In Meriwether Lewis, Thomas Jefferson found many of the traits required to prepare for and lead an Expedition from nearly one end of North America to the other, over about 8000 very rough miles (1-3). In scientific respects Lewis was lacking initially, but he was eager, a good observer and educable, and who better to provide all means but Mr. Jefferson himself, scientist, inventor, member of the American Philosophical Society of Philadelphia, and much, much more.
Lewis lacked sufficient scientific knowledge in botany, biology, astronomy, cartography and so forth at the outset. He lacked know-how of the Scientific Enterprise, the rigorous recording of data. By 1804, however, the American Philosophical Society of America already saw fit to make him a member among those elite who had been his teachers. (They did not so acknowledge William Clark, his co-leader, at any time.) Beyond that, Lewis also had the rough skills of a frontiersman, and he did not lack the "courage undaunted" and desire and will to accomplish the assignment just as Jefferson envisioned it. Mr. Jefferson described Lewis with the preceding compliment, "courage undaunted," and more, in his "Memoir of Meriwether Lewis," dated August 18, 1813 (1,3).
Nor, for the period, did Lewis lack the requisite skills to be "physician" to his Corps of Discovery. Jefferson seems to have had as much, if not more, confidence in the Expedition's captains to act as "physicians" as he had in the so-called, recognized physicians of the day (2). Cutright suggests that this view was held on the basis of Lewis's knowledge of herb therapy from his mother and Jefferson's own negative experiences with purging and blood-letting doctors. Purging was practiced in all manner of ways. The lancet was much the most frequently used instrument for blood-letting. If these measures make us cringe today, they were perhaps no less draconian than chemotherapy of modern times. A good Inquiry project would be to enumerate the side effects of chemotherapy and compare them side-by-side to those of purging.
When Lewis was in Philadelphia in May/June 1803 to complete his training and to make key purchases of instruments and goods, including thirty different kinds of drugs, he visited with the eminent Dr. Benjamin Rush to gain his advice, as requested by Jefferson (2,3). Rush, who was aware of Jefferson's skepticism (4), was particularly in favor of prescribing all-purpose purging pills of his own design, containing a mixture of calomel, mercurous chloride or HgCl, and jalap (3), a dried root from Mexico. Each is a purgative.
Lewis acquired, and shipped by wagon to Pittsburgh, supplies that included, notably, Dr. Benjamin Rush's purging "thunderbolts," Peruvian bark, jalap, opium, Glauber's salt, saltpeter, laudanum, calomel, tartar emetic, mercurial ointment, tourniquets, syringes, lancets, and forceps (2,3). Reference (5) describes these medicines (5). Peruvian bark comes from the cinchona evergreen tree of Central and South America. It is the source of quinine for treatment of malaria, whose use for alleviating fever dates to 1638. Opium is the milky juice of unripened poppy seeds. Morphine is the active ingredient. Use dates to 4000 B.C. in Sumeria and Europe. Laudanum is a tincture of opium. It was first prepared in the 16th century and was used for a variety of disorders through the 19th century. Glauber's salt is Na2SO4·10H2O. It is a mild laxative known since the 17th century. Saltpeter is KNO3 and was used as a diuretic. Tartar emetic is KSbC4H4O7·1/2 H2O and, among others, is toxic. Calomel was used to treat syphilis by ingestion in the form of a pill. Syphilis was a very common malady of the Corps (3), and its treatment with calomel does have serious side effects, known best by the example of the literary "Mad Hatter" of Alice in Wonderland.
Both Lewis and Clark administered these drugs to the Corps, and to the Indians at times. Lewis and Clark also are known to have done more serious doctoring, namely amputation of frostbitten toes (3). They were not known to have had a surgical saw, so this must have been a crude operation by any current standard (6).
The medical practices of 200 years ago were clearly less informed than those of today. The practice of blood-letting, to which even the leading physician of the day, Benjamin Rush, vigorously subscribed, was given vague credibility for treatment of maladies based on the manifestation of pulse rate (6). Lacking sufficient data, as was so at the time, science does sometimes go astray, and non-science even the more so. If doctors of Lewis's and Clark's time were invested in purgatives and blood-letting, it is because they did not know to ascribe illnesses to bacteria and viruses. The celebrated French chemist, Louis Pasteur, attributed organic decay to air-borne microorganisms later in the 19th century, which, in turn, led him to the powerful insight and proposition that germs cause disease (http://scienceworld.wolfram.com/biography/Pasteur.html).
Sterilization of medical instruments by heating was an outcome that he sought to encourage. Penicillin was later discovered in 1928 and streptomycin in 1943 (7), and so doctors now treat illnesses with a wide variety of synthetic, antibiotic drugs unknown to Pasteur. Moreover, as a consequence of the unraveling of the DNA structure in the mid-20th century by James Watson and Francis Crick (8,9), medicine has advanced to the next level, genetic engineering. Medicine today is much advanced from what it was only 200 years ago.
Nevertheless, as the title of Chuinard's book (6) indicates, these frontier doctors did quite well with what they had and what they knew. The one man of Only One man Died was Sergeant Charles Floyd, who has been theorized to have died as the result of an attack of appendicitis (6). If so, no physician of the time could have treated him effectively. "It was not long after the Lewis and Clark Expedition that appendicitis was recognized, but a long time before it was to be treated successfully (6)."
In the practice of medicine, as in much else, Lewis and Clark are to be judged by the largely successful result after a long time away from their civilization. Inquiry project: To be successful on a space expedition in the early 21st century, what would you pack on board, and what type of physician(s) would you want on board?
1. Coues, Elliott, ed., The History of the Lewis and Clark Expedition, Vol. I - III, New York: Dover Publications (1987 reprint of Francis P. Harper's unabridged 1893 edition).
Cutright, Paul Russell, Lewis & Clark: Pioneering Naturalists,
Lincoln, NB: University of
3. Ambrose, Stephen E., Undaunted Courage, New York: Simon & Schuster (1996).
4. Malone, Dumas, Jefferson and His Time: Jefferson the President, First Term, 1801-1805, Vol. 4 of Vols. 1-6, Boston: Little, Brown and Company (1970), pp. 184-189..
Harris, William H. and Levey, Judith S., eds., The New Columbia Encyclopedia,
6. Chuinard, Eldon G., Only One Man Died: The Medical Aspects of the Lewis and Clark Expedition, Fairfield, WA: Ye Galleon Press (1999), pp. 128-129, 238-239, 268.
7. Grun, Bernard, The Timetables of History (based on Werner Stein's Kulturfahrplan), New York: Simon & Schuster (1975).
8. Watson, James. D., The Double Helix, Markham, ON: Penguin Books Canada (1968).
9. Judson, Horace F., The Eighth Day of Creation, New York: Simon and Schuster (1979).