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18th-century sailors

18th-century sailors: no strangers to scurvy

During the age of exploration and long sea voyages, scurvy was a common malady among men who went for months on an unbalanced, limited diet. Scurvy is a serious disease that occurs when you have a severe lack of vitamin C (ascorbic acid) in your food. The symptoms of scurvy include weakness, fatigue, loose teeth, swollen gums, stinking breath, anemia, skin eruptions and even hemorrhages.

Vitamin C is vital for the health of connective tissues such as collagen, cartilage and bone; it is also critical to the body’s ability to absorb iron for healthy red blood cells. Though Lewis and Clark would not have known about vitamin C and its role in human health, they were certainly aware of the dangers of scurvy, and there is some evidence that they took concrete steps to prevent it during the Expedition.

Jug of vinegar

Vinegar did little to help prevent scurvy

Starting in Revolutionary times, the Continental Army included a daily dose of 4 teaspoons of vinegar in the men’s rations to help prevent scurvy among the troops. It is recorded in the journals  that William Clark obtained “750 rats. [rations] of Soap Candles & vinager” for the Corps of Discovery while at Camp River DuBois in January 1804. Since vinegar is never mentioned again in the journals, it is unknown whether the rations were handed out at Camp River DuBois, taken along on the expedition, or used for some other purpose than scurvy prevention.  In any case, the vinegar would not have helped much. Though cider vinegar is as tangy as lemon juice and would have supplied some of the acid ideally gotten through citrus fruits, it contains no vitamin C and thus would have had little practical effect in preventing scurvy.

A Treatise on the Scurvy by Dr. James Lind, 1753

A Treatise on the Scurvy by Dr. James Lind, 1753

Fortunately for Lewis and Clark, scurvy is not that easy a disease to get. It takes one to three months of complete vitamin C deprivation before the human body begins to show signs of scurvy. For much of the journey, the men were able to find fruits, vegetables, and berries along the trail that would have supplied some much-needed vitamin C. In various entries in the journals, Lewis and Clark mention the men consuming rosehips, plums, chokecherries, serviceberries, and currants. Also, some greens like cattail, lamb’s quarter, and miner’s lettuce are good sources of vitamin C and would have been available at points along the trail.

I did not know (until researching this blog) that some types of meat can also contain vitamin C. Organ meats such as kidneys and liver are sometimes rich in vitamin C, and so are some kinds of fish. So these sources would have also helped supply the much-needed vitamin in the Corps’ diet.

Nevertheless, some scholars believe that Lewis and Clark’s men may have suffered from the beginning stages of scurvy at some points along the expedition.   On May 10, 1805, while traveling through violent winds and sometimes snow in present-day Montana, Lewis wrote:  “Boils and imposthumes have been very common with the party Bratton is now unable to work with one on his hand; soar eyes continue also to be common to all of us in a greater or less degree.” Dr. E. G. Chuinard, author of Only One Man Died: The Medical Aspects of the Lewis & Clark Expedition, suggests that the “boils and imposthumes” may have been an indication of mild scurvy.

Hawthorn berries

Hawthorn berries from the Nez Perce provided desperately needed vitamin C

There can be no doubt that the Corps was badly malnourished when they emerged from the Bitterroot Mountains in September of 1805. Deep snows made the seven-day crossing of the rugged Bitterroot Range a terrible ordeal, and there was no wild game to be found. The Corps was reduced to slaughtering their horses and eating rancid “portable soup” Lewis had purchased back in Philadelphia two years before. During this time, Clark records that skin infections and boils were common among the men, and it would not have been surprising if these were a sign of scurvy. Fortunately, the Corps reached the Nez Perce villages, where the natives supplied hawthorn berries. Later on the Columbia River, they had access to fruits and fish that helped restore the men to health.

Albert Szent-Gyorgyi

Albert Szent-Gyorgi discovered Vitamin C in 1927

While various theories about the treatment of scurvy abounded, the actual cause of the disease remained somewhat poorly understood, and scurvy continued to be a scourge of armies and navies well into the 20th century. It was not until the 1920’s that Hungarian researcher Albert Szent-Gyorgyi isolated a substance known as hexuronic acid, or vitamin C. The connection between the lack of hexuronic acid and scurvy was finally proven in 1932, by American researcher Charles Glen King of the University of Pittsburgh.  Albert Szent-Gyorgyi won the Nobel Prize for his achievement – and renamed his discovery “ascorbic acid” in honor of its antiscorbutic (anti-scurvy) properties.

