“I Gave Him Barks and Saltpeter...”

On February 23, 1803, Thomas Jefferson wrote the following letter to Dr. Benjamin Rush, professor of the Institute of Medicine at the University of Pennsylvania and the foremost American physician of his day:

Dear Sir: I wish to mention to you in confidence that I have obtained authority from Congress to undertake the long desired object of exploring the Missouri & whatever river, heading with that, leads into the Western ocean. About 10 chosen woodsmen headed by Capt. Lewis my secretary will set out on it immediately & probably accomplish it in two seasons. … It would be very useful to state for him those objects on which it is most desirable he should bring us information. For this purpose I ask the favor of you to prepare some notes of such particulars as may occur in his journey & which you think should draw his attention & enquiry. He will be in Philadelphia about 2 or 3 weeks hence & will wait on you.

As Jefferson stated to Rush, he had just obtained from Congress the necessary authorization to send a party to explore the unknown reaches of the Missouri River and to find a route to the Pacific. To lead this parly he had selected Captain Meriwether Lewis—who would, in turn, ask William Clark, the brother of George Rogers Clark, to share the demanding duties of command. Jefferson’s letter to Dr. Rush also suggests that the President, who planned each step of the expedition with almost preternatural care, gave no serious thought at any time to engaging the services of a physician, being content to let Lewis and Clark handle whatever ills and miseries might befall the party.

This decision may have been made easier by his familiarity with Lewis’ family background. Lewis’ mother was a well-known Virginia herb doctor who had her own herb garden, grew and dispensed her own simples, and ministered regularly and faithfully to the sick of Albemarle County. Lewis shared his mother’s interest in herbs and herb therapy and had acquired much of her knowledge. Clark also had medical training of sorts. Like Lewis, he carried in his head the usual frontiersman’s storehouse of medical information: how to set a broken limb or remove an imbedded bullet, how to cope with croup, dysentery, and a wide range of other ailments. Being often closer to disease and disaster than to doctors, he found it imperative to know such things.

As Jefferson originally planned it, the expedition was too small to include a doctor; but his willingness to entrust medical matters to Lewis and Clark was no doubt also inspired by his own lack of sympathy with the physicians of his day. Living in the era of depleting remedies—purges, vomits, sweats, blisters—and of the bloodletting lancet, which was still by far the most-used medical instrument, Jefferson had good reason to distrust doctors. And yet, he did not hesitate to ask Dr. Rush to advise Lewis on medical matters relating to the expedition. Not long after the President had done so, Rush wrote back to say that he had furnished Lewis with “some inquiries relative to the natural history of the Indians,” and “a few short directions for the preservation of his health.” The latter present an interesting lesson in personal hygiene as it obtained early in the last century:

When you feel the least indisposition, do not attempt to overcome it hy labour or marching. Rest in a horizontal posture. Also fasting and diluting drinks for a day or two will generally prevent an attack of fever. Io these pre ventatives of disease may be added a gentle sweat obtained by warm drinks, or gently opening the bowels by means of one, two, or more of the purging pills.

Unusual costiveness [constipation] is often a sign of approaching disease. When you feel it take one or more of the purging pills. Want of appetite is likewise a sign of approaching indisposition. It should be obviated by the same remedy.

In difficult and laborious enterprises and marches, eating sparingly will enable you to bear them with less fatigue & less danger to your health.

Flannel should be worn constantly next to the skin, especially in wet weather.

The less spirit you use the better. After being wetted or much fatigued, or long exposed to the night air, it should be taken in an undiluted state …

Molasses or sugar & water with a few drops of the acid of vitriol [sulphuric acid] will make a pleasant & wholsome drink with your meals.

After having had your feet much chilled, it will be useful to wash them with a little spirit.

Washing the feet every morning in cold water, will conduce very much to fortify them against the action of cold.

After long marches, or much fatigue from any cause, you will he more refreshed hy lying down in a horizontal posture for two hours, than by resting a longer time in any other position of the body.

Rush would have been pained to learn how many of these rules Lewis and Clark totally disregarded. They ignored his injunctions to rest for two whole hours in a horizontal position with each indisposition and to waah their feet in cold water every morning. The idea of fasting to make difficult marches less fatiguing held no appeal for them whatever. Nor do we find in any of the journals mention of that “pleasant & wholsome” drink compounded of sweetened water and sulphuric acid.

Lewis and Clark’s original budget was $2,500. Of this total, $90.69 went for medicines. According to one calculation, their purchases included 1,300 doses of physic, 1,100 of emetic, 3,500 of diaphoretic (sweat-inducer), and fifteen pounds of febrifuge (fever-reducer), not to mention si/able amounts of drugs for blistering, salivation, and increased kidney output. Thus equipped with everything from camphor and calomel to tourniquets and clyster syringes, the medical team of Lewis and Clark seemed ready for almost any contingency.

