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3. “Two dozes of barks and opium”

Lewis & Clark as Physicians

Ronald V. Loge, M.D.

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-year-old 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

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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 early nineteenth-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.

To prepare Meriwether Lewis better for his formidable journey, President Jefferson sent him to Philadelphia to receive scientific instruction

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from some of Jefferson's fellow members of the American Philosophical Society. He expected Lewis to enhance his skills in natural history, zoology, botany, and astronomical navigation, and also to become proficient in field medicine.^[8] The principal teacher in Lewis's brief medical study was Benjamin Rush, whom Jefferson knew from the days of the Declaration of Independence, which they both signed.^[9] Dr. Rush was considered to be the most influential physician of his time. A zealous advocate of bleeding and purging techniques, probably to the extreme, Rush was said to have shed more blood than any general in history.^[10]

Although there is no record of any detailed medical training that Dr. Rush provided Meriwether Lewis, he did give Lewis a list of instructions for the health and hygiene of the men under his command and probably helped Lewis assemble medical supplies. Assessing Lewis's abilities for the mission, Rush wrote to President Jefferson, “Mr. Lewis appears admirably qualified for it,” thereby confirming to Jefferson that Lewis could be captain, naturalist, and physician.^[11]

Congress initially allocated $2,500 for the entire expedition, expected to field only a dozen men and take up to two years. Meriwether Lewis budgeted $55.00 for medicine and $696.00 for Indian presents, a ratio that reflected the relative needs he anticipated.^[12] As the journey unfolded, however, medicine, rather than the presents, secured the beneficial relationships with the northwestern natives.

A list of the medical items originally packed for this journey reflects the medical treatments of that era (see Table 1). George Gillaspy and Joseph Strong were Philadelphia physicians who owned the apothecary that supplied the medications. The total cost was $90.69, appreciably over budget. One-third of the expenditures, $30.00, was for Peruvian bark.

Other items included several laxatives (rhubarb, magnesia, and jalap, a powerful laxative derived from the Mexican morning glory) and substances to induce vomiting (ipecac and cream of tartar). Most frequently employed of the medical supplies were the bilious pills (fifty dozen) of Benjamin Rush, a potent laxative combination of jalap and calomel. Although inexpensive, Rush's bilious pills produced powerful results. Approximately 1,300 doses of laxatives were prepared for this journey. A medicine that would prove of great worth was vitriol, a topical solution of zinc sulfate and lead acetate, used for eye diseases.

Lewis, aware of reports from the upper Missouri River that syphilis was endemic amongst the Mandan Indians, anticipated that the sexual behavior of his men would require a store of mercurials.^[13] Calomel (mercurous chloride) was given orally as a laxative and also to treat syphilis. Lewis bought clyster syringes (enema and penis syringes). Although the penis syringe was designed to treat gonorrhea by urethral irrigation, it may have

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TABLE 1. Medical Items Purchased for the Lewis and Clark Expedition