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Having just endured the hottest, driest summer ever recorded in Central Texas, I admit I feel a certain reverse kinship with Lewis and Clark regarding the long, cold winter they spent at Fort Mandan. The winter of 1805-1805 was bitterly cold on the Dakota frontier. Clark started off the month of December noting in his journal that the days were “cold & windey,” “a Cloudy raw day,” and “a Cold raw morning … with some snow.” On December 6, Clark noted, “The wind blew violently hard from the N, N W. with Some Snow    the air Keen and Cold. The Thermometer at 8 oClock A, M, Stood at 10 dgs. above 0—.”

"Hunting with Sheheke: 'White Coyote' And An Expedition Member Approach Ft. Mandan Winter 1804-1805," by Michael Haynes

"Hunting with Sheheke: 'White Coyote' And An Expedition Member Approach Ft. Mandan Winter 1804-1805," by Michael Haynes

Unfortunately, it was only the beginning. The next day, Clark wrote:

The weather so excesive Cold wolves plenty, we only saved 5 of them, I with a party turned on the 8th out and found the Buffalow at 7 ms. distant    Killed 8 & a Deer, I returned with 2 Cows leaving men with remaining meat—    Several men badly frost bit—    The Themormeter Stood this morning at 44 d. below Breizing [freezing].

With temperatures dipping to – 44°F, frostbite became a major concern for Lewis and Clark. According to Or Perish in the Attempt by Dr. David J. Peck, frostbite occurs when the skin’s temperature drops to 24.8°F, the freezing point of pure, undiluted water. At that point, the fluids inside and outside the skin freeze, blood vessels spasm and leak fluid into the surrounding tissues, and circulation of blood slows down or even ceases altogether. In severe frostbite cases, the tissues are so oxygen-starved that major tissue damage occurs and the tissues can actually “die.” In milder cases, the skin becomes red, swollen, blistered, and extremely painful.

1804 was long before the age of Gore-Tex, silk underwear, and goose-down coats. Lewis and Clark’s men had only buckskins, flannel shirts, wool trousers and army coats to protect them from the severe cold, putting them at serious risk. Furthermore, because of the necessity of hunting, guard duty, and fatigue work, they could not always limit their exposure to the damp, blustery winds, deep snow, and sub-zero temperatures. Despite Lewis and Clark’s measures to protect them – the captains rotated Fort Mandan’s guards every half-hour at one point — many of the men suffered from frostbite on their hands, feet, and ears. At one point, poor York was even forced to contend with “a little” frostbite on his penis. It was no wonder. On December 17, Clark recorded a mind-blowing, bone-shaking 74° below zero.

Winter at the Mandan villages, 1804-1805

Winter at the Mandan villages, 1804-1805

Under such extreme conditions, Lewis and Clark’s men were not the only ones suffering from the colder-than-average temperatures. The Native Americans were also feeling the cold. Clark reported on January 10, 1805:

The Indians of the lower Villages turned out to hunt for a man & a boy who had not returnd from the hunt of yesterday, and borrowd a Slay to bring them in expecting to find them frosed to death    about 10 oclock the boy about 13 years of age Came to the fort with his feet frosed and had layen out last night without fire with only a Buffalow Robe to Cover him, the Dress which he wore was a pr of Cabra (antelope) Legins, which is verry thin and mockersons—    we had his feet put in Cold water and they are Comeing too—

Lewis was the boy’s primary care physician, and regrettably, there was not a whole lot he could do to warm the boy’s feet and restore circulation. The boy hobbled around for a couple of weeks before the tissue on his feet started to turn black and it was clear the damaged tissue on his feet would never heal. The only recourse was frontier surgery.