Their historic journey to the Pacific began at the frontier town of St. Charles, Missouri, on May 21, 1804. The expedition, consisting of some forty men, travelled in three vessels, a fifty-five-foot keelboat and two smaller craft called pirogues. Lewis and Clark would not see St. Charles again until September 21, 1806, two years and four months later.

They were a month and a hall out of St. Charles before they encountered their first potentially serious medical problem. On Wednesday, July 4, 1804, Clark wrote: “ussered in the day by a discharge of one shot from our Bow piece … passed the Mouth of a Bayeau … Came to on the L.S. [larboard side] to refresh our selves & Jos. Fields got bit by a Snake.”

This incident occurred north of present-day Atchison, Kansas, near the mouth of a small stream which Lewis and Clark, in honor of the day, called Independence Creek, the name it still bears. The snake that bit Joseph Fields was apparently innocuous. But since the party was now on unfamiliar terrain where snakes might belie their appearance, Lewis took no chances when he treated Fields, and applied a poultice of bark and gunpowder.

The frontiersman of that day employed many rem edies for snake bite, their very multiplicity affording the best evidence possible that none was entirely ef lective. Mark Twain was conversant with one of the most common. Readers of Huckleberry Finn will recall how Nigger Jim, after being struck by a rattler, grabbed the whiskey jug and “begun to pour it down.” This was one remedy the victims of snake bite found inviting, and great faith was placed in its ability to neutralize snake venom. Doctors as well as laymen re garded it as a sure-fire antidote. This belief was not only false but dangerous: by speeding the flow of blood, alcohol only hastens distribution and absorption of the venom.

The great majority of the remedies employed for snake bite were in the form of poultices. Favorite materials included garlic, onions, radishes, freshly chewed tobacco, and’ a wide range of other plants. Poultices of bark and gunpowder, such as Lewis applied, also were used. A poultice today is something of an anachronism, like the powder horn and the pot-bellied stove. As a general rule it consisted of a warm mass of a glutinous or oleaginous material—bread, lard, corn meal, bran, macerated plant material—which, combined with substances of reputed therapeutic value, was spread on a small piece of cloth and applied to the afflicted part. Doctors of the day thought that poultices would not only draw out the poison or other cause of inflammation but also act as a painkiller, antiseptic, and counterirritant. In those days, panaceas were almost as common as infirmities.

The bark employed by Lewis in treating Joseph Fields could have been that of the slippery elm ( Ulmus fulva ), the inner part of which is mucilaginous and was much used in poultices during the last century. But Lewis and Clark had with them fifteen pounds of pulverized Peruvian bark (cinchona), and when anyone used the word “bark” in those days, it almost always meant cinchona.

Cinchona, which contains quinine, was used for a wide assortment of diseases and afflictions, ranging from measles, dysentery, and dropsy to carbuncles and “ill-conditioned ulcers.” One-third of Lewis and Clark’s medical outlay had gone into pulverized Peruvian bark, an indication of their high regard for it.

The seventh of July, 1804, along that part of the wide Missouri just below the mouth of the Platte must have been a day of pitiless, penetrating heat. Clark wrote: “one man verry sick, Struck with the Sun, Capt. Lewis bled him & gave Niter which has revived him much.”

The niter employed here in treating sunstroke was potassium nitrate, better known as saltpeter. Even today its usefulness as a diuretic and diaphoretic—for increasing urine discharge and inducing sweats—is recognized, though other drugs are more commonly employed for those purposes. Lewis and Clark had two pounds of saltpeter with them and used it in treating a variety of unrelated disorders.

Saltpeter may have been a relatively harmless remedy, but bloodletting was not—in fact, it may well have killed more patients than it cured. For centuries, beginning even before Hippocrates and continuing almost to the present, doctors believed that practically every malady known to man, from pleurisy and scarlatina to bilious fevers and bubonic plague, could be treated effectively by drawing off blood. The practitioners of this sanguinary art included not only the physician but also the apothecary, the bath keeper, even the barber—hence the blood-red stripes on his barber pole. Many used leeches, and were known as leech doctors, while others insisted on the sharp-edged lancet. Some had a device known as a scarificator, a box-shaped instrument that made several incisions instead of the lancet’s one.

