Venereal disease and the Lewis and Clark expedition

Venereal Disease and the Lewis and Clark Expedition

Thomas P. Lowry With a foreword by Edwin C. Bearss University of Nebraska Press Lincoln and London

© 2004 by the Board of Regents of the University of Nebraska. All rights reserved. Manufactured in the United States of America. Set in the Enschedé type foundry’s Trinité by Tseng Information Systems. Book design: Richard Eckersley. Printed by Thomson-Shore, Inc.  Library of Congress Cataloging-in-Publication Data Lowry, Thomas P. (Thomas Power), 1932– Venereal disease and the Lewis and Clark expedition / Thomas P. Lowry ; with a foreword by Edwin C. Bearss. p. cm. Includes bibliographical references and index. isbn 0-8032-2959-3 (cloth : alkaline paper) 1. Lewis and Clark Expedition (1804–1806) 2. Sexually transmitted diseases – United States – History – 19th century. 3. Medicine – United States – History – 19th century. i. Title. f592.7.l89 2004 917.804'2—dc22 2004016157

Contents

List of Illustrations

vii

Foreword

ix

Preface

xiii

Acknowledgments

xvii

Introduction

1

1. Venereal Disease Today

5

2. What Did Lewis and Clark Know about Venereal Disease?

15

3. The Famous Shopping List

35

4. Indian Medicine

47

5. The Voyagers Speak

55

6. Aftermath

85

Notes

103

Bibliography

111

Index

115

Illustrations

figures 1. Effects of secondary syphilis

9

2. ‘‘Death Disguised as a Beautiful Woman’’

11

3. Meriwether Lewis’s famous shopping list

36

4. Aerial view of Knife River Hidatsa village

60

map Tribes with venereal disease, as described by Lewis and Clark

65

tables 1. Sexually Transmitted Diseases and Their Causes

4

2. Lewis’s Medical Shopping List

38

Foreword

A mid-October 2002 telephone call from longtime friend, historian, and author Thomas P. Lowry was exciting and intriguing. He informed me that he and his wife, Beverly – his equal as a researcher – had finished a manuscript highlighting an often-ignored but lasting medical problem that haunted members of Lewis and Clark’s Corps of Discovery, and the Native peoples they encountered, nearly two centuries ago. Tom inquired, ‘‘Would you be interested in reading the manuscript and, if warranted, writing the foreword?’’ After voicing concerns about time constraints and weighing them against a busy schedule, I answered, ‘‘Yes.’’ My decision to do so was reinforced by my interest in Lewis and Clark, which predated my infatuation with the Civil War. This later romance began in the winter of 1936–37, when my father, a Marine Corps veteran of the Great War and a Montana rancher, read to me John Thomason’s Jeb Stuart. Some six years before, Sarah Evans Morse, my maternal grandmother – a women’s rights crusader, educator, and social worker – introduced me to the Corps of Discovery and to Lewis and Clark. This was only natural, because Sarah Evans had come to Montana in the mid-1890s, fresh out of college, to teach in the Indian School at Crow Agency. By 1908 she held elective office as superintendent of schools in Yellowstone County, and for many years before her death on January 10, 1933, she served as executive secretary of the Monix

x Foreword

tana Tuberculosis Association, a position she had held since 1916. Her office was in the state capitol in Helena, and on my first visit to the building, as a first-grader, as well as on subsequent visits – the most recent in 1999 – I have always been impressed with the gigantic Charles M. Russell painting of the Corps of Discovery’s meeting with the Flathead Indians in Ross’s Hole. As a divorcée with only one child, Sarah Morse always spent Christmas vacations at my parents’ Sarpy, Montana, ranch, bounded on two of the four fence lines by the Crow and Northern Cheyenne Indian Reservations. On these visits she fired a youthful fantasy with Montana history, particularly the trials and tribulations of the Corps of Discovery. A born teacher, she took my brother and me on winter walks through the snow while sharing with us passages from the expedition’s journals. To make the walks more relevant, she assigned each of us a role: Sarah was Sacagawea; my brother was Meriwether Lewis; and I was William Clark, as I felt better able to relate him, both then as well as today. Following my introduction to the Civil War, and after a required course in Montana history in eighth grade, my interest in the Corps of Discovery ebbed for more than three decades. It did not return until the late 1960s, some twelve years after I joined the National Park Service as a historian. At that time, the service was preparing for publication, in 1975, of Lewis and Clark – Historic Places Associated with Their Transcontinental Exploration (1804–1806). Because of my background and familiarity with most of the Montana sites, I was elated to work closely with the author and editors of this project. Like all volumes in the National Survey of Historic Sites and Buildings series, the Lewis and Clark volume was site-oriented. Having returned to my Montana roots, I read with keen interest the critically acclaimed and masterful Undaunted Courage: Meriwether Lewis, Thomas Jefferson, and the Opening of the West by my friend

xi Foreword

Stephen Ambrose.The enthusiasm engendered by Ambrose’s blockbuster, which spent more than ten weeks on the New York Times best-seller list, and the approach of the Bicentennial of the Lewis and Clark Expedition afforded a challenging opportunity. In August 1999, I led an eight-day, seven-night van tour for History America of the route followed by the Corps of Discovery from the Great Falls of the Missouri to the confluence of the Clearwater and Snake Rivers at Lewiston, Idaho. This honed my knowledge of and appreciation for what they accomplished. Earlier, my years at military school and four years spent in the U.S. Marine Corps during World War II introduced an unsophisticated youth to a major problem that has plagued the military since 1498 – venereal disease. Back at St. John’s Military Academy, I remember our rotc lectures on the subjects of health and sanitation, which included information about venereal disease, then a no-no in public high schools. It covered transmission of venereal disease, Capt. Allen E. Smith’s cautionary warning that you don’t get gonorrhea from toilet seats, and his stern words that the only sure prophylaxis is ‘‘to keep your pecker in your pants.’’ In the Marine Corps, the boot camp lectures were more specific and were supplemented with gruesome photographs of the ravages caused to the body by syphilis. There was the monthly ‘‘short arm’’ inspection by naval corpsmen and the warning that time spent in sick bay would, like brig time, be added to the perpetrator’s enlistment term. Capt. Meriwether Lewis readied himself for the expedition that would be gone for several years from civilization, as white America knew it, through a review of relevant literature. Among the problems he foresaw was how to recognize and combat the venereal diseases that could be anticipated, resulting from sexual contact with the Native peoples. How Lewis and Clark met and mastered this challenge occupies center stage in Tom Lowry’s Venereal Disease and the Lewis and Clark Expedition.