On January 27, Clark wrote in his journal, “Capt Lewis took of the Toes of one foot of the Boy who got frost bit Some time ago.” Four days later, he made another entry: “Sawed off the boys toes.” It seemed the unlucky patient had lost more of his metatarsals. Fortunately, the boy escaped gangrene, infection, or further surgery. Less than a month later, on February 23, Clark recorded, “The father of the Boy whose feet were frose near this place, and nearly Cured by us took him home in a Slay—.”

By that time, the Corps of Discovery was already looking westward. They had begun to hack the keelboat and pirogues out of the ice. By February 25, Clark noted in his journal that “The Day has been exceedingly pleasant.” The worst of winter was over, and the men were anxiously looking forward to proceeding on.

More interesting reading: The Little Ice Age

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The Corps of Discovery at the Salt Camp

The Corps of Discovery at the Salt Camp

February 10, 1806 was not a good day for the Corps of Discovery. Captain Meriwether Lewis wrote in his journal:

Drewyer visited his traps today but caught no beaver. Collins and Wiser returned had killed no Elk. Willard arrived late in the evening from the Saltworks, had cut his knee very badly with his tommahawk. he had killed four Elk not far from the Salt works the day before yesterday, which he had butched and took a part of the meat to camp, but having cut his knee was unable to be longer ucefull at the works and had returned.    he informed us that Bratton was very unwell, and that Gibson was so sick that he could not set up or walk alone and had desired him to ask us to have him brought to the Fort.

Concerned about Bratton and Gibson, Lewis and Clark immediately dispatched a relief party to help the sick men get back to the fort. After an agonizing delay, Bratton finally limped into camp on February 15. Gibson followed behind, borne in a blanket by the relief party. Lewis was relieved to find that Gibson, though “much reduced,” was “by no means as ill as we had expected.”

Though he was ambulatory, the same could not be said of William Bratton. Of all the illnesses and injuries the men suffered on the expedition, Bratton’s was one of the worst. Working at the Salt Camp about 15 miles southwest of Fort Clatsop (present day Seaside, Oregon), Bratton had been struck down by a malady that strikes terror in the heart of anyone who has ever experienced it: severe low back pain.

Degenerated discs in the lumbar region

Degenerated discs in the lumbar region (likely Bratton's malady)

Bratton’s agony would continue for months. His pain grew so severe that he found it difficult to sit up, let alone walk.  The captains tried dosing him with cinchona bark and laxatives, but these did nothing to alleviate his discomfort. When the Corps turned their canoes back up the Columbia River in March 1806, Bratton appeared temporarily to regain some strength, his spirits no doubt buoyed by the prospect of going home. But the constant canoeing in cold, wet, and windy weather did his aching back no good. By April 11, he was worse than ever. Lewis noted the Bratton was weak and “unable to work.”

The pain dragged on. On April 20th, as they were preparing to recross the Bitterroot Mountains, Lewis wrote that “Bratton was compelled to ride as he was yet unable to walk.” Despite the attempts to make him comfortable, one can only imagine the man’s misery riding a horse over rugged mountain terrain, the peaks still buried under winter snow, his back screaming with every step. The invention of chiropractic care was over 90 years in the future.

By mid-May 1806, the Corps was enjoying a rest with the Nez Perce, near present-day Kamiah, Idaho. Still suffering, Bratton was ready to resort to desperate measures. The Corps’ blacksmith, John Shields, had come up with a radical idea. Sergeant John Ordway wrote in his journal: “Wm bratton having been so long better than 3 months nearly helpless with a Severe pain in his back we now undertake Sweeting him nearly in the manner as the Indians do …   we expect this opperation will help him.”

Lewis wrote about what happened next:

Indian sweat lodge

Indian sweat lodge (courtesy Oregon Historical Society)

Sheilds 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 a seat placed in the center of the hole for the patient with a board at bottom for his feet to rest on; some hopps 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 of about 3 feet high.    the patient being striped naked was seated under this orning in the hole and the blankets well secured on every side.    the patient was furnished with a vessell of water which he sprinkles on the bottom and sides of the hole and by that means creates 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 suddonly 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 our 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.

