“i Gave Him Barks And Saltpeter •”

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Saltpeter may have been a relatively harmless remedy, but bloodletting was not—in fact, it may well have killed more patients than it cured. For centuries, beginning even before Hippocrates and continuing almost to the present, doctors believed that practically every malady known to man, from pleurisy and scarlatina to bilious fevers and bubonic plague, could be treated effectively by drawing off blood. The practitioners of this sanguinary art included not only the physician but also the apothecary, the bath keeper, even the barber—hence the blood-red stripes on his barber pole. Many used leeches, and were known as leech doctors, while others insisted on the sharp-edged lancet. Some had a device known as a scarificator, a box-shaped instrument that made several incisions instead of the lancet’s one.

Regardless of what instrument he used, the blood-letter meant business. Disease was serious and demanded vigorous action. With a few, the stock apothegm was, “Bleed until syncope,” which meant in essence, draw blood until the patient is unconscious. Those who survived did so, of course, in spite of bleeding; today doctors rarely resort to the treatment. It is sometimes indicated in polycythemia vera , a rare disease in which the number of red blood cells has increased abnormally, and in certain grave heart and lung disorders where reducing blood volume is beneficial. Too, bleeding occasionally does seem beneficial for sunstroke. According to Dr. William Osier, the famous teacher at Johns Hopkins, “In the cases in which the symptoms are those of intense asphyxia, and in which death may take place in a few minutes, free bleeding should be practiced …” But whether or not the treatment helped the sunstroke victim of the Lewis and Clark expedition, it is impossible to say.

Soon after, however, tragedy struck for the first and only time during the whole journey to the Pacific and back. On July 31, just above the mouth of the Platte, Sergeant Charles Floyd noted in his journal, “I am verry Sick and Has been for Sometime but have Recovered my helth again.” But his recovery was only temporary. Three weeks later, on August 19, Clark wrote: “Serjeant Floyd is taken verry bad all at once with a Biliose Chorlick we attempt to relieve him without success as yet, he gets worst and we are much allarmed at his Situation …” Nothing, Clark said, would “Stay a moment on his Stomach or bowels.”

The next day Sergeant Floyd died, probably of a ruptured, gangrenous appendix. The journals reveal nothing of measures attempted to save his life. The odds are that Lewis both bled Floyd and purged him with laxatives. If he did the latter, it may well have hastened Floyd’s death, either by rupturing the appendix or by adding to the inflammatory material already in the peritoneal cavity. In any event, Lewis’ efforts were to no avail; probably the best medical talent of that day could not have saved the sergeant, for surgery then was almost entirely limited to the surface of the body. It was not until 1887 that the first appendectomy was performed by Dr. John Morton in Philadelphia.

The Lewis and Clark expedition passed the first winter in a hastily built but sturdy stockade, Fort Mandan, near the mouth of the Knife River, about fifty-five miles above the present Bismarck, North Dakota. Here, for six months, they lived surrounded by some 4,000 aboriginals—Mandans and Minnetarees (Hidatsas). From the very beginning, these Indians exceeded the bounds of what white men considered conventional hospitality. To the explorers they proffered not only corn, beans, and squash but also wives, daughters, and sisters. To them, as to many other Indian tribes, this was no deviation from rectitude; it was an old, established, and entirely respectable custom. However, even for the Indians there were limits to hospitality, and as the long winter wore on, many of the “squars” began to sell their “favors” for a string of beads, a looking glass, or a piece of ribbon.

Though the Indian men had no scruples about farming their wives out for the night, they were properly resentful if their offers were turned down without good reason. However, the evidence seems firm that Lewis and Clark themselves refused all such offers. It is most unlikely that they would have cheapened themselves in the eyes of their men in this manner and thus jeopardized the success of their mission.

Lewis and Clark had little to say in their journals about the sexual relations between soldiers and squaws, or about the sordid sequelae. On January 14, 1805, at Fort Mandan, Clark noted: “Several men with the venereal cought from the Mandan women.” And, a few days later: “one man verry bad with the pox [ i.e. syphilis].” Again, on March 30, as the expedition prepared to resume the ascent of the Missouri: “Generally helthy except Venerial Complaints which is verry Common amongst the natives and the men Catch it from them.”

The expedition leaders had anticipated venereal disease. Both men had served previous enlistments in the Army, and they knew something of the appetites and frailties of the average soldier. Thus, they carried ample supplies of mercury ointment, calomel (mercurous chloride), balsam copaiba, and saccharum saturni (sugar of lead), and they had armed themselves with four pewter urethral syringes. Lewis and Clark, however, make mention only of mercury in their treatment of venereal disease, which meant either mercury ointment or calomel or both. (Dr. Rush regarded mercury as the “Samson of the Materia Medica” in the treatment of syphilis.)