Regardless of what instrument he used, the blood-letter meant business. Disease was serious and demanded vigorous action. With a few, the stock apothegm was, “Bleed until syncope,” which meant in essence, draw blood until the patient is unconscious. Those who survived did so, of course, in spite of bleeding; today doctors rarely resort to the treatment. It is sometimes indicated in polycythemia vera, a rare disease in which the number of red blood cells has increased abnormally, and in certain grave heart and lung disorders where reducing blood volume is beneficial. Too, bleeding occasionally does seem beneficial for sunstroke. According to Dr. William Osier, the famous teacher at Johns Hopkins, “In the cases in which the symptoms are those of intense asphyxia, and in which death may take place in a few minutes, free bleeding should be practiced …” But whether or not the treatment helped the sunstroke victim of the Lewis and Clark expedition, it is impossible to say.

Soon after, however, tragedy struck for the first and only time during the whole journey to the Pacific and back. On July 31, just above the mouth of the Platte, Sergeant Charles Floyd noted in his journal, “I am verry Sick and Has been for Sometime but have Recovered my helth again.” But his recovery was only temporary. Three weeks later, on August 19, Clark wrote: “Serjeant Floyd is taken verry bad all at once with a Biliose Chorlick we attempt to relieve him without success as yet, he gets worst and we are much allarmed at his Situation …” Nothing, Clark said, would “Stay a moment on his Stomach or bowels.”

The next day Sergeant Floyd died, probably of a ruptured, gangrenous appendix. The journals reveal nothing of measures attempted to save his life. The odds are that Lewis both bled Floyd and purged him with laxatives. If he did the latter, it may well have hastened Floyd’s death, either by rupturing the appendix or by adding to the inflammatory material already in the peritoneal cavity. In any event, Lewis’ efforts were to no avail; probably the best medical talent of that day could not have saved the sergeant, for surgery then was almost entirely limited to the surface of the body. It was not until 1887 that the first appendectomy was performed by Dr. John Morton in Philadelphia.

The Lewis and Clark expedition passed the first winter in a hastily built but sturdy stockade, Fort Mandan, near the mouth of the Knife River, about fifty-five miles above the present Bismarck, North Dakota. Here, for six months, they lived surrounded by some 4,000 aboriginals—Mandans and Minnetarees (Hidatsas). From the very beginning, these Indians exceeded the bounds of what white men considered conventional hospitality. To the explorers they proffered not only corn, beans, and squash but also wives, daughters, and sisters. To them, as to many other Indian tribes, this was no deviation from rectitude; it was an old, established, and entirely respectable custom. However, even for the Indians there were limits to hospitality, and as the long winter wore on, many of the “squars” began to sell their “favors” for a string of beads, a looking glass, or a piece of ribbon.

Though the Indian men had no scruples about farming their wives out for the night, they were properly resentful if their offers were turned down without good reason. However, the evidence seems firm that Lewis and Clark themselves refused all such offers. It is most unlikely that they would have cheapened themselves in the eyes of their men in this manner and thus jeopardized the success of their mission.

Lewis and Clark had little to say in their journals about the sexual relations between soldiers and squaws, or about the sordid sequelae. On January 14, 1805, at Fort Mandan, Clark noted: “Several men with the venereal cought from the Mandan women.” And, a few days later: “one man verry bad with the pox [ i.e. syphilis].” Again, on March 30, as the expedition prepared to resume the ascent of the Missouri: “Generally helthy except Venerial Complaints which is verry Common amongst the natives and the men Catch it from them.”

The expedition leaders had anticipated venereal disease. Both men had served previous enlistments in the Army, and they knew something of the appetites and frailties of the average soldier. Thus, they carried ample supplies of mercury ointment, calomel (mercurous chloride), balsam copaiba, and saccharum saturni (sugar of lead), and they had armed themselves with four pewter urethral syringes. Lewis and Clark, however, make mention only of mercury in their treatment of venereal disease, which meant either mercury ointment or calomel or both. (Dr. Rush regarded mercury as the “Samson of the Materia Medica” in the treatment of syphilis.)

As is well known, syphilis manifests itself in three stages: a primary one extending from the appearance of the initial sore, a small red papule, or chancre, until the onset of constitutional symptoms; a secondary stage characterized by skin eruptions (the pox); and the tertiary, which shows up much later, often years after the original infection, in the form of general paresis, locomotor ataxia, or other equally grave disorders.

It is highly unlikely that Lewis cured any syphilitic cases using mercury. This drug may have been effective in clearing up evidences of the primary and secondary stages, but hardly the third. But it is obvious from his statements that Lewis believed that he had cured this disease in his men. For instance, on January 27, 1806, while camped at the mouth of the Columbia River, he said, “Goodrich has recovered from the Louis Veneri [ lues venerea ] which he contracted from an amorous contact with a Chinnook damsel. I cured him as I did Gibson last winter by the use of mercury.” However, we note that six months later he admitted: “Goodrich and McNeal are both very unwell with the pox which they contracted last winter with the Chinook women.”