Remarkably, Bratton felt an immediate improvement. Clark wrote the day after the sweat bath, “bratten is walking about to day and is much better than he has been.” The effects of the hot sauna-like pit, alternated with the cold river water, acted like a modern-day physical therapy treatment of alternating hot and cold packs. Such treatments relieve pain by reducing inflammation, easing muscle spasms, increasing blood flow to the injured area, and relaxing the connective tissues.

The journals do not report whether Bratton repeated the “Indian treatment,” but at any rate, the hot and cold therapy did the trick. Within a week or so, Lewis reported, “Bratton is much stronger and can walk about with considerable ease.” By June 8, Lewis declared that “we cannot well consider him an invalid any longer.”  Bratton’s aching back was cured.

More reading:

History of the Native American Sweat Lodge

How to Make a Sweat Bath in the Wilderness

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In this illustration from Searching for Sacagawea (National Geographic, February 2003), Clark tries bloodletting to ease Sacagawea's life-threatening fever, while her husband Charbonneau looks on.

Lewis and Clark’s time among the Nez Perce would have made a good reality TV show. The Nez Perce lived in the unbelievably beautiful Clearwater country; were exceptionally good-looking, intelligent, and sophisticated; and had never before encountered white people. The Corps of Discovery — ragged, multi-cultural, and possessed of unfathomable new technology such as compasses, magnifying glasses, and magnets — must have seemed like visitors from another planet. Especially on the return journey, when Lewis & Clark spent almost two months among the Nez Perce, there was time for friendship, music and dancing, athletic contests — even romance.

Even more important for both trade and goodwill were the services of one Dr. William Clark. Lewis and Clark were both highly skilled wilderness doctors, but during the outward-bound journey, Clark’s medical skills became particularly important. From this distance, it’s hard to say exactly why the Native Americans preferred him over the more highly-trained Lewis. The practice of western medicine was entirely alien to the Indians, and it may be that Clark’s friendly, fatherly, respectful manner was simply more attractive and reassuring than Lewis’s more prickly and analytical personality.

Nez Perce man near Spaulding, Idaho, around 1900. Courtesy University of Washington.

At this point in the journey, Clark needed to generate more than goodwill. Because the continent turned out to be much larger than Lewis and Clark expected, and the Rocky Mountain range so difficult, the Expedition had taken much longer than the explorers had expected. They were tattered, impoverished, and just about out of trade goods. Clark’s services were critical in bartering with the Indians for food and assistance in making the return trip over those “tremendious mountains.”

Clark’s impromptu medical clinics began among the Walula people, near present-day Kennewick, Oregon. In order to repay the people for their help and hospitality, Clark carefully splinted broken bones, handed out Rush’s Bilious Pills for anyone feeling the least bit “costive,” and applied soft flannel wraps to help nurse a cold. Eye problems among the Indians were legion (probably due to dietary deficiencies), and people came from miles around for a dose of Rush’s eye water, a mild astringent.

The effect on the Indians was unexpectedly electrifying. It turns out that Clark’s medical clinic was a monumental event among the people. Though mostly ineffectual by today’s standards (when not actually harmful), Clark’s remedies wowed the patients with their noticable effects. Moreover, Clark was skilled at hands-on doctoring, even trying his hand at massage to relieve rheumatism and muscle aches. His bedside manner must have been something else, because the word began to spread that the red-headed doctor possessed a powerful magic.

The word-of-mouth from the Walula clinic was so good that Clark’s arrival back in Nez Perce country a few days later was something of a minor sensation. A chief brought in his wife, suffering from a painful abscess on her back. Clark rather boldly lanced, drained, and packed the abscess, a painful operation that proved worthwhile, as the woman improved dramatically within days. A little girl with “rheumatism” got a gentle bath in warm water and balsam; a virtual parade of Indians with sore eyes received a dose of the now-famous eyewash. In exchange, Lewis & Clark asked for payment of two horses — which they promptly butchered and ate.

19th century medicine chest

19th century medicine chest

As Lewis and Clark settled in to wait out the mountain snow at the “Long Camp” near present-day Kamiah, Idaho, Clark’s medical clinic became an established feature of the Corps of Discovery’s cultural exchange. There were few ailments that couldn’t be made better with a dose of the Clark charm along with nostrums such as back rubs, eye drops, and elixirs. But one challenging case was to cement Clark’s legend as a healer among the Nez Perce.