xii Foreword

Lowry’s more than forty years as a doctor, in both public and private practice, and his and his wife’s sleuthing skills have led to a number of books, including the critically acclaimed The Stories the Soldiers Wouldn’t Tell: Sex in the Civil War. Lowry’s latest endeavor enlightens us on health problems – so frequently ignored – that plagued the expedition and the Native peoples with whom they interacted.Too often in our reverence for our forebears, we see them through the eyes of a Puritan. Thanks to Dr. Lowry, however, we can better understand their foibles and hardships and can appreciate what Lewis and Clark and the men of the Corps of Discovery accomplished in combating venereal disease as well as other ills and injuries. It is a mark of their skill that during the expedition only one man died (Sgt. Charles Floyd), and he of a ruptured appendix, a condition not fully understood until a century later. edwin c. bearss Historian Emeritus U.S. National Park Service

Preface

Sex is the long-ignored theme of Lewis and Clark and their immortal journey. Sex and venereal disease. Sex is ‘‘the elephant in the living room,’’ the gigantic fact that all agree to ignore. Comments about sex and venereal disease run rampant in the pages of their journals, yet they are mentioned only in passing in the many books about Lewis and Clark. And what caused Meriwether Lewis’s terminal insanity? What drove him to a truly bizarre mode of suicide, one in which he shot himself twice and then, some say, slashed his body from head to toe, adding strips of bleeding flesh to the gunpowder-burned holes in his chest and head? What could cause so brave and resilient a military leader to mutilate his body thus, as his final public act? Was it syphilis of the brain that skewed his thoughts? Of course, the journey of Lewis and Clark, now being commemorated in its bicentennial celebration, was about many things besides sex. To the historian, it was the first step in the nation’s expansion across the vast stretches of the Louisiana Purchase. To the geographer, it was the clarification of what lay beyond the upper reaches of the Missouri River. To the biologist, it was the first step in cataloging the plants and animals of half a continent.To the politicians, it was step one in keeping the English and French out of what are now the Dakotas. To those who admire competent planning, balanced discipline, and skilled leadership, the journey stands as an example of a perfect military expedition. xiii

xiv Preface

To those who love adventure and manly men, the Corps of Discovery was Columbus, Magellan, Daniel Boone, and Davy Crockett all rolled into one. For the lover of dogs, it was the story of Lewis’s big, black Newfoundland, who was finally taken on a walk long enough to satisfy his canine sense of what is proper, the story of a dog who got to sniff a whole continent and mark his territory. For the feminist scholar, it was a corps of lost boys, guided to safety by their faithful but unappreciated Sacagawea, the only woman in the group, who breast-fed her baby while pointing the way through the wilderness. For the student of race relations, it was the glorious inconsistency of York, Clark’s black slave, whose strength and endurance matched that of any white man on the voyage. York, whose post-expedition plea for freedom was answered by a beating, has become a symbol for four hundred years of oppression of black people. To the aficionado of Manifest Destiny, it was an essential step in extending the United States across the entire continent, a prelude to surveying, platting, and selling the earth in neat, square parcels, a new dawn in which the plow and barbed wire would change the land. To the American Indians, of course, it was something totally different – the beginning of disaster. The French had sold Louisiana, which they did not really own, to the Americans, who had no better claim to it.The area drained by the Missouri River was hardly an unexplored wilderness. It had been inhabited, farmed, fished, hunted, and fought over for millennia by its native inhabitants. They knew its rivers, its plains, and its mountain passes. They knew how to live in its bitter winterand through its summer prairie fires.Their hunting trips and seasonal migrations had made them familiar with vast regions. The visit of Lewis and Clark was, for the Indians, the start of a disease-ridden, bullet-pocked trail of tears, a story of near exter-

xv Preface

mination.Yes, there are many ways to regard the Corps of Discovery and its records. To the physician, it was about sex.To this author, who has studied history, public health, and human behavior for more than fifty years, the records made two centuries ago reveal that the explorers anticipated and expected sex and venereal disease, that their medicine chests were filled with venereal remedies, that they saw their men in numerous sexual encounters, and that they treated many, perhaps most, of their men for the effects of venereal disease. And, worst of all, their noble captain, the skilled and intrepid Meriwether Lewis, may himself have been ruined by that pale and microscopic killer, the spirochete of syphilis. Most writers about Lewis and Clark have mentioned the role of sex and venereal disease, but the mentioning has been in passing, sotto voce, a variation on ‘‘Sure, they had syphilis, but on to our real story.’’ The role of sex and venereal disease on the expedition has been trivialized, marginalized, downplayed. How could such a central part of the expedition go unremarked by eight generations of writers? A direct analogy can be seen in the hardest of the ‘‘hard’’ sciences: geology. In 1840 the most eminent geologist in the English-speaking world was Charles Lyell. His denunciation of those whom he dubbed ‘‘catastrophists’’ put a stop to any serious discussion of whether disasters such as meteors or volcanic explosions might explain the great gaps in the fossil record. Even the extraterrestrial origin of obvious impact sites, such as the Arizona meteor crater, was denied. It was not until the 1970s that mainstream geologists could embrace such events as the fall to earth of the iridium-bearing meteor, which put an end to the dinosaurs, without damaging their professional reputations. If events millions of years ago, long before our own species appeared, could generate academic angst, how unsurprising it is that value-laden subjects,

xvi Preface

such as sex, could be relegated to a very quiet corner of the Lewis and Clark story. The evidence – not mere opinion, but real evidence from the primary sources – strongly suggests the centrality of sex and venereal disease in the great exploration. The importance of sex and venereal disease should be restored to its rightful and central place. Not for the sake of some misguided revisionism, not for the sensation of ‘‘yellow rag’’ journalism, and certainly not for the sake of casting shame upon the explorers, for they had and have no cause for shame. The purpose of such a reconsideration is that of looking real history in the eye without blinking, of giving a fair appraisal to the joys and hazards of sexual union in the years between the expedition’s departure from St. Louis and its glorious return.

Acknowledgments

Happy is the author with so many friends and supporters. Kim Holien suggested this book. Budge Weidman and Mike Musick helped me in the National Archives. Ed Bearss encouraged me to complete it. Jack Welsh and Guy Hasegawa clarified many points of ancient pharmacology. Father Albert Ledoux and M. Antoine Kher assisted with Latin and French. Deborah Hayden reviewed the entire manuscript. The staffs of the Library of Congress, the Missouri Historical Society, and the National Library of Medicine were, as always, helpful. Beverly A. Lowry not only keyed in the manuscript but proofread it many times. For her research skills, long companionship, warm heart, and dedicated support I thank her once again.