Another tragic incident had its beginning late one afternoon when an Indian arrived at the fort and was much distressed not to find his thirteen-year-old son there. That night, one of the coldest of the winter, the temperature dropped to forty below. In the morning, with the boy still missing, the Indians of the lower village turned out en masse to hunt for him. At about ten o’clock the boy limped into the fort and reported that he had spent the night in the snow protected only by a buffalo robe. Luckily he had survived, though his feet were badly frozen. A week later Lewis had to turn surgeon when it became necessary to amputate the toes on one of the boy’s feet.

In this operation, if Lewis followed custom, he seared the cut surfaces with a hot iron. This was done to stop hemorrhage rather than to sterilize. With frozen members, however, there was ordinarily a minimum of bleeding if the surgeon cut through the dead tissue immediately beyond the living flesh. Lewis did not sew up the wounds as would be done today. If he had been cutting off a leg above the knee, for example, he might have taken two or three stitches, but not in minor surgery such as the removal of toes. Wounds were never sewed tight then, because they had to be left open to drain and to allow them to heal from inside out. All surgical steps—excision, cauterization, suturing—were taken, of course, without the aid of anaesthesia: back in the “good old days” surgery was a soul-scarring ordeal.

One of the most memorable events of that winter at Fort Mandan was the appearance of Sacagawea, the Bird Woman, whose name has become almost as familiar to present-day Americans as that of Pocahontas. Sister of a Shoshone chief, she was captured in 1800 by a war party of Minnetarees from the Knife River. In the attack, which took place at Three Forks, Montana, the Minnetarees killed several of the Shoshones and took Sacagawea and a number of other girls and boys prisoner. Some time later, a French trader, Toussaint Charbonneau, made her his wife. Since Charbonneau could speak the language of the Minnetarees, Lewis and Clark hired him as an interpreter. They also took along Sacagawea, thinking that she might be of value to them once they reached her people.

On February 11, 1805, Sacagawea gave birth to a son. Lewis, whose obstetrical role was a minor one, described the delivery:

It is worthy of remark that this was the first child which this woman had boarn, and as is common in such cases her labour was tedious and the pain violent; Mr. Jessome [René Jessaume, a Frenchman the expedition hired as an interpreter in the Mandan country] informed me that he had frequently administered a small portion of the rattle of the rattlesnake, which he assured me had never failed to produce the desired effect, that of hastening the birth of the child; having the rattle of a snake by me I gave it to him and he administered two rings of it to the woman broken in small pieces with the fingers and added to a small quantity of water. Whether this medicine was truly the cause or not I shall not undertake to determine, but I was informed that she had not taken it more than ten minutes before she brought forth, perhaps this remedy may be worthy of future experiments, but I must confess that I want faith as to its efficacy.

The child was christened Jean-Baptiste, though nicknamed Pomp (short for Pompey). Later Clark called a prominent rock formation on the Yellowstone, Pompey’s Pillar. Pomp, with his mother and father, travelled with the party from Fort Mandan to the Pacific and back. He was seriously ill only once, when he was fifteen months old. On May 22, 1806, beside the Clearwater River, as the expedition waited for the melting of the snows in the Bitterroot Mountains, Lewis wrote:

Charbono’s Child is very ill this evening; he is cuting teeth, and for several days past has had a violent lax, which having suddonly sloped he was attacked with a high fever and his neck and throat are much swolen this evening. We gave him a doze of creem of tartar and flour of sulpher and applyed a poltice of boiled onions to his neck as warm as he could well bear it.

Most probably Pomp’s trouble was tonsillitis complicated by an infected cervical lymph gland. Lewis and Clark brought him around using not only cream of tartar, flowers of sulphur, and onion poultices but also clysters (enemas) and a plaster of basilicon which was, in Clark’s words, “a plaster of sarve [salve] made of the rozen of the long leafed pine, Beeswax and Bears oil mixed.”

Cream of tartar (potassium bitartrate) is both diuretic and cathartic. It is best known as an ingredient of baking powder. Combining it with flowers of sulphur, an excellent fungicide and insecticide, would not have altered its effect. Lewis and Clark probably would have used plain warm water, or water with soap, in the enemas they gave Pomp.

Two months after the party left Fort Mandan, Sacagawea herself took sick and nearly died. Her illness, which neither Lewis nor Clark could positively diagnose, occurred on that stretch of the Missouri immediately above the mouth of the Marias River, in presentday Montana. Since Lewis had gone ahead to look for the Great Falls of the Missouri, Clark had charge of her case at first. He seems to have had no idea what was wrong with her, but he was attentive and did all he could. On the first day he bled her, and on the next, her condition having failed to improve, he bled her again. The operation, he noted, “appeared to be of great service to her.” On the fourth day he gave her “a doste of salts,” which seemed to be of no help at all, for the next morning she was “excessively bad” and her case “somewhat dangerous.” She complained of abdominal pain and was “low spirited.” Clark applied a bark poultice to “her region.”