 The family of an elderly chief brought their father to see Clark. The old man had been paralyzed for five years, though he was able to eat normally and possessed all of his mental faculties.  Clark had recently developed a knowledge of sweat baths which he had used to help treat one of the men for severe back pain, and decided it just might help the chief. After a little time in the sweat hole, the man received 30 drops of laudanum, an opium-based painkiller. After three days of Clark’s therapy, the man was moving his arms and hands for the first time in years. By the fifth day he was moving his legs again.

Nez Perce man, 1899

In his great book on Lewis & Clark medicine Or Perish in the Attempt, David J. Peck theorizes that the man must have had a mental rather than a physical disorder. In either case, it was no mean feat for Clark to overcome a condition that had beset the man for five years.

It was largely due to Clark’s efforts, along with the good behavior of the Corps of Discovery, that led to the extraordinary friendship that developed between the Nez Perce and the Americans. In the 1830s, a delegation of Nez Perce even traveled to St. Louis to visit the now-elderly Clark and asked him to send missionaries to teach them the powerful medicine contained the white man’s book (the Bible). As late as the 1850s, the Nez Perce could rightly boast that they had never killed a white man. Then gold and greed changed everything. But that’s another story, one far removed from the peace and friendship extended, and accepted, between doctor and patients in those simpler times in the spring of 1806.

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During the course of their 2 ½ year journey, Lewis and Clark faced an enemy even more implacable than the Teton Sioux, the grizzly bear, and the dreaded mosquito. This was the Louis Veneri—also known as syphilis.

Columbus meeting the Natives

Columbus meeting the Natives - unfortunately, they exchanged more than a handshake

Syphilis was first identified as a disease three centuries earlier, when it burst upon the scene in Europe with sudden and shocking virulence. Its origins were (and still are) controversial. Syphilis exploded during the French invasion of Naples in 1495, decimating the French army and earning it the nickname, “the French disease.” However, the French army was heavily loaded with mercenaries from other European countries, including men who had sailed as part of Christopher Columbus’s crew just a few years earlier. It’s possible these men had become infected with the disease in the New World. The “Old World-New World” controversy rages to this day, with some scientists hypothesizing that syphilis was present in Europe as far back as ancient Greece and others believing it was a New World transplant.

At any rate, the strain of syphilis that hit Europe at the end of the 15th century was much more virulent than the disease is today. Unfortunate victims became covered with pustules from head to knees, suffered flu-like symptoms, and, as the disease began to affect the internal organs and central nervous system, declined and died within a few months. This extreme virulence had moderated by Lewis and Clark’s day, but the disease was recognized as a serious problem that needed careful treatment.

Lewis and Clark obviously anticipated that venereal disease might be a problem on the Upper Missouri River, and that their men would likely have sexual contact with native women. They packed the medicine chest with several drugs to help combat syphilis and gonorrhea, including mercury-laden calomel, copaiba, and mercury ointment. They were not disappointed. William 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.” Apparently the men of the Corps of Discovery were feeling modest, for Clark notes that they “got clare [clear]” of the Sioux “without taking their squars.” But by October 15, 1804, Clark recorded that the party had arrived at the Camp of the Arikara, and that “Their womin [were] verry fond of caressing our men &c.” 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.”

Syphilis spirochete

The syphilis spirochete - persistent and potentially deadly

Syphilis is caused by a variety of bacteria called a spirochete, which enters the body during sexual intercourse and penetrates the mucous membranes, infecting the blood or lymph system. It can incubate in the body for weeks or even months before the infected person manifests any symptoms. The first sign is usually a painless skin lesion at the site of the infection (often the genitals), followed by skin rashes, fever and fatigue, and aches and pains. Men and women who had contracted syphilis often had pustules or “pox” on the skin and were said to be “poxed.”