Introduction

Lewis and Clark, on their immortal voyage of discovery, faced many perils: swelling rivers, thundering waterfalls, hostile Indians, blizzards, frostbite, starvation, grizzly bears, rattlesnakes, and the great unknown of the Rocky Mountains. Of these dangers, one of the greatest and most feared was venereal disease. It is easy today to think of sexually transmitted diseases in moral terms, to see our time as an age of moral decay and shocking promiscuity, and to view our nation’s distant past as a golden age where sins of the flesh were of lesser import and men’s feet trod the narrow path of moral rectitude. Yet the written records of our ancestors tell a different story. Diaries of famous New England clerics of the 1600s reveal burning obsessions. Michael Wigglesworth (1631–1705), author of Day of Doom, felt overwhelmed by ‘‘unresistible torments of carnal lust’’ and spent many mornings in anxious prayer because of ‘‘filthy dreams and nocturnal pollutions.’’ Cotton Mather (1663– 1728), an even more eminent divine and the author of 450 books, prayed daily to escape his ‘‘lascivious thoughts.’’ James Creeke of Essex County, Massachusetts, was tried in 1682 for ‘‘heinous, lascivious and adulterous carriage with Elizabeth, wife of Luke Perkins.’’ In 1721, Anglican priest John Urmstone despaired of his North Carolina flock: ‘‘A nest of the most notorious profligates on earth . . . chiefly people such as have been educated at some of the famous colleges of Bridewell and Newgate [notorious London prisons].’’ He hired a maidservant, who turned out to be ‘‘a notorious whore and thief ’’ but was ‘‘preferable to any that can be hired here.’’ 1 1

2 Introduction

At the pinnacle of the first families of Virginia were the Randolphs, but even this family’s affairs swirled with allegations of incest, child murder, and miscegenation.2 At a later period, during the American Civil War, 25 percent of all brides were pregnant and 20 percent of all pregnancies ended in abortion. Startling, perhaps, but in 1760 even more brides were pregnant than in the 1860s.3 Whole books could be – and have been – written documenting the carnal history of early America. In brief, there is overwhelming evidence that unauthorized, unapproved sexual behavior, even if unacknowledged in most history classes today, has been a major factor in American civilization. Today, sexual mores, conservative religious opinion, and government policy are very closely tied, but it must be remembered that this union is recent, part of a cycle of alternating liberality and conservatism in our public life. Consider the era of Lewis and Clark.The major religious revival that swept the colonies from 1739 to 1742, the so-called Great Awakening, was followed by lesser waves of spiritual fervor, some termed ‘‘New Lights’’ of the Great Awakening. But there was a countercurrent: the Enlightenment, an age that had produced a new ‘‘religion’’ – deism. The movement had its origin in the 1600s and held that reason was sufficient to prove the existence of God, removing the need for revelation or authority (such as the Bible). Deists believed that God had, indeed, created the world, but afterward assumed no control over people’s lives, much less taken an active interest in human affairs or historical events.To deists, the separation of church and state was both natural and necessary. The new federal Constitution made no provisions for public funding for any church. Many of the founding fathers were deists, including Thomas Jefrson, who had grave doubts about the divinity of Christ and believed that traditional Christianity was little more than ‘‘an engine for en-

3 Introduction

slaving mankind.’’ Jefferson went so far as to edit and publish his own Bible, in which he eliminated those parts of holy writ that he deemed mere superstition. Jefferson strongly believed in the ascendancy of the rational mind. He was convinced that religion of the fundamentalist, evangelistic type would soon die away and that within a generation ‘‘every young man would die a Unitarian.’’4 Meriwether Lewis was a practical man, a traveler, and an army officer who had served at many isolated frontier posts. There the key to survival was action, not theological theorizing or religious rumination. In his years as Jefferson’s private secretary, as Lewis was preparing to lead the incredible journey into the unknown, he absorbed not only Jefferson’s interest in geography, botany, and ethnology but also, it would seem, Jefferson’s rather neutral view of the connection between sexual behavior and religious teachings. The goals of the Voyage of Discovery were geographic research, mapping, exploration of natural resources, and the establishment of relations with the Indians. An even more fundamental goal was that of returning safely with the journals and biological specimens that were of such interest for political and natural history.The party needed to prepare for venereal disease as a known hazard, not only along the eastern seaboard but in the great sweep of the Louisiana Purchase, a disease most likely brought to the Indians by French, British, and Spanish adventurers. On the Pacific coast, American and British trading ships had already brought syphilis to the Native populations of the lower Columbia River. Lewis and Clark’s thirty virile young men were unlikely to remain celibate for two years; the captains needed to prepare for the consequences of encounters with potentially infected women, not to mention whatever diseases his men may have had previously.When Lewis went shopping for medical supplies, his list included many remedies for venereal disease. In the chapters to follow, we will explore what is known about vene-

4 Introduction

real disease today; what was known in 1803, and the origins of that knowledge; Meriwether Lewis’s medical shopping list; the actual events pertaining to sexual behavior during the journey; the health of the voyagers in the years that followed; and, finally, the legacy of these remarkable years as the West was opened to its European inheritors.

Table 1: Sexually Transmitted Diseases and Their Causes Disease AIDS Non-specific urethritis Trichomoniasis Yeast infection Chancroid Lymphogranuloma venereum Granuloma inguinale Genital herpes Scabies Crabs (pubic lice) Molluscum contagiosum Venereal warts Syphilis (lues, the pox) Gonorrhea (clap, gleet)

Causative Organism Human Immunodeficiency Virus Chlamydia trachomatosis Trichomonas vaginalis Candida albicans Haemophilus ducreyi Chlamydia trachomatosis Calymmatobacterium granulomatosis Herpes simplex virus, type 2 Sarcoptes scabiei Phthirus pubis A pox virus Human papilloma virus Treponema pallidum Neisseria gonorrhoeae

1 Venereal Disease Today

Our present knowledge of health and disease results not from any cleverness on our part but rather from the fact that we are the heirs of centuries of dedicated observers. A wholly unearned sense of omniscience may seize us as we think of how ‘‘ignorant’’ medical people were two hundred years ago. But two centuries from now our current state of understanding will no doubt look even more primitive. We, like the men of Lewis and Clark’s time, know what we know, and that is useful enough. Today the list of sexually transmitted diseases usually includes all of those listed in table 1. Only the last two, syphilis and gonorrhea, are mentioned in the Lewis and Clark journals, and only those two will be discussed here. Gonorrhea is spread almost exclusively by sexual contact. In men the first symptoms appear two to fourteen days after contact with an infected partner. Painful urination and a purulent discharge appear first; as the infection spreads upward into the posterior urethra, the need to urinate becomes more frequent and more urgent. A diagnosis of infection can be confirmed by examination of the discharge under the microscope or by an incubated specimen. Left untreated, gonorrhea may, in perhaps 10 percent of infected men, spread throughout the body, causing painful infections of the epididymis, abscesses around the urethra, and prostatic infection. A very unpleasant late effect is scarring and narrowing of the urethra, which must be treated by forceful dilation using curved metal rods. Gonorrhea in women may lie hidden with mild or no symptoms, 5