When Lewis rejoined the main party, he found Sacagawea’s pulse rapid, irregular, and barely perceptible, and her condition “attended with strong nervous symptoms, that of the twitching of the fingers and leaders of the arm.” He immediately took charge. He continued the “cataplasms [poultices] of bark and laudnumn” instituted by Clark and ordered a cask of mineral water brought from a spring on the opposite side of the river. He had great faith in the efficacy of this water, since it was highly impregnated with sulphur and “precisely similar to that of Bowyer’s Sulphur Spring in Virginia.” He had Sacagawea drink freely of it and by evening was gratified to find her pulse stronger and more regular, her nervous symptoms somewhat abated, and her abdominal pain less severe. He believed that her trouble “originated principally from an obstruction of the mensis [menstrual fluid] in consequence of taking cold.”

The next morning Sacagawea was so far improved that she asked for food and ate as heartily as Lewis would permit of “broiled buffaloe well seasoned with pepper and salt and rich soope of the same meat.” To the medicine already prescribed, Lewis now added fifteen drops of oil of vitriol, and considered her in “a fair way to recovery.” And she no doubt would have been if her husband, who had been given specific orders to watch her, had prevented her from downing a meal of white apples and dried fish, as a result of which her pains and fever returned. After employing army language to tell Charbonneau what he thought of him, Lewis went to work on his patient again, prescribing “broken dozes of diluted nitre [saltpeter] untill it produced perspiration and at 10 P.M. 30 drops of laudnumn.” The latter was, of course, a tincture of opium, widely used in those days to deaden pain and induce sleep. Lewis’ customary dose of thirty drops, about two cubic centimeters or one-half teaspoon, was not a big one; its effect would probably be similar to that of a quarter-grain injection of morphine.

Although from here on the Indian woman’s recovery was rapid and uncomplicated, her case seems to have been a prime example of the patient’s recovering in spite of the treatment. Certainly the purging and bleeding could have had no effect upon the cure except to retard it. How much blood Clark withdrew is speculative. Some of the doctors of the day removed only four to eight ounces; others were not satisfied until they had siphoned off from a pint to a quart. Only a few casehardened dissidents were dead set against withdrawing any at all. The removal of a quart is enough to cause grogginess in an individual, and taking any more induces fainting spells. Phlebotomists probably did not often measure the blood accurately; when they had taken what they thought was enough they applied a tight bandage to stop the flow. Very serious infection sometimes set in at such wounds, and it was by no means unheard of to have the patient die as a result.

One harmful effect of excessive bleeding is to reduce the quantity in the blood of calcium, magnesium, and potassium. The muscle twitching reported by Lewis in Sacagawea may very well have been induced by a deficiency of such important minerals. Also, bleeding in conjunction with purging and fever produces dehydration. If the considerable amount of mineral water Lewis had his patient drink benefited her at all, it was because it relieved dehydration and restored vital minerals.

The journals carry many references to dysentery and constipation, “cholick & griping,” “lax” and “relax,” “heaviness of the stomach”—all debilitating conditions referable to the gastrointestinal tract. Happily for Lewis and Clark, Missouri River water was not then the devil’s brew of topsoil, sewage, and industrial waste it is today. They drank it neat for months on end. Only now and then did they suspect that it might be the cause of any of their gastric or intestinal troubles.

For disorders of the digestive tract, Lewis and Clark dispensed pills and doses of salts as they saw fit. On May 4, 1805, above the mouth of the Yellowstone, Lewis wrote, “Joseph Fields was very sick today with the disentary had a high fever I gave him a dose of Glauber salts, which operated very well, in the evening his fever abated and I gave him 30 drops of laudnum.” Glauber’s salt (from J. R. Glauber, the German chemist who originally prepared it) was sodium sulphate and was, like Epsom salts, a well-known physic. Lewis and Clark had six pounds of it, which cost ten cents a pound, and they did not hesitate to use it.

Early in June, 1805, Lewis, with four of his best men, left the mouth of the Marias River and started on foot up the north bank of the Missouri. Clark and the rest of the party followed by boat. Lewis had been “somewhat unwell with the disentary,” but he set out nevertheless. As the day advanced, he developed a violent pain in the intestines and a high fever. Since the medical supplies had been left with the main party, Lewis “resolved to try an experiment with some simples,” these being the medicinal plants with which any good herb doctor would be familiar. His eyes soon fell on the chokecherry, a small shrub (probably Prunus virginiana ) that he had encountered frequently along the Missouri. He had his men gather a number of the twigs and, after stripping off the leaves, cut the twigs into pieces about two inches in length. These were then boiled in water “untill a strong black decoction of an astringent bitter tast was produced.” At dusk Lewis drank a pint of this, and about an hour later downed another. By ten o’clock he was perspiring gently, his pain had left him, and his fever had abated. That night, all symptoms which had disturbed him having disappeared, he slept soundly. The next morning at sunrise, fit and refreshed, he took another stiff swig of the drink and resumed his march.

