A medical journey with Lewis and Clark

November 2016 - Vol. 35, No. 10
Hordes of mosquitos plagued the men incessantly.

Hordes of mosquitos plagued the men incessantly.

Mosquitoes, boils, frostbite, dysentery, and venereal disease test the mettle of explorers and their caretakers

By M. Eugene Tardy, Jr., MD, Professor Emeritus, University of Illinois School of Medicine at Chicago, and the first Legends of Otolaryngology honoree

One rainy afternoon in May 1804, nearly four dozen carefully selected young men, their two captains, and a dog pushed off in a keelboat and two pirogues up the Missouri River from St. Louis in pursuit of President Thomas Jefferson’s quest to explore the heretofore unknown western regions of the American continent. Facing unknown territory, bitter weather, unpredictable Indian tribes, wild animals, and geographical challenges, the Corps of Discovery endured continuous and vexing medical challenges.

And, in an arduous journey of more than 8,000 miles and 28 months, only one man died.

Throughout the journey, 375 elk provided much of the protein required by the expedition's participants.

Throughout the journey, 375 elk provided much of the protein required by the expedition’s participants.

In the end, the Lewis and Clark expedition failed to find an all-water passage to the Pacific Ocean, but they realized an incredible outcome: the men documented knowledge of the West, the Native Americans, and plant and animal species; invigorated the western fur trade; established the United States’ claim to the western territories; and unveiled the mysteries of the West to stimulate unprecedented westward migration.

Of all the many challenges the explorers faced, a wide variety of medical problems taxed their ingenuity, limiting their capabilities and challenging their primitive but dedicated medical skills.

Constantly and pervasively, hordes of “mosquiters” tormented the men and their animals, creating repetitive skin eruptions and infection. The descriptive journals religiously kept by the explorers document well the torment they endured.

Whether the presence of a physician during the expedition would have better protected the health of the men is open to question. The captains ministered most professionally to the men, the Indians, and each other, employing common sense and the traditional remedies available to them.

President Jefferson arranged for Meriwether Lewis to receive instruction from Dr. Benjamin Rush of Philadelphia, the leading physician of his time. As the prevailing sense of medical care in the early 19th century, the use of “bleed, blister, and purge” characterized the limited armamentarium of most physicians. Dr. Rush counseled the value of the following “medications” to be included with the explosive purgative of chlorine, mercury, and jalap; opium; laudanum; mercury ointment; emetics (ipecac); diaphoretics (camphor); barks (quinine-containing cinchona); various herbs; and saltpeter.

When they encountered the immense Great Falls of the Missouri, expedition participants were forced to carry canoes and equipment 18 ½ miles in one month.

When they encountered the immense Great Falls of the Missouri, expedition participants were forced to carry canoes and equipment 18 ½ miles in one month.

In his surgical kit, Lewis selected scalpels, suturing tools, probing forceps (for musket balls and arrowheads), tooth extractors, enema and penis syringes, lancets, and tourniquets.

As the Corps pulled, paddled, and pushed their heavily loaded boats up the Missouri River, within the first month illness magnified the hardships of the journey. The captains wrote: “the party is much afflicted with Boils and several have Decissentary, which I attribute to the river water. Two thirds with ulsers or Boils, some with 8 or 10 of those Tumors.” In addition, sore feet, chafed thighs, insect bites, bloating, fatigue, diarrhea from contaminated water, and a poor diet plagued the men. And yet, without complaint, “We Proceeded On.”

On July 4, 1804, a rattlesnake bit Private Joseph Fields on the ankle. After treatment with a poultice of Peruvian bark (quinine) he painfully resumed his duties. Lewis “opened the Tumer of a man on the left breast, which discharged half a pint.” Repeatedly, the journals record the phrase “Mosquiters excessively troublesum.”

The first indication of a serious medical problem surfaced on July 30. According to William Clark: “Sergt Floyd very unwell a bad cold and chills.” On August 30: “Serjeant Floyd taken very bad all at once with a Biliose Chorlick. We attempt to relieve him without success as yet, he gets worse and we are much allarmed.” After tending to Floyd all night, Clark wrote: “Sergeant Floyd much weaker and no better … as bad as he can be, no pulse and nothing will stay a moment on his Stomach or bowels.”

Floyd’s violent diarrhea and vomiting with symptoms of shock suggest to most authorities the diagnosis of ruptured appendix with peritonitis. Doubtless no surgeon, under these severe circumstances, could have saved the life of Sgt. Floyd, who “died with A great deal of composure.”

In October Clark wrote: “last night at 1 oClock I was violently and Suddenly attacked with rhumetism in the neck which was so violent I could not move. … Capt. Lewis applied a hot stone raped in flannel which gave me some temporay ease.” Cervical muscle spasm due to severe muscular effort and possible nerve root impingement marked the first of several otolaryngological ailments the Corps encountered.

