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Chapter 3 “Two dozes of barks and opium” Lewis & Clark as Physicians Ronald V. Loge, M.D. 70 After the purchase of the Louisiana Territory in 1803, President Thomas Jefferson entrusted the fate of the expedition to explore the Missouri River headwaters to his capable friend and personal secretary, twenty-eight-yearold Meriwether Lewis. Having planned the expedition for ten years, Jefferson outlined detailed and precise goals. He was interested in opening up the west in order to establish trade routes, particularly for the fur trade, and he wanted to lay claim to the Pacific Northwest. In addition, Jefferson wished to learn more about the indigenous peoples, their cultures, and their health. He provided Meriwether Lewis with the necessary instruction to prepare for this journey. Lewis invited a former fellow army officer and experienced frontiersman, thirty-two-year-old William Clark, to serve as cocaptain of this expedition of discovery.1 This remarkable journey of 8,000 miles up the Missouri River, over the Rocky Mountains, down the Columbia River, and back again was successfully completed because of rigorous preparation, frequent good luck, and exceptional tenacity. Although the voyagers on this journey faced extreme weather, many types of injury and disease, and encounters with hostile Indian tribes and grizzly bears, only one of the expedition members died. The skillful leadership and care provided by Lewis and Clark were central to this successful outcome. Possessing a low opinion of most physicians and their treatments, Thomas Jefferson considered a physician to be an unnecessary encumbrance on the expedition and assumed that all illnesses and injuries would be handled effectively by Captains Lewis and Clark.2 Some background about the state of medicine of the early 1800s helps explain how the capable army captains were able to function as physicians. Medicine in 1804 had evolved very little in the two thousand years from the time of Galen and Hippocrates. Thus, the theories and treatments used in medical practice persisted into the nineteenth century. Newer scientific discoveries, however, had changed the names of some of these descriptors from good and ill humors of the Greeks to inflammation, morbid conditions , and nervous irritability. Purging and bloodletting endured as the standards of therapy.3 The first medical school in the colonies was founded in 1765, and by 1800 the five medical schools in the new republic had graduated a cumulative total of 250 physicians. Many practitioners had little or no training. One doctor in ten held a medical degree. Though many nondegree physicians had legitimate apprenticeship training, impostors were widespread. A New York City newspaper from the late 1700s described the city as having forty doctors, “the greatest part of whom were mere pretenders to a profession of which they were entirely ignorant.”4 Frontier areas had few, if any, trained physicians, and most of medicine was practiced with only a basic understanding of first aid. Midwives and “yarb” (herb) doctors were common. One of the better known yarb doctors in Albemarle County, Virginia, was Lucy Marks, the mother of Meriwether Lewis. She was undoubtedly a source of his knowledge of herbal remedies.5 With an abiding interest in medicine, Thomas Jefferson had an extensive medical library and corresponded with leading physicians of the day. Jefferson understood very well the limitations of both insight and abilities possessed by his contemporaries. Succinctly summarizing the state of earlynineteenth -century medicine, he wrote: “Thus, fulness of the stomach we can relieve with emetics; disease of the bowels, by purgatives; inflammatory cases, by bleeding; intermittents, by the Peruvian bark; syphilis, by mercury; watchfulness, by opium; etc. So far I bow to the utility of medicine.”6 These principles of medical practice outlined by Jefferson were the basis of treatments used by Lewis and Clark. Therapeutic bleeding goes back to the time of the Greeks and was probably practiced even before written history. In Jefferson’s time few maladies escaped treatment with the phlebotomy lancet. “Intermittents” described intermittent fever, usually malaria, but the term was also applied to any sort of fever. Peruvian bark, or cinchona, contains quinine and other alkaloids that reduce fever. “Bark,” the aspirin of its day, was used frequently by Lewis and Clark. Syphilis was treated with mercurial salts. Mercury had been used for nearly three centuries to treat syphilis, both the primary and secondary forms, and was standard therapy through the end of the nineteenth century .7 Watchfulness, a diagnosis that included insomnia, anxiety, and probably even depression, was treated with opium...


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