6 Venereal Disease Today

especially in the early stages, yet still be contagious to a partner.The cervix and the Fallopian tubes are the areas most usually infected. The latter may become the site of voluminous abscesses, which may produce few symptoms until they burst, rendering the woman desperately ill with an almost instantaneous peritonitis. Another form that gonorrhea may take in women is the disseminated type, spread widely through the bloodstream with skin lesions and arthritis from the gonococcus bacteria growing in the joint fluid. A generation ago, a major cause of blindness in newborn babies was gonorrhea of the eyes, contracted from an infected mother during childbirth. Silver nitrate or antibiotics are now routinely placed in the eyes of newborns, rendering neonatal blindness from gonorrhea largely a thing of the past. In male parlance, thevisible external discharge is most commonly called ‘‘the clap’’ or ‘‘a drip.’’ A century ago the term ‘‘gleet’’ was in common usage. Since military organizations are common locations for widespread gonorrhea, the ‘‘short-arm inspection’’ has long been part of army lore. In this procedure, each man is required to expose his member and manipulate it in a way that would cause any hidden discharge to become manifest. In individuals employing routes of sexual connection other than conventional heterosexual intercourse, gonorrheal infections of the tonsils or rectum are common. Forty years ago, the treatment of gonorrhea was simple: a shot of penicillin. Thanks to the improper use of antibiotics, the wondrous adaptability of microorganisms, and the pernicious influence of the sex industry (particularly in Southeast Asia), penicillin is now next to useless for the treatment of gonorrhea.1 As of this writing, a combination of ceftriaxone (Rocephin) and doxycycline (Vibramycin) – the latter for the chlamydia so often found with gonorrhea today – is more likely to prove curative.2 In 1995 there were 400,000 reported cases of gonorrhea in the United States and almost 2 million cases

7 Venereal Disease Today

worldwide. The number of cases at the time of Lewis and Clark is unknown. The other relevant sexually transmitted disease, very well known to the Corps of Discovery, was syphilis, also called Lues venereum or the pox. The cause is a delicate spirochete, Treponema pallidum, hard to seewith a conventional microscope and even more difficult to culture. Outside the body, it quickly dies; inside the body, it can cause a vast catalog of mischief.The many possible manifestations of syphilis, and its dozens of guises, caused the great Canadian-AmericanBritish physician Sir William Osler (1849–1919) to exclaim, ‘‘Know syphilis in all its manifestations and relations, and all other things clinical will be added untoyou.’’ 3 Osler’s interests ranged widely, but his observation was strongly endorsed by men who made syphilis their life’s work. Sir Jonathan Hutchinson, in his 1887 tome simply entitled Syphilis, advised his readers that ‘‘syphilis has no lesions or type-forms of disease which are peculiar to itself.’’ This view was echoed a generation later by John Stokes in Modern Clinical Syphilology (1926), when he wrote that ‘‘syphilis apes every disease in any field of medicine’’ with a ‘‘Machiavellian facility in disguise, deceit and malevolence.’’ In brief, while general statements may be made about the appearance of syphilis, the exceptions may be as likely as the rule.4 After the victim has contact with an infected partner, three weeks usually elapse before the first symptom appears, most commonly in the form of a chancre, a painless ulcer found on the part of the body that made contact. With the chancre, the nearby lymph nodes enlarge, also without pain. This, the primary stage, lasts about a month in an untreated person. Many unobservant persons are not even aware that they have been infected. This is especially true in women, since the chancre is often out of sight. The secondary stage follows, five to twelve weeks after the chan-

8 Venereal Disease Today

cre, with skin rashes, patchy hair loss, fever, headaches, and a variety of lesions at the junction of mucous and cutaneous skin surfaces. The skin lesions may resemble pityriasis (a group of more than twenty different skin diseases characterized by the shedding of small, flat, dry flakes), rubella (German measles), or a fungal infection, and they are often misdiagnosed or overlooked, reminding us again of Osler’s dictum. The various crusted and scabbed skin lesions bore such names as rupia, tetters, and morphews (see fig. 1). One of the many possible skin manifestations of secondary syphilis is ‘‘condyloma lata,’’ flattened gray or pink mucous lesions that, though they do not seem very dramatic, are extremely infectious. Tender lesions on the palms and soles are common. In the days before blood tests, which came a century too late for Lewis and Clark, the skin lesions of secondary syphilis might be any type of lump, bump, pimple, scab, rash, freckle, ulcer, scale, patch, or eruption. It was common to describe a latent phase, following the secondary manifestations, in which there were few symptoms for years or even decades. A proper reading of the great syphilologists of previous generations makes it clear that the spirochetes, even if unseen, are busy at work during this phase, torturing the victim with every imaginable symptom.The sufferer is likely to endure episodes of unexplained but incapacitating pain, intermittent paralysis, inflammation of the iris, partial blindness or deafness, whistling in the ears, headaches, and vomiting. With the initial chancre long forgotten, the patient usually received a huge catalog of mistaken diagnoses.5 The later stages of syphilis may appear years or decades after the initial infection. For reasons unknown, roughly two-thirds of the cases of untreated syphilis do not progress to the tertiary stage, but the one-third that do progress become host to some devastating medical conditions. One, rarely seen today, is gumma, a slow-

1. Effects of secondary syphilis. This young man has the rupia form of secondary syphilis, as shown in an 1893 atlas of clinical medicine. (National Library of Medicine photograph, catalog number a029351)