Bought of Gillaspy & Strong the following article for use of M. Lewis Esquire on his tour up the Mississipi [sic] River, & supplied by his Order (Phila., May 26, 1803).—Viz.
SOURCE: Donald Jackson, ed., Letters of the Lewis and Clark Expedition, with Related Documents, 1783–1854 (Urbana: University of Illinois Press, 1962), 1:80–87.
15 lb. Pulv. Cort. Peru	$30.00	4 oz. Laudanum	.50
½ lb. Jalap	.67	2 lb. Ung. Basilic Flav. 50	1.00
½ lb. Rhei [rhubarb]	1.00	1 lb. […] Calimin 50	.50
4 oz. lb. Ipecacuan.	1.25	1 lb. Epispastric.	1.00
2 lb. lb. Crem. Tart.	.67	1 lb. Mercuriale	1.25
2 oz. Gum Camphor	.40	1. Emplast. Diach. S.	.50
1 lb. lb. Assafoetid.	1.00	1. Set Pocket Insts. Small	9.50
½ lb. lb. Opii Turk. opt.	2.50	1 lb. Teeth	2.25
¼ lb. lb. Tragacanth	.37	1. Clyster Syringe	2.75
6 lb. Sal Glauber 10	.60	4. Penis do.	1.00
2 lb. Nitri 33½	.67	3. Best Lancets .80	2.40
2 lb. Copperas	.10	1. Tourniquet	3.50
6 oz. Sacchar. Saturn. opt.	.37	2 oz. Patient Lint	.25
4 lb. Calomel	.75	50. doz. Bilious Pills to Order of B. Rush .10	5.00
1 lb. Tartar Emetic	.10	6. Tin Canisters 25	1.50
4 lb. Vitriol Alb.	.12	3. 8 oz. Gd. Stopd. Bottles 40	1.20
½ lb. Rad. Columbo	1.00	5 4 lb. 0 Tintures do	1.85
¼ lb. Elix. Vitriol	.25	6 4 lb. Salt Mo.	2.22
¼ lb. Ess. Menth. Pip.	.50	1. Walnut Chest	4.50
¼ lb. Bals. Copaiboe	.37	1. Pine do. Porterage	1.20
¼ lb. Traumat.	.50		.30
2 oz. Magnesia	.20		—
¼ lb. Indian Ink	1.50		$90.69
2 oz. Gum Elastic	.37
2 lb. Nutmegs	.75
2 lb. Cloves	.31
2 lb. Cinnamon	20
	$46.52

been more effective as a deterrent. Three of the best lancets were included in the inventory.

After securing the plans, training, and materials needed for the expedition, Captain Lewis traveled down the Ohio River and met his friend, William Clark, at Clarksville, Indiana Territory. They proceeded on to Camp DuBois, near St. Louis, where, during the winter of 1803–04, they assembled and prepared a crew of hearty woodsmen and army volunteers, now numbering fortyfive.

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In May 1804 the Corps of Discovery set off upriver on the mighty Missouri River at high water in a heavy iron keelboat and two smaller boats, called pirogues. The strenuous voyage had begun. These boats had to be rowed, sailed, poled, and pulled up the 2,300 miles of the Missouri River.

The voyagers had not traveled far before some men complained of sore eyes, probably from blowing sand and ultraviolet keratitis from the bright sun on the water. But the first real medical problem occurred on 4 July 1804, when one of the men suffered snakebite on his foot, which immediately began to swell. Captain Lewis applied a poultice of gunpowder and Peruvian bark to the wound.^[14] Lewis did not ignite the poultice, as was the practice in some quarters to treat snakebite.

No one was severely ill until mid-August when the group arrived at what is now the area of Sioux City, Iowa, where the only fatality on the entire journey occurred. Sergeant Charles Floyd died of an acute illness that was described as “bilious colic.” Floyd had complained of being ill for several days in late July but had soon improved. On 19 August, however, Floyd developed crampy abdominal pain, vomiting, and diarrhea and died the next day.^[15] Although no treatment is described in the journals, the customary use of purgatives and bleeding for such illnesses may have been employed, with catastrophic consequences. A ruptured appendix with peritonitis has been the traditional historical diagnosis used to explain Floyd's death. Floyd was about twenty years old, and certainly appendicitis is common in this age group. Arsenic poisoning and cholera-like illnesses have also been suggested as etiologies.^[16] Chronic peptic ulcer disease with perforation and peritonitis has not been previously considered and should be added to the list of possible causes of Floyd's illness and death. Undoubtedly, apprehension arose thereafter whenever anyone developed the frequently occurring symptoms of colic or abdominal pains.

Medical events were infrequent until the explorers reached Fort Mandan, where the corps spent its first winter on the banks of the Missouri River, adjacent to Mandan and Hidatsa Indian villages. These friendly Indians provided food for the visitors in exchange for trinkets and important blacksmith goods. But of greater significance, the captains acquired knowledge of the upper Missouri, the uncharted waters ahead of them.

