

 
Though the modern reader might wonder at the sense of making cold feet colder, or of wearing wet flannel the idea of resting when one felt fatigued seems like good advice.  It is also interesting to note that Rush made a “pitch” for his own pills!  In reading the journals, we can not assess whether Lewis followed Rush’s helpful hints.  He certainly used Rush’s Pills, and he did purchase 45 flannel shirts for the journey, but he doesn’t mention the advice that he was given specifically.  With supplies purchased, the time had come for Lewis to make his way to St. Louis.
Lewis and Clark:  Doctors in the Wilderness
                  When the Lewis and Clark expedition left St. Louis in May of 1804 the captains knew that they would face many challenges; not the least of which would be the many illnesses and injuries that plagued them all the way to the Pacific and back!  Lewis’s crash course in medicine would be put to good use as he faced cases of:  heatstroke, frostbite, hypothermia, a dislocated shoulder, strained back, various cuts and bruises (from cacti, an axe, etc.), diarrhea / dysentery, syphilis, boils, a gunshot wound, fleas, lice, and other pests.  There were also less clear cut ailments like ague (fever and chills), intestinal disorders, and stomach complaints.  Such disorders might have been caused by bugs (fleas, ticks, mosquitoes) parasites in the food and water of the expedition, malaria, or other viral infections. 
                  In the Journals of Lewis and Clark, the reader finds instances in which both explorers make reference to illness, and medical treatment.  Yes, Clark served as camp doctor right along with Lewis! Even though Clark had not had the advantage of formal training, he would have shared Lewis’s “frontier upbringing” and military background, so was quite proficient at ministering to the medical needs of his men.  It is obvious that Dr. Rush had an impact on the young captains. On July 7, 1804, Clark wrote that “one man verry Sick, Struck with the Sun.”[69]  He was referring to Robert Frazer, who according to Dr. David Peck, was probably suffering from heatstroke or heat exhaustion.  The logical treatment for either ailment would have been shade, rest, and the consumption of liquids to re-hydrate the soldier.  Clark wrote that “Capt. Lewis bled him & gave Niter which has revived him much.”[70]  In this case, Dr. Peck notes that bloodletting probably worsened Frazer’s condition, leading to even further dehydration and exhaustion.  Though Frazer survived, it was probably NOT due to Lewis’s treatment!  Clark used blood letting on at least two other occasions that are noted in the journals.  On January 26, 1805 one of the men was diagnosed with pleurisy (an infection of the lungs and or chest cavity), and Clark wrote that he treated this man with a “Bleed.”[71] Clark also used the lancet on Sacagawea after she became ill in June of 1805.  On the 10th of that month, he noted that “our Indian woman verry sick” and recorded that he “blead her.”[72]  Though we do not know what afflicted Sacagawea, Clark showed great concern for the young Indian mother, and tried several different treatments before affecting a “cure”. 
                  In September of 1805 (September 23 to October 1st), Clark wrote that the men were suffering from “Lax & heaviness at the stomach” and a “running of the bowels”.  His journal over several days “is practically a hospital daybook”.[73]  He related that “Capt. Lewis scarcely able to ride on a jentle horse . . . Several men So unwell that they were Compelled to lie on the Side of the road . . . 3 parts of the Party sick . . . Capt. Lewis very sick . . .” and finally that he himself was “ a little unwell.”[74]    Clark attacked the illness, probably dysentery caused by a change in diet, with “Rush’s pills”.  Was it appropriate to give men disabled by dysentery a powerful purgative?  Such treatment gave them even worse diarrhea and caused greater intestinal irritation, and dehydration, but was the accepted medical treatment of the day. There are countless examples of the Captain’s using purgatives in the journals; it was definitely the treatment of choice on the expedition!
                  On several occasions in the journals we see both the influence of the captains’ military background and Dr. Rush’s training.  This was evident in the treatment of syphilis.  Syphilis was considered a routine disease in the military in the early 19th century, and Lewis and Clark were well prepared to treat the disorder.  It is obvious in reading the journals that the men had sexual contact with native women.  Clark noted on October 12th of 1804 that the Sioux had a “curious custom”, as did the Arikara, which was “to give handsom squars to those whome they wish to Show some acknowledgements to.”[75]  He goes on to note that the party had “got clare [clear]” of the Sioux “without taking their squars.”[76]   But by October 15, 1804 Clark noted that the party had arrived at the Camp of the Arikara, and that “Their womin [were] verry fond of caressing our men &c.”[77]    By March of 1805 he noted that the men were “Generally helthy except Venerials Complaints which is very Common amongst the natives . . . and the men Catch it from them.”[78]  On January 7th 1806, Lewis described the incidence of venereal disorders which he observed amongst the natives of the Columbia River Valley.[79]  On that same day, he made a note that one of his men, Goodrich, “has recovered from the Louis Veneri [syphilis] which he contracted from an amourous contact with a Chinnook damsel.”[80]  Lewis cured Goodrich, with the “uce of mercury” and tried to determine if the natives had any “simples” or cures for the disease but determined that they did not.[81]  He also noted that both gonorrhea and syphilis existed amongst the native tribes west of the Rockies, but that the incidence of these diseases had declined when compared to the natives of the Plains.  