Or Perish in the Attempt by David J. Peck

Or Perish in the Attempt by David J. Peck (2002)

In the Corps of Discovery, as in the previous three centuries, the preferred treatment was mercury. According to David J. Peck in Or Perish in the Attempt, mercury is actually toxic to the bacterial organism that causes syphilis and can be moderately effective in treating syphilitic symptoms. The trouble is, it is also toxic to the patient that carries the disease. Peck suggests that when a man in the Corps complained of having the “Louis Veneri,” Lewis and Clark used mercury ointments applied topically for several weeks, or until the patient began to salivate. Physicians of the day believed that salivation was a sign that the disease was being expelled from the body. We know today that it is a sign of mercury poisoning.

Lewis recorded the incidences of venereal disease he found among the natives along their journey, along with the natives’ own remedies to cure the malady. He penned this journal entry at Fort Clatsop on January 27, 1806:

Goodrich has recovered from the Louis veneri which he contracted from an amorous contact with a Chinnook damsel. I cured him as I did Gibson last winter by the uce of murcury. I cannot learn that the Indians have any simples which are sovereign specifics in the cure of this disease; and indeed I doubt very much wheter any of them have any means of effecting a perfect cure.    when once this disorder is contracted by them it continues with them during life; but always ends in decipitude, death, or premature old age; tho’ from the uce of certain simples together with their diet, they support this disorder with but little inconvenience for many years, and even enjoy a tolerable share of health; particularly so among the Chippeways who I believe to be better skilled in the uce of those simples than any nation of Savages in North America. The Chippeways use a decoction of the root of the Lobelia, and that of a species of sumac common to the Atlantic states and to this country near and on the Western side of the Rocky Mountains.    this is the smallest species of the sumac, readily distinguished by it’s winged rib, or common footstalk, which supports it’s oppositely pinnate leaves.    these decoctions are drank freely and without limitation.    the same decoctions are used in cases of the gonnaerea and are effecatious and sovereign.    notwithstanding that this disorder dose exist among the Indians on the Columbia yet it is witnessed in but fiew individuals, at least the males who are always sufficiently exposed to the observations or inspection of the phisician.    in my whole rout down this river I did not see more than two or three with the gonnaerea and about double that number with the pox.—

Lewis and Clark did realize the terrible progression of the disease if left untreated, thus they took it seriously. Mercury was freely given, though apparently not in lethal does. In 2002, archeologists were able to pinpoint the location of Travelers Rest, Lewis and Clark’s campsite of September 1805 and June-July 1806, because of the mercury deposits found in the soil there.

Traveler's Rest State Park, Montana

Traveler's Rest State Park, Montana

Syphilis is still a dangerous disease today, but can be effectively cured with penicillin and other antibiotics. Syphilis was at the center of the  most notorious biomedical health study ever conducted in the United States, in which the U.S. Public Health service withheld penicillin from a group of infected African-American sharecroppers in Tuskegee, Alabama for decades, in order to study the long term progression of untreated syphilis.

There has been some speculation, notably by epidemiologist Reinhardt Ravenholt, that Meriwether Lewis himself may have acquired syphilis during his journey to the Pacific, and that this disease led to Lewis’s mental illness and eventual suicide. Other historians disagree, believing Lewis’s physical illness and depression could have resulted from malaria or other causes. You can read Dr. Ravenholt’s article here.

Trail’s End for Meriwether Lewis

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In May 1803, an Army purchasing agent named Israel Whelan walked into Gillaspy & Strong, druggists, at the corner of 2nd and High Streets in Philadelphia. He brought with him a very important shopping list. It was the list of medicines that Meriwether Lewis wished to purchase for the Lewis & Clark Expedition.

19th century medicine chest

19th century medicine chest

The list is a fascinating glimpse into the theory and practice of “heroic medicine” in the early 19th century. First off, Lewis’s list contained purgatives—various drugs used to cleanse the body, either gently or violently. “4 oz. Calomel, 10 lbs. Epsom or Glauber Salts, 8 oz Powder Jalap, 8 oz Powdered Rhubarb” are featured prominently on the list. Calomel, a mercurous chloride compound, was taken internally and used as a laxative and disinfectant, as well as in the treatment of syphilis. It was a favorite of Lewis’s teacher Dr. Benjamin Rush, who advised giving “bilious” (i.e. constipated) patients calomel until they began to salivate. Rush did not mention that at high doses, the mercury in the compound reach poisonous levels and cause the patient’s hair and teeth to fall out.