Also traded were sexually transmitted diseases! Clark wrote: “they are helth. except the—vn. [venereal]—which is common with the Indians and have been communicated to many of our party at this place—those favores bieng easy acquired” (3:322). The natives believed that powers or “medicine” could be transferred through sexual relations. Thus, it was a common practice for esteemed visitors to have the honor of sexual intercourse with the Indian women.^[17] Since syphilis was endemic in the tribes, Lewis and Clark administered mercurials throughout that winter.

Clark learned that smallpox had previously decimated some of the Mandan

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villages. Although helpless against smallpox epidemics, the Indians might have been aided by Lewis and Clark if President Jefferson's plans could have reached fruition. Jefferson and Rush, both ardent advocates of Jenner's new cowpox (kine-pox) vaccination methods, believed that the scourge of smallpox could be prevented. In his final instructions to Meriwether Lewis in June 1803, Jefferson wrote, “Carry with you some matter of the kine-pox,” and he encouraged Lewis to teach its use to and vaccinate especially those with whom they would spend their winter encampment.^[18] The potentially historic opportunity to vaccinate the Mandan and Hidatsa tribes never came about because, as Lewis reported in a letter to Jefferson in October 1803, “the Vaxcine matter,” supplied by the president, “has lost it's virtue.”^[19]

During that cold Dakota winter when the group experienced forty days of temperatures below zero, frostbite was common. In January they found a young Indian boy who had spent a 40-degrees-below-zero night out on the prairie wrapped only in a buffalo robe. He had badly frostbitten toes, which turned gangrenous. Three weeks later, the captains sawed off the boy's affected toes (3:281). His recovery likely left a favorable impression on the Indians.

The most significant event of the winter at Fort Mandan was the captains’ introduction to Sacagawea, a Shoshone woman who had been captured by the Hidatsa Indians four or five years earlier. Lewis and Clark immediately perceived that she would be a key link to the western Indians. She was about sixteen years old, married to a French fur trapper named Charbonneau, and pregnant. In February 1805 Sacagawea began a long and difficult labor. Captain Lewis was approached by Ren Jessome, another French fur trapper, who said that in situations like this “he had frequently administered a small portion of the rattle of the rattle-snake” (5:291). Lewis had a rattle that Jessome broke into small pieces, mixed with water, and gave to Sacagawea. Lewis, in his only foray into obstetrics, observed that within ten minutes the patient delivered a healthy baby boy.

With the breakup of the Missouri River in the spring of 1805, the Corps of Discovery resumed its upstream travel. Lewis, a gifted naturalist and botanist, described plant and animal life extensively, including fruits and wild vegetables that grew along the way. Sacagawea—now part of the corps—would occasionally dig roots to supplement their meat diet (4:15). And with buffalo and elk abundant on the prairie, there was never a short-age of food.

When the group neared the Great Falls of the Missouri, Lewis became afflicted with abdominal pain and fever. Would he, while experiencing “violent pain in the intestens” (4:278), have remembered Sergeant Floyd's fatal illness and recognized the perilous balance that such new intervening diseases created? He did recall what was presumably one of his mother's

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herbal remedies made from chokecherry twigs boiled in water. After drinking this black decoction, Lewis described feeling remarkably better. By the next day he was able to march twenty-seven miles (7:279).