In July of 1806, Lewis reported that two of the men, Goodrich and McNeal were “both very unwell with the pox which they contracted last winter with the Chinnook women” and determined to make use of an “interval of rest [so that] they can use the mercury freely.”[82]  The use of calomel or mercury to treat syphilis was extremely common in the early 19th century; “But the administration of mercury to cure a nasty problem was a very sharp double-edged sword.”[83]  Mercury is toxic to the spirochete that causes syphilis, but it can also be toxic to the patient.  The medicine could be given in one of two forms, orally (usually by pill – calomel) or via a salve (usually applied under the arm).  The topical application tended to work more slowly, but was safer as the mercury was absorbed slowly into the system.  With either application, “side effects of the mercury could cut nearly as deep as the syphilitic bacteria.”[84]  It was generally known that treatment should end when the patient began to salivate excessively.  Today we know that “salivation is the first sign of mercury poisoning.”[85] In addition to salivation, patients often experienced mouth sores and bad breath.  Their teeth often became loose or fell out, and their mouths turned brown.  In severe cases a patient might suffer “inflammation to the mouth, throat, and intestines, causing pain, nausea, vomiting” and diarrhea.[86]  If exposure to the mercury continued, and the poisoning became chronic, the patient would experience a “red body rash, sweating, loss of appetite, increased heart rate”, and might suffer kidney failure and death.[87]  Though Lewis’s treatment of his men in this case could have been lethal, there was little alternative.  At least with mercury there was a chance that the disease could be stopped before it advanced to the second stage or beyond. 
Why didn’t the captains ask their men to abstain from sexual encounters, or use some sort of contraceptive device to lessen their risk of infection?  Lewis and Clark did ask the men to abstain for a time at Fort Clatsop on the Pacific Coast, but their reasons were related to commerce not the prevention of disease.  The men grew accustomed to trading goods for sexual favors amongst the Clatsop and Chinook Indians. By the winter of 1805-1806, with supplies dwindling, the Captains cut off this practice to conserve the Corps trade goods for the return trip.  While condoms seem a good modern solution to the problem, they were not commonly used in America in the early 1800’s.  As early as the 17th century Europeans (led by the French) had learned that covering the penis during intercourse could help to prevent syphilis, and condoms made of “oiled silk, fish bladders, and the intestines of goats, sheep, or cows” were widely available by the early 1700’s.[88]  In the United States, the first recipe for condoms appeared in 1844 (yes, you could make them at home), but they did not become widely available until the 1850’s, alas too late for poor Goodrich andhis fellow explorers![89]   
                  Lewis and Clark would be forced to deal with many medical problems on their expedition.  While the training that Lewis received from Dr. Rush was evident in his use of blood letting and purgatives, we can also see the influence of his mother’s herbal arts, and his military discipline and training.   The Corps of Discovery would travel over 8,000 miles from 1804 to 1806, and only suffered one death.  Sgt. Charles Floyd would become ill on August 19th (1804).  Clark noted that “Serjeant Floyd is taken verry bad all at once with a Biliose Chorlick     we attempt to relieve him without success yet.”[90]  Floyd grew worse over night and was dead within days.  Most historians and Dr. Peck agree that Floyd was probably suffering from appendicitis, which would have proved fatal even had he been attended by Dr. Rush himself.  It is amazing that the Corps which consisted of 33 men (and Sacagawea) was able to travel so far, with so few fatalities.  But, as Dr. E. G. Chuinard stated in his book Only One Man Died, “the generally non –scientific basis of medical practice at the time permitted . . . [Lewis and Clark] . . . to care for their men as well as a graduate physician of the day might have done.”[91]  Throughout the journals, the men of the expedition exhibit only confidence in their captains.  Even in the case of Sgt. Floyd’s death there is no hint of criticism.  Patrick Gass wrote, “Floyd died, notwithstanding every possible effort [that] was made by the commanding officers, and other persons, to save his life.”[92]   
Though many of the treatments used by Lewis and Clark offered little potential for real healing, and may have done more harm than good, the men would have received nothing better in a 19th century hospital.  Medical technology simply had not reached a professional state by 1804.  Doctors, like Benjamin Rush followed inaccurate theories, guessed at the cause of disease, and used treatments that were as likely to kill as to heal.    As physicians, Lewis and Clark both performed admirably.  They showed care and concern for the men under their command and even for the Indians they met.  They used all the information available to them at the time to keep the Corps safe and healthy.  The “practical skills” of most doctors of the day were not much better than those “possessed by Meriwether Lewis”, and “as an amateur, Lewis was probably more conservative in his treatments than a trained physician, whose unfounded confidence in his medical abilities would likely have made him more aggressive.”[93]  Lewis and Clarks’ conservative treatments probably helped to insure the health of their party.  The expedition they led was an absolute success.  The captains not only opened the west, they brought every man but one home with them, safe and sound! 
 