The Mexican herb, jalap

The Mexican herb, jalap, a powerful laxative

Almost as powerful as calomel, jalap is a Mexican root described as “useful in all cases where it is desirable to produce an energetic influence on the bowels, or to obtain large evacuations.” Rhubarb, also a strong laxative, has been used in both western and eastern medicine for centuries. For cases where such drastic measures weren’t necessary, Lewis also stocked Epsom or Glauber’s salt. This magnesium sulfate compound could be used for everything from inducing gentle bowel movements (a la Milk of Magnesia) to reducing inflammation and soothing sore skin.

In case all of the above remedies didn’t do the trick, Whelan also laid in 50 dozen of Rush’s pills, the infamous “thunderbolts” that purged the bowels with a dramatic combination of calomel and jalap. In case they did the trick too well, Lewis asked for “2 lbs. Coperas,” a substance used to treat diarrhea. So on that end of the alimentary canal, the men of the Corps of Discovery were covered.

Ipecacuana

Ipecacuana, the vomit comet

In addition to purgatives, emetics were included on Lewis’s medicine list. Lewis requested “4 oz Powder’d Ipecacuana” (known to us as the vomit-inducing ipecac syrup) and “1/2 oz. Tarter emetic.” The small amount of tartar emetic Lewis requested shows his awareness that it should be given sparingly, in very small doses. Tartar emetic is extremely hard on the body. In emergency cases, it can be used in tiny doses to induce vomiting, salivation, and sweating.

Anticipating skin ailments, Lewis asked Whelan to purchase some compounds he could use to treat wounds and skin irritation. This included “8 oz Borax” (the antifungal salt sodium borate), “1 Flour of Sulphur” (used to treat chapped or inflamed skin), and “2 lbs Yellow Basilicum” ( a fragrant skin ointment). Lewis also asked for “2 Sticks of Symple Diachylon,” used to reduce swelling and dissipate tumors of the skin. Not wanting to be unprepared in case he needed to induce, rather than treat, inflammation, Lewis also requested “1 lb. Blistering Ointments.”

For pain relief, Lewis fell back on the good old staples, laudanum and opium. Whelan’s receipt from Gillaspy & Strong shows 4 oz. laudanum and ½ lb. Turkish opium among the items he purchased.

Peruvian Bark

Peruvian Bark, effective for fever

Among the more useful medicines Whelan purchased for Lewis included 15 pounds of “best powder’d Bark.” Peruvian bark was a popular tonic and cure-all of its day, used to treat fevers of all kinds. Unbeknownst to Lewis, Peruvian bark (or cinchona) contained quinine, which made it genuinely effective in treating malarial fever. Lewis also packed in some “white vitriol” (zinc sulfate) and “Lacteaum Saturni” (sugar of lead), which when combined made an effective, soothing, and harmless eyewash that made Captain Clark the Indians’ “favorite physician” during the Corps of Discovery’s return trip along the Columbia in 1806.

Turlington's Balsam of Life

Turlington's patented "Balsam of Life"

One last item on Lewis’s list reveals that although he was a competent field doctor and knowledgeable herbalist, he was still susceptible to clever advertising. Lewis requested “4 oz Turlingtons Balsam.” This was a product made by British patent medicine vendor Robert Turlington, who gave his product the irresistible name, “The Balsam of Life” and claimed it was effective for “stone, gravel, cholic, & inward weaknesses.” Containing some 27 ingredients, Turlington’s Balsam was actually effective as a mild antiseptic and in the treatment of blisters. It is known today in modified form as the compound tincture of benzoin.

For more great reading, visit this great page on the Discovering Lewis & Clark site: “Lewis’s Medicines.”

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Every newcomer to the Lewis & Clark Journals makes the delightful discovery that the explorers wrote so strongly in their own voices that it is almost possible to hear Meriwether Lewis’s Virginia drawl and William Clark’s bluegrass twang resonate off the pages. Creative spelling has a lot to do with the charm of the journals. Back then, spelling had not yet been standardized, and both explorers tend to sound out the words the way they would have pronounced them.