At about the same time Sacagawea became gravely ill, the infirmity lasting nine days. William Clark wrote in his journal on 10 June 1805: “Sah cah gah, we a, our Indian woman verry Sick I blead her” (7:277). Like a sagacious and attentive physician, Meriwether Lewis noted the following in his journal on 16 June 1805:

about 2 P.M. I reached the camp found the Indian woman extreemly ill and much reduced by her indisposition. this gave me some concern as well for the poor object herself, then with a young child in her arms, as from the consideration of her being our only dependence for a friendly negotiation with the Snake Indians on whom we depend for horses to assist us in our portage from the Missouri to the columbia River. … I found that two dozes of barks and opium which I had given her since my arrival had produced an alteration in her pulse for the better; they were now much fuller and more regular. I caused her to drink the mineral water altogether. When I first came down I found that her pulse were scarcely perceptiable, very quick frequently irregular and attended with strong nervous symptoms, that of the twitching of the fingers and leaders of the arm; now the pulse had become regular much fuller and a gentle perspiration had taken place; the nervous symptoms have also in a great measure abated, and she feels herself much freer from pain. she complains principally of the lower region of the abdomen, I therefore continued the cataplasms of barks and laudnuum which had been previously used by my friend Capt Clark. I beleive her disorder originated principally from an obstruction of the mensis in consequence of taking could. I determined to … restore the sick woman. (4:299–301)

Sacagawea did recover with, or in spite of, the treatment. Lewis's observations suggested a pelvic disorder. The syndrome of lower abdominal pain, fever, and occasional delirium may have been pelvic inflammatory disease (PID), a likely possibility considering the presence of gonorrhea among the Hidatsa Indians of that era. History suggests that she did have another child in about 1812.^[20] In that so many infertile years passed before this presumably sexually active young woman had a second child, PID may be a credible retrospective diagnosis.

The exhausting portage around the Great Falls of the Missouri was made worse by a trio of pests: mosquitoes, gnats, and prickly pears. All three made the next leg of the journey to the three forks of the Missouri River unpleasant. The hard, sharp thorns of prickly pears penetrated their moccasins, broke off in the flesh, and caused abscesses. The three forks of the Missouri, the convergence of the Gallatin River, the Madison River, and the Jefferson River, had been the site of Sacagawea's abduction by the Hidatsa tribe five years before. Near this key geographic point, Lewis and Clark anticipated

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finding the Shoshone Indians. The expedition, however, was unexpectedly forced to halt here. Captain Clark had become alarmingly ill. Several days earlier he had complained of blisters and prickly pear thorn wounds on his feet. On 26 July 1805 he felt “verry unwell & took up Camp” (4:432). On the 27th, as described by Lewis: “at 3 P.M. Capt Clark arrived very sick with a high fever on him and much fatiegued and exhausted. he informed me that he was very sick all last night had a high fever and frequent chills & constant aking pains in all his mustles.” Lewis noted that Clark was “somewhat bilious and had not had a passage for several days.” He persuaded Clark to take a dose of Rush's pills, which Lewis had “always found sovereign in such cases” (4:436).

Captain Clark did take five of Rush's pills, a very large dose, and though sick throughout the night, began to feel somewhat better, particularly after the medicine had “operated.” The following day Clark had improved, although he was still very languid and complained of a general soreness in all his limbs. He took Peruvian barks, which probably assuaged his symptoms. The following day, 30 July, he was well enough to travel (5:14).

What was the cause of Clark's febrile illness at Three Forks? Although this illness caused Captain Lewis to suspend their voyage at this critical juncture, scores of previous analyses have simply dismissed this infirmity as constipation, exhaustion, malaria, or infection from prickly pear punctures. Current knowledge of infectious diseases and epidemiology suggests that a person presenting now with these symptoms during the summer season in south-western Montana would usually be suffering from Colorado tick fever. This viral infection, transmitted by wood ticks, is endemic today in the Three Forks area. The 1805 journal account of Clark's illness may be the first clinical description of Colorado tick fever, written by two good clinical observers.

The captains must have been elated when, on 8 August, Sacagawea recognized the Beaverhead Rock and stated that beyond it they would find her people. Indeed, reunion with her Shoshone tribe took place a few days later just south of presentday Dillon, Montana. Cameahwait, a Shoshone chief and Sacagawea's brother, agreed to provide horses and a guide for the corps to make the overland journey.

