Lewis and Clark: Doctors in the Wilderness (review)

This work is a timely contribution to this country's observance of the two hundredth anniversary of the lengthy explorations of the Lewis and Clark expedition, a westward trip across mostly uncharted land from the existing United States to the Pacific Ocean. The book is also a scholarly and publishing rarity, a book-length volume that deals with the medical aspects of the expedition. Moreover, although Bruce Paton has directed his work deliberately toward the ordinary reader, what he has produced should appeal as well to physicians, historians of medicine, and other types of historians. In short, his retelling of this classic episode of American history is highly engaging and deserving of plaudits.

Paton, a retired cardiac surgeon, describes himself as having a longtime enthusiasm not only for history, but for the wild places of the world and for the often daring individuals who have explored such places. He has frequently worked as a physician on extended modern tours and expeditions into remaining wild places, and has played an important role in the organization of wilderness medicine as a medical specialty. His book, therefore, is essentially an interpretation of the medical history of the Lewis and Clark expedition through the interests and outlooks of today's successful wilderness physician.

The book starts with an informative general review of notable explorations from antiquity to the nineteenth century, touching on the political, economic, intellectual, and other motives behind them. The author then comments on Thomas Jefferson's lively interest in such pursuits, and on the eventual emergence of plans and preparations for the ambitious Lewis and Clark expedition during Jefferson's presidency. Then, in a final introductory section, he examines the medical ideas and practices of the day, along with the medical equipment and pharmaceuticals that were gathered for the trip.

The main portion of the book is the series of chapters that review the expedition's daily happenings or experiences, but mainly, of course, the medically related events or cases. Paton's principal sources of such information were the journal observations of Lewis, Clark, and other members of the expedition, and he seems to have selected for his own comment virtually all of the medical events that the explorers considered important enough to record. In fact, for each of his discussions of such events in the book, he goes through a process of trying to make the nineteenth-century medical assumptions, nomenclatures, and therapeutic choices understandable for readers of the twenty-first century. Near the end he readily admits that many of his conclusions are no better than intelligent guesses, and points out that such guessing is often the best that today's wilderness medical practitioner, in the absence of advanced drugs and technology out in the wilds, can provide.

For a book that is generally so informative and interesting, I have only two substantial complaints or problems. One is the author's decision not to provide footnotes. The other is his selection of a title that is ambiguous: in the absence of a designated physician, it fell to Lewis and Clark to do virtually all of the "doctoring" on the expedition—yet Paton himself repeatedly found it necessary to remind the reader that neither man had had any of the formal medical training often implied by the title "Doctor."

In other respects, the book is predominantly praiseworthy. It is clearly written and has an appealing style. Except for Paton's inquisitive medical passages, his narrative moves along rapidly. And even those passages have a certain drive, imbued as they are with the acknowledged excitements of the author's involvement in reconstructing this heroic expedition of the past, and with the vibrancy of his admiration for each member of the expedition.