Clark in particular raised spelling to the level of performance art, and never was he more creative than when writing of one of the Expedition’s greatest pests, known to us as the “mosquito.” Clark came up with no fewer than 19 variations, including mesquestors, misquestors, misquitor, misquitoes, misquitors, misqutors, misqutr, missquetors, mosquiters, mosquitors, mosquitos, muskeetor, musqueters, musquetors, musquiters, musquitoes, musquitors, musqueters, and musqutors.

Lewis & Clark campsite on the Missouri River, Niobrara State Park, Nebraska

It’s fun to have a chuckle at Clark’s expense, but no matter how you slice it (or spell it), the frequent journal entry “mosquitoes very troublesome” was no laughing matter. The wandering Missouri River created many swamps and backwaters which bred billions of mosquitoes on the Great Plains. At times the insects attacked the Corps of Discovery so ferociously that it was impossible for them to shoot their rifles accurately for all the bugs swarming in their faces. They were frequently driven to move campsites to try to escape the mosquitos, with their only defense being smoky fires, mosquito netting, and a smelly repellant they made from tallow and hogs’ lard. There were many nights that they couldn’t even eat without taking in mouthfuls of bugs.

Our trio of pests still invade and obstruct us on all occasions, these are the Musquetoes eye knats and prickley pears, equal to any three curses that ever poor Egypt laiboured under, except the Mahometant yoke. – Meriwether Lewis, July 24, 1805

Malaria cells

As if being under siege by biting insects wasn’t bad enough, mosquitoes posed another danger, one Lewis and Clark didn’t understand. It would be eighty years before pioneering scientists realized that that mosquitoes were a disease vector, almost one hundred years before they conclusively proved the matter. Until then, malaria, along mosquito-borne yellow fever, would be the bane of the American frontier. In fact, malaria may well have been a significant contributor to the death of Meriwether Lewis  just three years after the Expedition.

Malaria (also known as “the ague” — pronounced ay-gyuh) was known to originate in the swamps, but the medical thinking of the day held that the dank, fetid air somehow caused the disease. In any case, ague was as common as a cold in frontier America, so universal that it was considered hardly worth mentioning. Moreover, like the cold, it could be contracted again and again; some forms of the disease can also produce recurring symptoms months or even years later. Thomas Jefferson, James Madison, and probably William Clark were among the chronic sufferers; it is likely that every member of the Corps suffered from painful, debilitating ague at one point or another.

Upon the onset of a case of malaria, the sufferer experiences fever, joint pain, vomiting, red urine, and severe chills. Eventually, the fever can spike to 105 degrees, bringing on a knee-buckling headache. Finally, an extreme sweating breaks the fever. Most victims recover, though some, especially children, suffer permanent damage to the eyes and brain.

The best treatment for the ague was one of the world’s first great miracle drugs. Jesuit missionaries in the 1600s had learned from the Indians of a substance called Peruvian bark (the bark of the cinchona tree) that could help alleviate the fever of malaria. When he equipped the Expedition’s medical kit, Lewis brought along 15 pounds of the pricy imported bark (later shown to contain the alkaloid quinine). Lewis was known to treat malarial symptoms in others with the bark, but for himself, he turned most often to what he considered a quick fix: Rush’s pills, a powerful patent medicine laxative containing high doses of mercury.

Meriwether Lewis, by Thomas C. Danisi and John C. Jackson, 2009

Chronic malaria may have played a role in Lewis’s death in 1809. As Thomas Danisi details in his biography of Lewis’s post-expedition life, frontier military physicians record patients so tormented by headaches, eye pain, and severe inflammation of the spleen and liver that they had to be restrained from suicide. In addition, it is entirely possible that Lewis was suffering mercury poisoning from his use of Rush’s pills; headaches, ringing in the ears, and nausea from the use of Peruvian bark; and/or the effects of the laudanum and wine that was used to make the medicine more palatable. Danisi writes that Lewis may have committed suicide in a last, desperate attempt to end his suffering.

While the drainage of wetlands led to the end of malaria in the United States, the disease continues to be a worldwide scourge, especially in Africa, where hundreds of millions of human beings are infected and two to three million people die from malaria every year.

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