A heavy September snowstorm made the seven-day crossing of the rugged Bitterroot Range a severe struggle. With no wild game, the captains staved off starvation with horse meat and “portable soup,” a canned soup concentrate purchased by Lewis in Philadelphia. Some scholars have suggested that, by this time, the party had developed scurvy, because Captain Clark made frequent mention of skin infections and boils.^[21] The journals, however, provide no clues to any illness with the clinical manifestations of scurvy in the men. Furthermore, they had adequate sources of vitamin C from rosehips, plums, chokecherries, serviceberries, and currants.

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Descending to the Clearwater River valley, in what is now Idaho, the group reached a Nez Perce Indian village. The Corps of Discovery troops were famished. The natives provided a feast of dried salmon, berries, and roots. Apparently because of the food, all of the men became extremely ill for several days with what may have been some type of bacterial enteritis to which the Indians were immune. Lewis was, in fact, so weakened by vomiting, abdominal pain, and diarrhea that he could not ride his horse. And what treatment did Captain Clark administer to all of these men with dysentery? None other than the “sovereign” bilious pills of Dr. Rush!

After this two-week delay, the expedition proceeded down to the Columbia River in handhewn canoes, establishing contact with Indian tribes as they went. On this part of the journey Lewis and Clark began their medical practice with the Indians by treating their very common eye complaints with vitriol eye drops. The Indians suffered from sore eyes and blindness, perhaps caused by trachoma, still the leading cause of blindness in the world today.

On 7 November 1805 Clark wrote, “Great joy in camp we are in View of the Ocian” (6:33). The winter camp, Fort Clatsop, was fairly quiet, except for some interaction with the local Indian tribes. These natives had the same sexual mores as the Mandan Indians. In spite of admonitions of chastity, the captains had again to treat many of the men with mercurials for “the venerial” (6:416).

Three men were dispatched from Fort Clatsop to the ocean to make salt by boiling seawater. In February 1806 one of them, Bratton, became ill with a cough and low back pain. The back pain persisted for four months and caused him to be totally disabled. On the return journey, while camped along the Clearwater River in May, Bratton asked that he be sweated in an attempt to restore his health. After a set of vigorous sweats in a sweat hole, followed by immersion in cold water, his back finally began to improve, and he was soon able to resume his duties (7:283).

Captain Lewis had purchased nearly $700 worth of gifts and trinkets for the Indians to be used to barter for food, horses, canoes, and goodwill. Returning up the Columbia, they lacked resources to complete the return trip, and their supply of trade items was depleted. Although they resorted to cutting buttons off their clothes to trade for food and horses, it was the medical practice of Captain Clark that saved the day. Word of the redhaired doctor and his “Big Medicine” had gotten out to the Columbia River tribes, and on the return voyage, natives were waiting for him with their medical problems. And Captain Clark had many important successes.

Lewis wrote that Clark gave an Indian man some liniment to rub on his knee and “the fellow soon after recovered and has never ceased to extol the virtues of our medicines and the skill of my friend Capt. C. as a phisician” (7:209). Word of the medical skills of Lewis and Clark traveled fast and far.

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Indians came from as distant as two days’ ride on horseback just to seek medical attention. Captain Clark would see as many as fifty people a day at his clinics, while Captain Lewis carried on diplomatic negotiations with tribal leaders.

The expedition lacked sufficient numbers of horses to cross back over the mountains. Captain Clark's medical practice produced the needed horses. One of the many horses came from an Indian man whose wife had an abscess in the small of her back. He promised a horse for the treatment of the abscess. Captain Clark received a second horse in exchange for medicine for a little girl with rheumatism. Lewis noted, “[M]any of the natives apply to us for medical aid which we gave them cheerfully so far as our skill and store of medicine would enable us. schrofela, ulsers, rheumatism, soar eyes, and the loss of the uce of their limbs are the most common cases among them” (7:243).