10 Venereal Disease Today

growing, tumorlike mass of inflammatory tissue that can become larger than a golf ball and erode through bone and cartilage. Another is aneurysm (weakening and dilation) of the aorta, which may burst, spilling out all five quarts of the sufferer’s blood in a matter of seconds. About 5 percent of persons with untreated primary syphilis will develop syphilitic lesions of the brain, with terrible effects on coordination and mentation – what used to be called gpi: general paralysis of the insane. The coordination problems include muscle spasms, slurred speech, paralysis of the eye muscles, seizures, tremors, and a masklike face. Another manifestation of late syphilis can be tabes dorsalis, in which the dorsal columns of the spinal cord are destroyed. With tabes there can be paroxysmal disturbances of the stomach and larynx, wasting away of the bones and joints, difficulties with urination, failure of sexual function, and so-called tabetic crises, in which sudden attacks of extreme abdominal pain lead to fruitless exploratory surgery. Mental symptoms of tertiary syphilis can include depression, inappropriate gaiety, poor judgment, decreased memory, delusions (including the delusion of being healthy), hallucinations, paranoia, irritability, personality changes, emotional overreaction, decreased moral sense, and impairment of calculation. There may be ‘‘clear’’ periods of remission, adding to the confusion in diagnosis. I once treated a colonel’s wife who had been admitted to a psychiatric ward because of her strange behavior. She proved to have neurosyphilis, not schizophrenia, a souvenir of her husband’s overseas posting twenty years before. She did not know that she had ever been exposed to syphilis. For some, the final stages lead to overwhelming insanity, paralysis, and death. Figure 2 shows in visual metaphor that beauty can be a mask for disaster. In a strange development that suggests the dangers of overspecial-

2. ‘‘Death Disguised as a Beautiful Woman.’’ An 1851 French poem used this engraving to caution readers about lovely women with hidden syphilitic lesions. (National Library of Medicine photograph, catalog number a012290)

12 Venereal Disease Today

ization in the field of medicine today, syphilis of the brain, with its attendant mental symptoms, has ‘‘disappeared’’ from the diagnostic canon.The professional organization of psychiatrists, the American Psychiatric Association, publishes an 800-page book that lists and describes dozens of psychiatric syndromes. In the 1994 edition, syphilis (or any of its synonyms) is not listed. Of course, syphilis of the brain has not disappeared; whether it is called ‘‘paresis’’ or ‘‘general paralysis of the insane’’ or ‘‘softening of the brain,’’ it still exists.True, it is less common, and it exists today in the United States almost entirely in African Americans and white homosexual males, but no committee can make a disease disappear, and it certainly had not disappeared at the time of Lewis and Clark.6 Today, syphilis can be diagnosed in several ways. The first is by blood test. The old Wasserman test has been replaced by several more reliable diagnostic studies, such as the Venereal Disease Research Laboratory (vdrl) Test and the rapid plasma reagin (rpr) tests, and even more specific ones such as the fta-abs, the mhatp, and the tpha, all of which are beyond the scope of this brief overview. Neurosyphilis is diagnosed by the analysis of spinal fluid. Scrapings from the active primarychancre, examined with a darkfield microscope, can give the diagnosis in moments, while latestage aortic aneurisms may be visible on a chest X-ray. As always, the doctor today must think of syphilis, since its presence is so often a surprise. Lewis and Clark, no doubt reflecting its widespread occurrence, were themselves quick to think of syphilis. Treatment today is still based on large dosages of penicillin. For primary and secondary syphilis, 2.4 million units of Benzathine penicillin G, given intramuscularly in one injection, will suffice. For the far more ominous neurosyphilis of the later stages, a more dramatic dosage is needed: 20 million units of aqueous crystalline penicillin G, given intravenously every day for two weeks, followed

13 Venereal Disease Today

by a final intramuscular injection of Benzathine penicillin. Patients allergic to penicillin will benefit from other antibiotics. The progression of late-stage syphilis can be stopped, but damage already done is irreversible. As the spirochetes die during penicillin treatment, they may set off a temporary reaction that resembles a violent allergic attack. Two years of follow-up blood tests are needed to determine whether cure is a reality or an illusion. In North America, as of 1999, the World Health Organization estimated that there were 100,000 new cases of syphilis each year.Worldwide the problem is far worse, with over 11 million new cases a year. South and Southeast Asia combined have 4 million new cases a year; sub-Saharan Africa also has 4 million cases, while close behind is Latin America with 3 million cases. At the far bottom of the list are Australia and New Zealand, with a combined total of 10,000.7 It is easy to see that gonorrhea and syphilis were and are formidable enemies and that Lewis and Clark faced a major threat to their Corps, one that was in many ways as dangerous as grizzly bears, snakes, warfare, and slippery trails.

2 What Did Lewis and Clark Know about Venereal Disease?

The study of syphilis dates back to 1495, three years after Columbus’s first voyage to the New World and 308 years before the Corps of Discovery started up the Missouri River. It is worth considering the term ‘‘venereal disease.’’ The word ‘‘venereal’’ is derived from Venus, the Roman goddess of love, who in turn traced her roots to Aphrodite and Ishtar, goddesses of sexual love, sexual intercourse, lust, dangerous eroticism, and fertility. Botticelli’s famous painting The Birth of Venus is a wonderfully idealized image of that event. On his luminous canvas, Venus/Aphrodite glides in on a gentle wave out of an azure sea, floating in her giant clamshell. A beatific smile wreaths her countenance, and a strand of golden hair conceals her intimate parts.The actual details of Aphrodite’s birth are far different, reflecting the dark, chthonic reality of the erotic, a force the Greeks understood better than we do today.1 The Greek proto-gods, Chaos and Earth, emerged from the void. Earth fertilized herself and bore a son, Ouranos, with whom she mated endlessly, spawning Titans and fifty-headed monsters, affronts to Heaven. Chronos, an early Titan, ended this abomination by castrating Ouranos and hurling the gory trophies into the waters of the Mediterranean.The blood and semen formed a frightful froth upon the ‘‘wine-dark sea.’’ Our school textbooks gloss over the cascade of mangled genitals and merely tell us that ‘‘sea foam’’ was the substance that bore our love goddess to the beach. Botticelli’s masterpiece, nicknamed ‘‘Venus on the Half Shell,’’ painted just a 15

16 What Did Lewis and Clark Know?

decade before syphilis swept Naples, was the happy face of Venus. But the Greeks knew better.The Hindu goddess Kali, with her necklace of skulls, teaches us that destruction is the other face of creation. So does Aphrodite. The venereal is pleasure. It is also danger. ‘‘Venereal’’ pertains therefore to a disease communicated by the sexual act. No other disease is named by its mode of transmission; tuberculosis is not called a breathing disease, or osteoarthritis a jogging disease, or cataracts a sunbathing disease. This observation gives rise to a conclusion so obvious that it might escape our notice: A ‘‘venereal’’ disease immediately conjures up a mental image of how it was transmitted, of people in the very act, with a secondary vision of the disintegrating private parts of the participants. As Claude Quétel has helpfully suggested, watch the face of the receptionist in a doctor’s office as one patient tells her that his appointment is for an earache, while the next patient says he thinks he has syphilis. The receptionist’s usual expression of vague professional helpfulness, so apparent with the earache patient, will quickly give way upon hearing the word ‘‘syphilis.’’ A fleeting look of disgust, concern, and apprehension will cross her features as she recomposes her professional face. She is likely to discard into the wastebasket the pen with which he registered.2 Here sin and disease are seen as interlocked in our culturally conditioned minds. When moralists speak of sinners, they are not fulminating against parishioners who have glaucoma or lupus or fractured wrists or malaria. Not at all. The objects of their concern are those who, as the Victorians – those great euphemists – might have put it, have been celebrating the rites of Venus.They are the fornicators, the whores, the rakes, the sodomists, the buggerers, the lewd, the profligate, the violators of the holy bonds of matrimony, where conjugal union serves procreation and pleasure is grimly given second place. The sermon is highly unlikely to mention that nearly all