The group of explorers built a fort and camped over the bitter winter near the Mandan Indian villages. Clark recorded: “last night was excessively cold … the Murckery this morning stood at 40 degrees below zero.” Under such extreme conditions, it is not surprising that cold injury surfaced in both men of the Corps and the Indians as well. On December 8 during a bitterly cold buffalo hunt, York, Clark’s African-American slave, suffered frostbite of his penis, from which he apparently completely recovered. The journals reveal “a boy about 13 years of age Came to the fort with his feet frosed.” “4 men of ours who had been hunting returned, one frost’d.” “Capt. Lewis took off the toes of one Foot of the Indian boy who got frost bit Some time ago.”

1592In early October, Clark lyrically recorded: “a curious custom with the Sioux and well as the Ricarees is to give handsom squars to those whome they wish to show some acknowledgements to.” Venereal disease thus was introduced as one of the many medical ailments of the men of the expedition, as most of the Indian tribes were accustomed to bartering wives and daughters as sexual partners to visitors.

Clark noted on November 4, 1804: “a French man by Name Chabonah [Toussaint Charbonneau, a French Canadian] … visit us, he wished to hire and informed us his 2 squars were Snake Indians.”  Charbonneau, who proved to be a bungler and coward, was hired as interpreter and chose to bring along his 15-year-old Indian wife, who was six months pregnant. Thus Sacagawea, who proved invaluable to the success of the expedition, entered the scene. In February, Lewis assisted in the delivery of her child, Jean Baptist.

On November 29, 1804, a journal recording reads: “Sergeant Pryor in taking down the mast put his Sholder out of Place, we made four trials before we replaced it.”

The Corps spent the bitter winter with the Mandans, and proceeded up the Missouri once again when the ice melted in March 1805.

Encountering the immense Great Falls of the Missouri, they were forced to portage their canoes and equipment 18 ½ miles over one month, suffering cut feet, cactus thorns, heat exhaustion, and massive exhaustion.

Finally encountering the Shoshone Indians, Sacagawea’s original tribe, with horses they crossed the massive Continental Divide and Bitterroot mountains despite deep snowdrifts, bitterly cold weather, and absent trails. Hunger and constant dysentery plagued the men, and the Nez Perce Indians they encountered schemed to kill them for their weapons, but were dissuaded by an Indian woman who had earlier been well treated by white men.

Finally reaching the Columbia River estuary in crudely dug out canoes, the Corps passed a miserable winter of 1805-1806 in a constant wet, flea- and mosquito-infested and food-deprived state. Elk sustained them, but rotted quickly in the extreme weather. With clothes rotting off their bodies, they joyously began their easterly homeward voyage on March 22, 1806.

Encountering the Walla Walla and Nez Perce tribes once again, Clark used his medical skills to soothe the Indians’ severe conjunctival irritations (probably gonorrheal conjunctivitis) and a variety of other complaints. His medical skills proved to be valuable commodities in exchange for food and horses.

Sacagawea’s son developed neck swelling, perhaps cervical abscess, tonsillitis, mastoiditis, or parapharyngeal abscess, and was treated with cream of tartar and a poultice of boiled onions—with complete recovery.

After two attempts, the men were finally able to cross the cold and snow-covered mountains and commence their homeward journey eastward. Their arrival on September 23, 1806, in St. Louis after 28 months and a journey of 8,000 miles was nothing short of miraculous.

This fascinating, captivating story begs the questions:

  1. Would the expedition have fared better with a physician along?
  2. Why did Sacagawea abandon her Shoshone tribe and continue with the expedition to the Pacific?
  3. What was life like for York, Clark’s slave, during the journey?
  4. Where are the lost journals of Captain Lewis documenting the early part of the journey?
  5. How different would the narrative of the expedition be if told from the perspective of the Native Americans?
  6. Was Lewis actually bipolar, and perhaps an alcoholic?

In the end, President Jefferson characterized the Lewis and Clark Expedition as “having all the success which could have expected.” The mysterious West was opened for further exploration and migrant expansion. The fur trade was opened, and the American claim to the western territories was secured. Clark mapped the continent.

I personally am firmly of the conviction that every American school child should be taught the critical lessons of the men and woman of the Corps of Discovery: courage, discipline, teamwork, perseverance, improvisation, negotiation, and, not least, devotion to country.

And all admirably accomplished  despite the maddening, inescapable, recurring and plaintive record of: “Mosquiters very troublesome.”

Please consider making a donation to the AAO-HNS Foundation’s Annual Fund in honor of Dr. Tardy. Your donation, in any amount, can be made by going to www.entnet.org/donate and selecting “Legends of Otolaryngology.” All donor names will be listed on Dr. Tardy’s web page at www.entnet.org/content/annual-fund-legends-otolaryngology.