One of the most interesting patients among the Nez Perce was a paralyzed chief. Lewis wrote,

a Cheif of considerable note at this place has been afflicted with it for three years, he is incapable of moving a single limb but lies like a corps in whatever position he is placed, yet he eats heartily, digests his food perfectly, injoys his understanding, his pulse are good, and has retained his flesh almost perfectly, in short were it not that he appears a little pale from having lain so long in the shade he might be taken for a man in good health. (7:243)

Lewis perceptively observed that the chief's muscles were not atrophied and he looked well. The usual remedies of sulfur, purgatives, and dietary changes did not help. Relatives of this chief had seen Bratton's sweat therapy and subsequent recovery. They persuaded Lewis and Clark to sweat the chief even though the Indians could have done this themselves. Before the first sweat, the captain-physicians sedated the chief with a dose of laudanum. After the sweat the chief began to use his arms, and after several more treatments, he regained the use of his limbs. After a month in the camp “hospital,” he had nearly recovered.

Like Clark's fever at Three Forks, this illness has undergone little analysis by medical historians. The chief was possibly disabled by a conversion reaction resulting from past psychological trauma that remained unresolved in the male Indian tradition and culture of the time.

Why were these Army captains effective healers among the Indians? Lewis noted that “everything which is incomprehensible to the Indians they call big medicine, and is the opperation of the presnts and power of the great sperit” (4:101). Since Lewis and Clark presented a novel appearance, spoke a strange language, dressed differently, had unusual-colored skin or hair (Clark had red hair and Clark's servant, York, was black), and employed unique remedies, they were perhaps considered to be

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personifications of the Great Spirit. Their treatments seemed to produce powerful results for the Indians.

Lewis gave credit to his partner, Captain Clark, as the Indians’ “favorite phisician.” Lewis and Clark acknowledged they were not actual physicians, but in their circumstance they felt that it was “pardonable to continue this deseption for they will not give us any provision without compensation in merchandize and our stock is now reduced to a mere handfull” (7:209, 210). This “pardonable deseption” enabled the Corps of Discovery to secure the critical provisions and packhorses needed to return over the mountains.

Similarly to Hippocrates, Lewis stated: “we take care to give them no article which can possibly injure them” (7:210). Their journals give evidence that as good physicians, the captains truly cared for these native people and desired as good an outcome as possible.

In June 1806 they retraversed the rugged Bitterroot Range and proceeded on their homeward voyage. In August of that year an accident of grave potential occurred at the junction of the Yellowstone and Missouri Rivers, when Meriwether Lewis was accidentally shot in the leg by one of his own men. Fortunately, it was only a superficial wound. He recovered quickly, and shortly thereafter the Corps of Discovery “proceeded on.” Arriving in St. Louis on 23 September 1806, the troops “received a harty welcome.” Writing from St. Louis to President Jefferson, Meriwether Lewis summarized the importance of their health: “The whole of the party who accompanyed me from the Mandans have returned in good health, which is not, I assure you, to me one of the least pleasing considerations of the Voyage.”^[22]

The role of Captain Lewis and Captain Clark as expedition physicians was vital to the overall success of this mission. Included among the physician-captains’ patients were their troops, Sacagawea, her baby, the Native Americans, and each other. Their aid to the Indians assured the success of travel and prevented starvation. With the exception of one tragic encounter with a Blackfeet hunting party on Lewis's return, their interaction with the native people was friendly. By using diplomacy, honesty, and their medical skills, Lewis and Clark achieved more than any conquering army might have for their president and for their country.

NOTES

Acknowledgment: the author would like to thank Edward W. Hook, M.D., for his encouragement to publish this Medical Center Hour presentation and for his assistance with manuscript editing. Thanks are extended also to Joyce S. Garver for manuscript preparation, and especially to my wife, Charlene, for editing and encouraging me in this endeavor.

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