 
 
 
 
   
 
 
 
 
 
Works Cited
 
Ambrose, Stephen E.  Undaunted Courage:  Meriwether Lewis, Thomas Jefferson and the Opening of the West:
                 New York:  Simon and Schuster, 1996.
 
Anderson, Ann.  Snake Oil Hustlers and Hambones:  The American Medicine Show.  North Carolina:  McFarland
                 & Company, Inc.  2000.
 
Barth, Gunther.  The Lewis and Clark Expedition:  Selections from the Journals, Arranged by Topic.  Boston:
 Bedford/ St. Martin’s Press, 1998..
 
“Benjamin Rush”,  2004.  University of Virginia Health System (On Line).  4 May, 2004.
                  <www.healthsystem.virginia.edu>.
 
Brodie, Janet Farrell.  Contraception and Abortion in 19th Century America.  New York:  Cornell University
Press.  pg. 205-211.
 
Chuinard, E. G., M.D.  Only One Man Died:  The Medical Aspects of the Lewis and Clark Expedition, Glendale:
  Arthur H. Clark Company, 1980.
 
DeVoto, Bernard.  The Journals of Lewis and Clark.  Boston:  Houghton Mifflin Company, 1981.
 
Jackson, Donald.  Letters of the Lewis and Clark Expedition:  with related documents 1783-1854.  Urbana:
 University of Illinois Press, 1962.
 
“Lewis and Clark” 2002.  Lewis and Clark College, Portland Oregon.  4, April, 2004.
 <www.lclark.edu/org/bicprog/200/060103.html>
 
Miller, Brandon and Marie.  Just What the Doctor Ordered.  Minneapolis:  Lerner Publications Co., 1997.
 
Moulton, Gary.  2003.  The Journals of the Lewis and Clark Expedition:  Introduction (on-line).  5 April 2004.
  <http.lewisandclarkjournals.unl.edu>.
 