17 What Did Lewis and Clark Know?

these activities have been tolerated or even praised in other societies, both past and present. Thus diseases arising from venereal activities have always had a dual life: a medico-biological life of objective facts and a culturally defined life of moral judgments. A disease-free monogamous couple will indeed remain free of venereal disease. Sexual diseases are conveyed by what our culture labels as improper sexual activities, that is, sin. For professional moralists, it is but a short jump to the conclusion that sexual diseases are punishment for the sin that transmitted them, a conclusion that they are happy to pass on to their followers. It is true today and it was true in the centuries that preceded Jefferson, Lewis, and Clark. Most diseases can be traced through the millennia by archaeological evidence. Egyptian mummies tell us by their bones about rickets and arthritis. Their jaws tell us of gum disease and abscessed teeth. Job’s boils have long intrigued diagnosticians. Most illnesses seem to go back to the beginning of time. By contrast, syphilis appears to have burst upon the European world as a truly new entity in the spring of 1495. Its possible origin in the New World is still hotly debated, as will soon be shown. In 1495 Europe was engaged in yet another convoluted and unnecessary war.The preceding September, King Charles VIII of France had entered Italy with an army of Flemish, Gascon, Swiss, and Spanish mercenaries, bent on destruction of the Kingdom of Naples and Sicily. Almost unopposed, Charles’s forces occupied Rome on New Year’s Day 1495. After weeks of unrestrained debauchery, they staggered onto the roads and headed south. In late February, Naples fell without a fight and the troops celebrated again with wine and women. On May 12, 1495, in a stage-managed triumphal entry, Charles rode into Naples, dressed as a Byzantine emperor, riding in a chariot drawn by four white horses.

18 What Did Lewis and Clark Know?

Perhaps the previous owners of these steeds had been the Four Horsemen of the Apocalypse. A week after his dramatic entrance to the city, Charles fled Naples in terror, driven out not by Sicilian troops but by a firestorm of boils and running sores, the startling entrance of syphilis into European history. The first known description of this new pestilence that took its place in human affairs alongside the Mosaic plagues of Egypt was by Cumano, a Venetian military doctor, who described ‘‘pustules on their faces and all over their bodies . . . [which] usually appeared on the outer surface of the foreskin or on the glans, accompanied by a mild pruritus [itching] . . . some days later, the sufferers were driven to distraction by the pains they experienced in their arms, legs and feet.’’ Benedetto, another Venetian doctor, described a victim’s entire body as ‘‘so repulsive to look at’’ that it was worse than the most disfiguring leprosy. Benedetto was the first to name this new condition; he called it the French disease.3 No one wished to claim the new child. The French called it the Spanish disease, or the Neapolitan sickness. In the German states it was the French sickness.The English at Bristol called it the Bordeaux disease, while the Danish thought ‘‘French scabies’’ seemed proper. In the first decades after its appearance, syphilis was endowed with a virulence hard to imagine today. Eyes rotted out.The genitals, both male and female, crumbled away in an agony of pain. Noses shriveled, leaving gaping and purulent holes in the middle of the face. The rot ate through the palate; food, instead of being swallowed, came out the nostrils. Those who lost feet could not walk, and those without hands could not feed themselves. Unlike the slow and generally painless progress of leprosy, syphilis struck hard and fast. The victim went from well to sick in hours or days. The infection inflamed the nerve-filled membranes that surround the bones; the sufferers claimed their bones were being broken ‘‘all night long.’’ 4

19 What Did Lewis and Clark Know?

As the demoralized French armies disbanded, they carried syphilis home – and beyond. It swept through southern France the same summer that Charles had fled Naples. The next year, Swiss authorities banned travelers with ‘‘the pox’’ from entering Geneva. The French city of Lyons ordered all ‘‘contagious wretches’’ to be expelled. By now, Strasbourg and Nuremberg were infected. Preachers denounced the moral laxity that had caused this venereal plague. They, like the public in general, had recognized that it was spread by sexual contact. But whether the disease was a punishment for sin is beyond the grasp of mortal man.5 In 1497 syphilis reached Scotland, where James IV ordered all infected persons to be isolated on the island of Inch ‘‘until God restores their health.’’6 Those who did not cooperate were to be branded on the face with a red-hot iron. On it spread. The Poles called it the German sickness, while the inhabitants of Moscow called the new affliction the Polish disease. The Japanese and the people of the East Indies thought the Portuguese had brought it (they were probably correct) and named it accordingly. It was not just kings, priests, and doctors who concerned themselves with this new horror. Albrecht Dürer, a famous engraver, created a series of woodcuts for Sebastian Brant’s Das Narrenschiff (The Ship of Fools). In these images, we see pustule-ridden supplicants at the feet of the Virgin. Other German artists produced votive images with the text calling upon St. Denis, the patron saint of France, for protection against the pox. Only three years after the appearance of syphilis, the first illustrated medical treatise on the subject was published. Bartholomew Steber’s A Malafranzos Morbo Gallorum portrayed two physicians at work with a pustule-covered couple. One doctor is using a spatula to apply ointment to the husband’s legs, while a second examines the wife’s urine in a flask held up to the light.