In late July the party arrived at Three Forks, that geographically important site in southwestern Montana where the Jefferson, Madison, and Gallatin rivers (as Lewis and Clark named them) unite to form the Missouri. Clark was sick, “with high fever … & akeing.” Upon learning that Clark had not had a bowel movement for several days, Lewis prevailed upon him to bathe his feet and legs in warm water and to take five Rush’s pills, which he had “always found sovereign in such cases.” The next morning, the medicine having “opperated,” Clark felt better.

Rush’s pills, a product of the “genius” of Dr. Benjamin Rush, were well-known in those days and referred to, often with some feeling, as Rush’s “thunderbolts.” Each consisted of ten grains of calomel and fifteen of jalap (a powdered drug prepared from the purgative tuberous root of a Mexican plant of the morning-glory family); they were a powerful physic. Lewis and Clark carried fifty dozen of these pills and, in treating gastrointestinal disturbances, it seems to have been a coin-tossing proposition whether they used the “thunderbolts” or Glauber’s salts.

In mid-September, 1805, Lewis and Clark spent ten arduous days crossing the Bitterroot Mountains to the Columbia watershed. They suffered intensely from fatigue, cold, and hunger. There was great rejoicing when they reached the beautiful valley of the Clearwater River and were greeted by the friendly Nez Percé Indians. Food was again plentiful, but quite different from that to which they had long been accustomed. It consisted almost entirely of such Nez Percé staples as dried salmon and the roots of the camass ( Camassia quamash ), a liliaceous plant whose bulb could be eaten raw or in soups or breads. There was nothing to suggest that more trouble was in the offing—not until Clark found himself “verry unwell all the evening from eateing the fish & roots too freely.”

During the next few days practically every man in the party, including Lewis, was sick, some violently. Excerpts from the journals reveal a sorry state of affairs:

Clark —September 23: Capt Lewis & 2 men Verry Sick this evening.

Clark—September 24: several 8 or 9 men sick … Capt. Lewis scercely able to ride on a jentle horse … I gave rushes Pills to the Sick this evening.

Sgt. Gass —September 24: The men are generally unwell, owing to the change of diet … Captain Clarke gave all the sick a dose of Rush’s Pills, to see what effect that would have.

Sgt. Gass —September 25: The water is soft and warm, and perhaps causes our indisposition more than anything else.

Clark —September 25: when I arrived at Camp found Capt. Lewis verry Sick, Several men also verry Sick, I gave Some Salts and Tarter emetic .

Clark —September 26: Capt. Lewis Still verry unwell. Several men taken Sick on the way down, I administered Salts Pils Galip [jalap] Tarter emetic &c. I feel unwell this evening.

It is quite apparent that the men were in bad shape. With Lewis sick it was incumbent on Clark, himself “unwell,” to take charge. He was an uncertain and much puzzled “doctor,” but that did not deter him from prescribing Rush’s pills “to see what effect that would have,” nor, as the cases multiplied, from taking seriously Hippocrates’ maxim: “Desperate diseases require desperate remedies.”

The cause of the general “lax” among the men is conjectural. The camass roots may have had a purgative effect on one unaccustomed to them, as Lewis and Clark believed. The next spring, as they ascended the Columbia, they tried to avoid eating them. On the other hand, the trouble may have been due simply to a drastic change in diet.

Lewis and Clark could scarcely credit the high incidence of eye troubles among the Indians of the Columbia River basin. Wrote Clark:

The loss of sight I have observed to be more common among all the nations inhabiting this river than among any people I ever observed, they have almost invariably sore eyes at all stages of life, the loss of an eye is very common among them; blindness in persons of middle age is by no means uncommon, and it is almost invariably a comcammitant of old age. I know not to what cause to attribute this prevalent deficientcy of the eye except it be their exposure to the reflection of the sun off the water to which they are constantly exposed in the occupation of fishing.

When the Indians came to Lewis and Clark to have their eyes treated, as they did increasingly in the succeeding months, Lewis had his own special eyewash: “a solution of white vitriol [zinc sulphate] and the sugar of lead [lead acetate] in the proportion of 2 grs. of the former and one of the latter to each ounce of water.” Dropped into the eyes, it brought at least temporary relief.

