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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!

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