20 What Did Lewis and Clark Know?

This was an age when astrology was a serious undertaking, occupying some of the greatest minds of Europe. A recent conjunction of Saturn and Jupiter was said to have predicted the appearance of the illness and also foretold when it would fade away – the year 1500. On this latter point, the prediction seems to have failed. The dramatic European appearance of syphilis just a few years after Columbus’s voyage to the New World strongly suggested that the disease had its origins in the native inhabitants of the newly ‘‘discovered’’ lands. Almost as soon as an American origin was proposed, others entered the fray, claiming it had always existed in the Old World, and a debate ensued that still rages. As a background for Lewis and Clark’s encounters with the Indians, it is essential to examine the arguments for and against an American origin.7 In 1492, Columbus was a forty-one-year-old healthy, experienced seafaring man, a successful survivor of many journeys and of the intricate politics of the Spanish court. During his second voyage, a year later, he had a high fever with delirium and was blind and amnesiac for weeks; for months he was too weak to feed himself. Although there were intermittent recoveries, by the time of his 1496 return he was so weak that he had to be carried ashore. On his third voyage he continued to have violent fevers, insomnia, and inflammation of many joints. To this were added auditory hallucinations and a growing conviction that he was a chosen emissary of God. In 1504, when he returned from his fourth and final voyage, he had had celestial visions and a voice that spoke to him about the Bible. When he died two years later, he was demented, delusional, and half blind, with the lower part of his body swollen from edema. All of these symptoms are highly consistent with late-stage syphilis. Ruiz Diaz de Isla, a physician who outlived Columbus, practiced in Barcelona, Seville, and Lisbon. De Isla wrote that Hispaniola was certainly the point of origin of syphilis, that Columbus had had ‘‘re-

21 What Did Lewis and Clark Know?

lations and congress’’ with natives of that island, and that Columbus’s sailors had carried syphilis to Spain by 1494. De Isla further asserted that Spanish mercenaries, infected with syphilis, were recruited into the armies of Charles of France in the king’s campaign to conquer Naples.8 Gonzalo Fernandez de Oviedo y Valdes, a politically successful physician and administrator, was not only present at Naples in 1495 but later spent a decade in Mexico as the king’s superintendent of the gold and silver mines of the New World. In 1526 he reported to the king: ‘‘Your Majesty may take it as certain that malady comes from the [West] Indies.’’ 9 Oviedo went on to say that Spanish sailors gave syphilis to Spanish women, who passed it on to Spanish soldiers, who brought it to Naples. Gabrielo Fallopio agreed with Oviedo and de Isla that the voyages of Columbus had imported the pox to Christian Europe. Bartolomé de la Casas, a man sympathetic to the plight of the Indians under homicidal Spanish rule, endorsed the position of the other American-origin writers, asserting that the Indians had told him of the presence of syphilis on Hispaniola before the Spanish came, and added, ‘‘It is also well known’’ that Spaniards who had intercourse with the Native women became infected with the pox.10 Advanced syphilis leaves its marks not only on the living victim but also on the victim’s bones. The eroded skulls of syphilis victims fill two shelves at Philadelphia’s famed Mütter Museum; instead of the smooth dome of a normal calvarium, one sees large eroded areas, resembling the gnawing of rats or the ravages of termites. Archaeologist Bruce M. Rothschild, within the past five years, has unearthed pre-Columbian bones in Hispaniola that, in the opinion of Rothschild and his co-researchers, show indisputable evidence of syphilitic infection.11 However, lingering doubts remain concerning an American origin. Nicolò Leoniceno, a professor of medicine at Ferrara, autopsied

22 What Did Lewis and Clark Know?

many of the victims of the 1495 outbreak and found two distinct patterns: one with visible surface lesions, the other without visible external manifestations but causing bone inflammation and pain. Perhaps there are (or were) distinct strains of syphilis. Perhaps an old European strain had mutated into the dramatic and horrible epidemic that swept Europe for decades. In 1495 a Sicilian physician, Nicolas Squillacio, in a letter to a friend, attributed this new disease to the French, but one must keep in mind that every nation attributed the pox to some other nation. A strong argument against an American origin is based on timing. The second voyage of Columbus, which seemed to carry with it the most disease, did not return until 1496, yet the Naples outbreak had begun in 1495. But this objection overlooks the two less-well-known voyages of Antonio de Torres, who, in 1494 and 1495, brought back to Spain more than three hundred Indians, both men and women.The Spanish soldiers, according to seventeenth-century physician and alchemist David de Planis-Campy, ‘‘mixed lewdly’’ with the women, a not surprising event in light of la Casas’s detailed history of Spanish rapine throughout the Indies.12 The most current views of the Old World–New World controversy have yielded a picture that is more, rather than less, complex. The spirochete of syphilis, Treponema pallidum, is one of three treponematoses that leave permanent traces in the bones, the ‘‘hard evidence’’ that endures after the centuries have melted away the flesh. Those three diseases are syphilis, bejel (found mainly in the Mideast), and yaws, which is widespread in tropical climes. Syphilis is usually transmitted by sexual contact, but yaws and bejel are not. While most experts see the diseases as caused by three biologically distinct pathogens, the factors of climate, group immunity, diet, and efficacy of treatment give some reason to think that they may only be different manifestations of the same underlying condition.

23 What Did Lewis and Clark Know?

All treponematoses tend to inflame bone that is close to the skin, such as the skull and the shin (tibia). If an archaeologist studying the origins and spread of syphilis finds a shinbone with signs of inflammation and erosion, was the long-dead victim suffering from syphilis or from one of the other two treponematoses? To further confuse the issue, treatment of syphilis with mercury, the usual remedy for five hundred years, greatly increases the severity of the bone lesions.13 Evolutionary, mutative, and adaptive changes take place in all forms of life, but they occur most rapidly in microorganisms. The ability of bacteria to become resistant to new antibiotics is a modern example. Over the long term, there is a contrary trend: host populations tend to become resistant to the bacteria that attack them. There is strong evidence that treponematoses were present in both the New and Old Worlds before Columbus. The sexual manifestations of treponematosis – syphilis – most likely were introduced into Europe by Columbus’s voyages, but this conclusion will no doubt be influenced by further research. Relevant to the medical challenges facing Lewis and Clark is the following question: Did the Indians of the upper Missouri River have syphilis that existed among them from pre-Columbian times, or was it something brought recently to them by the white trappers or even by the Corps of Discovery? And, if the natives of Hispaniola had syphilis from time immemorial, would that necessarily mean that the Mandans and the Hidatsas had syphilis before 1492? It is roughly three thousand miles from today’s Dominican Republic to today’s North Dakota. An ocean, not to mention swamps and mountains, stands as a barrier. Warring tribes and mutually unintelligible languages would reinforce this division. Of course, war produces female captives, and coitus requires no interpreter, but one can argue that syphilis in Hispaniola did not necessarily mean syphilis on the upper Missouri River.