The prevalence of sore eyes among the natives was not caused by anything as innocent as reflection of the sun from water. It was probably due to trachoma or venereal disease. Both appear to have been common in all stages of development among the Columbia Valley Indians, and in all age groups. Trachoma, a highly contagious form of conjunctivitis characterized by granulations on the conjunctival surfaces, may lead to partial or complete blindness. So may gonorrheal conjunctivitis (ophthalmia neonatorum), which babies can inherit from their mothers at birth.

The journals do not mention Private William Bratton as performing any unusual act of bravery, or being party to any of the more breath-taking moments of the expedition except for once being chased for a mile and a half by a grizzly bear. He was a good soldier and a skilled gunsmith; we would know little else about him if he had not become the only member of the party who was seriously ill for an extended period.

As soon as the expedition reached the Pacific, in mid-November, 1805, Bratton was one of five men detailed to evaporate sea water to obtain salt, the supply of that commodity having been exhausted. Some time later, Lewis and Clark received word that Bratton was “verry unwell,” and five days later he showed up “much reduced” at Fort Clatsop, their newly constructed winter quarters at the mouth of the Columbia. The next day, February 16, Clark wrote, “Bratten is verry weak and complains of a pain in the lower part of the back when he moves which I suppose proceeds from debility. I gave him barks and saltpeter.”

As time went on, however, Bratton’s condition became worse. “He complains,” wrote Lewis, “of a violent pain in the small of his back and is unable in consequence to set up we gave him one of our flanel shirts, applyed a bandage of flannel to the part and bathed and rubed it well with some vollatile linniment which I prepared with sperits of wine, camphor, castile soap and a little laudinum.”

As the time for the return journey drew near, Bratton still remained an invalid. On March 21 Lewis wrote: “Bratton is now so much reduced that I am somewhat uneasy with rispect to his recovery; the pain of which he complains most seems to be seated in the small of his back and remains obstinate. I believe that it is the rheumatism.”

Two days later the expedition left Fort Clatsop and began the long journey back home. Bratton, unable to walk, made the trip to Camp Chopunnish on the Clearwater by boat and by horse. When they arrived, two months later, he was still “verry unwell.” His cure came suddenly, even dramatically. In Lewis’ words:

[Private] John Shields observed that he had seen men in a similar situation restored by violent sweats. Bratton requested that he might be sweated in the manner proposed by Shields to which we consented. Shields sunk a circular hole of 3 feet diamiter and four feet deep in the earth, he kindled a large fire in the hole and heated well, after which the fire was taken out [and] a seat placed in the center of the hole for the patient with a board at bottom for his feet to rest on; some hoops of willow poles were bent in an arch crossing each other over the hole, on these several blankets were thrown forming a secure and thick orning [awning] of about 3 feet high, the patient being striped naked was seated under this orning in the hole and … by that means creats as much steam or vapor as he could possibly bear, in this situation he was kept about 20 minutes after which he was taken out and suddenly plunged in cold water twise and was then immediately returned to the sweat hole where he was continued three quarters of an hour longer then taken out covered up in several blankets and suffered to cool gradually, during the time of his being in the sweat hole, he drank copious draughts of a strong tea of horse mint.

This treatment of alternating heat and cold was effective; it is used successfully in similar cases today. The very next day Bratton was walking about, almost entirely free of pain, and within two weeks he had, Lewis wrote, “so far recovered that we cannot well consider him an invalid any longer, he has had a tedious illness which he boar with much fortitude and firmness.”

The obscure lumbar ailment which Bratton endured for four long months cannot be definitely diagnosed at this late date. Medical men suggest sciatica or infectious arthritis or an inflamed sacroiliac joint. Bratton’s cure was apparently permanent. He fought in the Battle of Tippecanoe and, later, in the War of 1812. In 1819 he married and in time became the father of eight sons and two daughters.

From beginning to end, the members of the expedition suffered from skin infections—boils, tumors, abscesses, and whitlows, these last being inflammations at the ends of the fingers and toes. Such infections could not be avoided. Cuts and skin abrasions which would allow the entrance of germs occurred daily, especially among the boatmen. Theirs was hardly child’s play. In places they toiled waist-deep in water for hours on end, scrambling over sharp-edged rocks which cut moccasins to shreds. At one time Lewis wrote: “Many of them have their feet so mangled and bruised with the stones … that they can scarcely walk or stand; at least it is with great pain that they do either.”