Peck, D.O. David J.  Or Perish in the Attempt:  Wilderness Medicine in the Lewis and Clark Expedition.  Far
                  Country Press. 2002. 
 
Porter, Roy.  The Greatest Benefit to Mankind:  A Medical History of Humanity.  New York:  W.W. Norton &
Company.  1997. 
 
Risjord, Norman K.  The Revolutionary Generation.  New York:  Rowman & Littlefield Publishers, Inc. 2001.
 
Rush, Benjamin.  The Autobiography of Benjamin Rush.  New Jersey:  Princeton University Press. 1948.
 
Tone, Andrea.  Devices and Desires:  A History of Contraceptives in America.  New York:  Hill and Wang, 2001.
 
 
 
 
 
 
 
 
 
 ------------------------------------------------------------------------
[1] Coues M.D., Elliot as quoted in:  Chuinard, E. G., M.D.  Only One Man Died:  The Medical Aspects of the Lewis
                  and Clark Expedition, Glendale:  Arthur H. Clark Company, 1980.  pg. 25.  Cous: in subsequent notes.
[2]Coues, pg. 25.
[3] Wheeler, Olin D. as quoted in:  Chuinard, E. G., M.D.  Only One Man Died:  The Medical Aspects of the Lewis
                  and Clark Expedition, Glendale:  Arthur H. Clark Company, 1980.  pg. 25.   Wheeler was writing in 1904. 
                  Wheeler in subsequent notes.
[4] Moulton, Gary.  The Journals of the Lewis and Clark Expedition:  Introduction (on-line).  5 April 2004.
  <http.lewisandclarkjournals.unl.edu> pg. 4. Moulton in subsequent notes.
[5] Moulton.  pg. 4.
[6] Chuinard, E. G., M.D.  Only One Man Died:  The Medical Aspects of the Lewis and Clark Expedition, Glendale:
  Arthur H. Clark Company, 1980.  pg. 27.  Chuinard in subsequent notes.
[7] Ambrose, Stephen E.  Undaunted Courage:  Meriwether Lewis, Thomas Jefferson and the Opening of the West:
                 New York:  Simon and Schuster, 1996.  pg. 40, 59.  Ambrose in subsequent notes.
[8] Ambrose.  pg. 23.
[9] Ambrose.  pg. 23.
[10] Chuinard.   pg. 107.
[11] DeVoto, Bernard.  The Journals of Lewis and Clark.  Boston:  Houghton Mifflin Company, 1981.  pg. 135.
 DeVoto in subsequent notes.
[12] De Voto.  pg. 135.
[13] Peck, D.O. David J.  Or Perish in the Attempt:  Wilderness Medicine in the Lewis and Clark Expedition.  Far
                  Country Press. 2002.  pg. 163.  Peck in subsequent notes.  and DeVoto.  pg. 135. 
[14] Clark’s Journal, as quoted in Chuinard.  pg. 80.
[15] Chuinard.  pg. 79.
[16] Tilton, James, in Economical Observations, as quoted in:  Chuinard, E. G., M.D.  Only One Man Died:  The
 Medical Aspects of the Lewis and Clark Expedition, Glendale:  Arthur H. Clark Company, 1980.  pg. 80.
[17] Tilton, in Chuinard.  pg. 40.
[18] Chuinard.  pg. 39.
[19] Chuinard.  pg. 39.
[20] Peck.  pg. 33.
[21] Peck.  pg. 33.
[22] Anderson, Ann.  Snake Oil Hustlers and Hambones:  The American Medicine Show.  North Carolina:  McFarland
                 & Company, Inc.  2000.  pg. 21.  Anderson in subsequent notes.
[23] Anderson.  pg. 21.
[24] Anderson.  pg. 21.
[25] Anderson.  pg. 27.
[26] Chuinard.  pg. 52.
[27] Chuinard.  pg. 51.
[28] Chuinard.  pg. 51.
[29] Rush, Benjamin.  The Autobiography of Benjamin Rush.  New Jersey:  Princeton University Press. 1948.  pg. 35. 
                  Rush in subsequent notes.
[30] Rush. pg. 36.
[31] Rush.  pg. 36.
[32] Rush. pg. 38.
[33] Miller, Brandon and Marie.  Just What the Doctor Ordered.  Minneapolis:  Lerner Publications Co., 1997, pg. 27.
                  Miller in subsequent notes.
[34] Miller.  pg.  29.
[35] Miller.  pg. 30.
[36] Peck.  pg. 40.
[37] Anderson.  pg. 21.
[38] Porter, Roy.  The Greatest Benefit to Mankind:  A Medical History of Humanity.  New York:  W.W. Norton &
Company.  1997.  pg. 290.  Porter in subsequent notes.
[39] Porter. pg. 290
[40] Risjord, Norman K.  The Revolutionary Generation.  New York:  Rowman & Littlefield Publishers, Inc. 2001.
  pg. 183.  Risjord in subsequent notes.
[41] Peck.  pg. 41.
[42]Peck., pg. 180, and  Porter.  pg. 290.
[43] Risjord.  pg. 187.
[44] Risjord.  pg. 180.
[45] Risjord.  pg. 180.
[46] Miller.  pg.  36.
[47] Peck.  pg. 45.
[48] Peck., pg. 45
[49] Anderson.  pg. 23.
[50] Ambrose.  pg. 89.
[51] Anderson.  pg. 23.
[52] Miller.  39.
[53] Peck.  pg. 45.
[54] Risjord.  pg. 199.
[55] Risjord.  pg. 199.
[56] Miller.  pg.   39.
[57] Peck.  pg. 46-47.
[58] “Benjamin Rush”, University of Virginia Health System (On Line).  pg. 1.
[59] Peck. pg. 49.
[60] Peck.  pg. 45.
[61] Peck. pg. 51.
[62] Peck. pg. 51.
[63] Peck. pg. 52.
[64] Peck. pg. 52.  A list of the medical items gathered by Lewis can be found in Appendix B.
[65] Peck. pg. 55.
[66] Peck. pg. 55.
[67] Rush, uses the term “costiveness” in his list.  In the Oxford English Dictionary, the term is defined as “constipation”.
[68] Jackson, Donald.  Letters of the Lewis and Clark Expedition:  with related documents 1783-1854.  Urbana:
 University of Illinois Press, 1962.  pg. 54.  The complete list of rules is found in Appendix C.
[69]Peck.  pg. 93-95. 
[70] Peck. pg. 93.
[71] Peck.  pg. 129-130.  and  DeVoto.  Pg. 78
[72] DeVoto.  pg 141-146.
[73] DeVoto.  pg  141.
[74] DeVoto.  pg. 241.
[75] Barth, Gunther.  The Lewis and Clark Expedition:  Selections from the Journals, Arranged by Topic.  Boston:
 Bedford/ St. Martin’s Press, 1998.  165.  Barth in subsequent notes.
[76] Barth.  pg.  165.
[77] Barth. pg. 166-167.
[78] Barth. pg. 166-167.
[79] Barth. pg. 168.
[80] Barth. pg. 168.
[81] Barth. pg. 168.
[82] Barth. pg. 169
[83] Peck.  pg. 118.
[84] Peck.  pg. 118.
[85] Peck. pg. 118.
[86] Peck. pg. 118
[87] Peck. pg. 118
[88] Brodie, Janet Farrell.  Contraception and Abortion in 19th Century America.  New York:  Cornell University
Press.  pg. 205-211.  and  Tone, Andrea.  Devices and Desires:  A History of Contraceptives in America. 
New York:  Hill and Wang, 2001.  pg. 51.  Brodie and or Tone in subsequent notes.
[89] Brodie.  pg. 205-211.  Condom recipes allowed farmers who butchered their own animals to make the prophylactics from animal intestines and lye, the process was fairly simple.
[90] DeVoto.  pg. 21.
[91] Chuinard.  pg. 27.
[92] Journal of Patrick Gass as quoted in,  Peck.  pg. 103.
 
[93] Peck.  pg. 60.