Lewis and Clark, of course, knew nothing of the doctrine of sepsis. Pathogens, such as bacteria, protozoa, and viruses, had yet to be recognized for what they are: almost three-quarters of a century would elapse before the world would know of Louis Pasteur and the germ theory of disease. Physicians of this preantiseptic era treated skin infections with poultices and ointments, and Lewis and Clark followed standard practice. For instance, when Private John Potts’ cut leg became inflamed and painful, Clark applied first a poultice of the root of the “Cowes” ( Cogswellia cous ), an herb of the Northwest, and later, another of “the pounded root & leaves of wild ginger [ Asarum caudatum ] from which he found great relief.” Another time, when an Indian woman showed up with an abscess on the small of her back, Clark opened it and applied basilicon ointment. This was a salve for external application consisting ordinarily of such ingredients as resin, yellow wax, and lard.

Today, it is difficult to evaluate such treatments. If poultices were applied hot, as frequently happened, they may have been of some benefit. Or if they contained a blistering agent, such as Spanish fly (cantharides) or oil of mustard, they would have been effective as counterirritants. It is safe to say that poultices generally did no harm when applied to skin that was still intact.

Just six weeks before the end of the trip, near the mouth of the Little Missouri, Lewis was felled by a bullet which struck him, according to Sergeant John Ordway, “in his back side.” As Lewis described it:

… opposite to the birnt hills there happened to be a herd of Elk … I determined to land and kill some of them accordingly we put too and I went out with [Private Peter] Cruzatte only, we fired on the Elk. I killed one and he wounded another, we reloaded our guns and took different routs through the thick willows in pursuit of the Elk; I was in the act of firing on the Elk a second time when a ball struck my left thye about an inch below my hip joint, missing the bone it passed through the left thye and cut the thickness of the bullet across the hinder part of the right thye; the stroke was very severe; I instantly supposed that Cruzatte had shot me in mistake for an Elk as I was dressed in brown leather and he cannot see very well; under this impression I called out to him damn you, you have shot me, and looked towards the place from whence the ball had come, seeing nothing I called Cruzatte several times as loud as I could …

Receiving no answer, Lewis rushed to the conclusion that he had been shot by Indians. Therefore, though in great pain, he quickly made his way back to the boat, where he ordered the men there to follow him and “give them battle and relieve Cruzatte.” But Lewis’ wound soon became so painful and his thigh so stiff that he could go no farther. The rest of the party went ahead and about twenty minutes later returned, bringing Cruzatte with them. They had encountered no Indians. Cruzatte was blind in one eye and nearsighted in the other; he had shot Lewis unintentionally and, because of embarrassment, had kept quiet when Lewis called to him.

Sergeant Gass helped Lewis introduce “tents of patent lint into the ball holes” and, later that evening, they applied a poultice of Peruvian bark. It was a nasty wound. When Clark first dressed it, Lewis fainted dead away.

In those days a tent consisted of a roll of lint, or linen, unsterilized of course. It was supposed to expedite drainage and, by keeping the surface of the wound open, to insure the formation of new tissue from the inside out. It a tent was not used, wounds tended to heal at the surface, thus precluding drainage. In similar situations, surgeons today sometimes employ rubber tubes of various kinds, called drains, some of which are open, others filled with gauze.

On August 22, eleven days after Lewis had been shot, Clark reported, “I am happy to have it in my power to Say that my worthy friend Capt. Lewis is recovering fast, he walked a little to day for the first time. I have discontinued the tent in the hole the ball came out.” Four days later he removed the tent from the other wound, and by September 9, his worthy friend could “walk and even run nearly as well as ever he could.” And just in time. Two weeks later Lewis was in St. Louis enjoying a hero’s welcome. For that, a man needed two good legs under him.

Lewis and Clark, though not medically trained, were men of obvious talent and vast common sense in whom the spirit of inquiry ran high. Of the two leaders, Lewis was better educated and more knowledgeable, with the logical and deductive mind of a good scientist. He was a man of many moods and sought solitude rather than companionship. Clark, on the other hand, was genial and gregarious, the friend of prince and pauper alike. It was to him the men turned with their problems. If, subsequently, either of the captains had studied medicine, it is reasonable to believe that he would have distinguished himself. Lewis, from what we know of him, would have come nearer being the astute, discerning diagnostician. Clark, certainly, would have had much the better bedside manner.

The one inconvertible fact about the medical practice of Lewis and Clark is that in twenty-eight months of traveling some 8,000 miles in a land of thirsty sands, rampaging rivers, and unpredictable savages, they lost only one man, poor Sergeant Floyd, and the best medical men in the country—even, probably, Dr. Rush—could not have saved him. Thomas Jefferson, it would seem, made no mistake in entrusting the health and welfare, as well as the military command, of the party to these two resourceful, clear-headed frontiersmen. In fact, considering the primitive state of medicine in the world at that time, who can conscientiously insist that the expedition would have fared better in the hands of a qualified doctor than in those of Meriwether Lewis and William Clark?