24 What Did Lewis and Clark Know?

The medical examination and dating of pre-Columbian bones by archaeologists, difficult in itself, is made more arduous today because of recent laws restricting the study of human remains and artifacts. A final answer to the question of syphilis’s origin may always elude us. From the fragmentary evidence of records two centuries old, it would seem that the Indians of the upper Missouri were free of syphilis in 1766 and became infected over the next thirty years. There is no known evidence that Lewis and Clark’s men were carrying venereal disease as they headed upriver from St. Louis. These, then, are the principal points in the controversies over the geographic origin of syphilis, and how that origin might relate to the Corps of Discovery. Of course, patients are not interested in theories of causation or contagion. What patients want is cure. Could physicians of the late 1400s offer hope of such? Many remedies were tried. Bloodletting, still popular up to the time of Abraham Lincoln, was used early on. As might be expected from our current vantage point, it was useless. Sweat baths to expel the ‘‘poisons’’ from the body were widely used. Ulrich von Hutten tells us that the victims were so eager to be rid of their venereal curse that some were actually cooked to death by charlatans in an effort to maximize sweating.14 The North American Indians likewise used sweat baths in physical and spiritual healing, although whether they actually cured any disease is difficult to evaluate. Gaspar Torella recommended, for the man with an early chancre, that he thrust his infected member into the body of a living rooster or a frog that had been split in two.15 Many treatments were tried and discarded. Only two found wide and continued usage: guaiac and mercury. The guaiac tree, Guiacum officinale, chiefly native to South America and the West Indies, is also known as lignum vitae. Its extremely

25 What Did Lewis and Clark Know?

dense wood is used in self-lubricating pulleys and bearings in the machinery for making clothes. Its essential oils have a balsamic odor and find use in massage oils and aromatherapy. It is sufficiently in demand today that the tree is considered an endangered species. As used in the 1500s, the guaiac wood was ground into a powder and made into a liquid decoction that was simmered until properly dissolved. The method of Hutten, published in 1519, was to put the patient in a very warm room, wrapped in blankets. He was then to drink large doses of the guaiac concoction. The patient received little or no food in a regimen that continued for forty days. Since guaiac induces profuse sweating as well as diarrhea, the effect of the fluid loss plus five weeks of fasting must have been dramatic. Hutten states that his own syphilis was cured by this method.16 The principal theorist on the subject of guaiac versus mercury was Jacques de Béthencourt, who endorsed, on religious grounds, the prolonged fast associated with guaiac. His logic was simple: syphilis came from sin; fasting was the penance for having sinned. In his lengthy essay, a dialogue in which guaiac and mercury plead their cases, Béthencourt was the judge, finally ruling in favor of mercury. In his opinion, the guaiac was less efficacious and the prolonged fast and dehydration were too dangerous.17 Mercury, on the other hand, held the field and continued to do so until 1909, when Erlich and Hata introduced Salvarsan, a trivalent arsenical of considerable use in treating syphilis. Mercury may have reigned supreme for four hundred years, but it was not a benign ruler. Nearly all doctors agreed that it was useful in suppressing syphilitic symptoms, but there was a never-ending controversy on two subjects: What was the best route for the administration of mercury, and what dosage would kill the disease without killing the patient? This was not a matter to be taken lightly. As early as 1497, Alexandri Benedicti, a Venetian physician, wrote of the trembling,

26 What Did Lewis and Clark Know?

salivation, and loss of teeth found with large doses. A Spanish doctor, Gaspar Torella, attributed the deaths of Bishop Jean Borgia and the Cardinal of Segovia to mercury.18 Photographs from the American Civil War show us soldiers whose faces have sloughed away from excessive mercury.19 In the early 1500s, ointments made with mercury were applied to the visible skin lesions.The chancres, buboes, pustules, and blotches were coated with these ointments by the use of large spatulas, suggesting that the doctors understood the toxicity of mercury and avoided applying it with their bare hands. Some doctors prepared sticking plasters with a mercury ointment base. This poultice was thought to speed the absorption of the poxicidal remedy. Other doctors, to hurry this process, placed the patient in a steam room for two or three weeks while coating his body with mercury ointment. An even more dramatic full-body application was the ‘‘mercurial fumigation.’’ The patient was prepared with purges, which, through vomiting and diarrhea, ‘‘tempered the humors.’’ He was then placed naked in an overheated tent with a portable stove at his feet. Powdered cinnabar (mercury ore) was thrown onto the glowing embers. Soon the patient was lost in a fog of mercury vapor, and there he (or she) stayed for hours. This treatment, if reviewed by the Environmental Protection Agency today, would have been shut down within minutes and the doctors held without bail. However, these doctors were using what to them were state-of-the-art and cutting-edge treatments. Who today has not seen the ferocious side effects of cancer chemotherapy? A dreadful disease may justify a powerful treatment. The enormous inconvenience of ointments, plasters, purges, and sweat baths led to the obvious next step: taking mercury by mouth. In 1535, Petrus Matthiolus, of Venice, began to prescribe pills of mer-

27 What Did Lewis and Clark Know?

curial red precipitate. Over the centuries, variations on the theme of mercury were played out on the stage of medical history as doctors sought modes of delivery that might be more beneficial. In the 1600s mercury enemas were in vogue. Corrosive sublimate (mercuric chloride) was proposed as the new oral wonder drug. This was followed by calomel (mercurous chloride), which was a mainstay of U.S. Army doctors until the middle of the Civil War. In fact, the Union’s surgeon general, William Hammond, was court-martialed and dismissed in disgrace, in part for his opposition to calomel.20 Summarizing four centuries of experience with mercury toxicity, one simple point emerges: Whether it was applied as an ointment, as a vapor, as an enema, or as a pill – it was dangerous. But then, so was syphilis. One side effect of mercury was salivation – enormous floods of salivation. Doctors thought that the fountain of drool was carrying away the syphilitic toxins and disagreed only on the ideal volume of saliva. Most thought that one or two pints of saliva a day was optimal (it was carefully collected and measured) and denounced their colleagues who strove for up to four quarts a day. With the salivation came an astonishing degree of bad breath associated with the destruction of the gums and the loosening of the teeth. Trembling, paralysis, deafness, insanity, unquenchable thirst, and ulcers of the lips and palate completed the picture. One must imagine the horrors of syphilis itself to understand why the infected person would tolerate such debilitating and painful treatment. To further confuse the sufferings of the tormented, doctors could not agree on whether gonorrhea and syphilis were two separate diseases or different manifestations of the same disease, although all agreed that both were spread by sexual contact. In 1767, Dr. Francis Balfour of Edinburgh wrote that they were separate and distinct conditions, but his view was not widely accepted. A century later,

28 What Did Lewis and Clark Know?

the eminent French syphilologist Philippe Ricord, personal physician to Napoleon III, pronounced them separate conditions; Ricord’s reputation and (often reckless) clinical studies settled the matter. (His experiments were wildly unethical by today’s standards; he once inoculated twenty-five hundred prostitutes with gonorrheal pus to see if they would develop syphilis.) The later developments of microbiology confirmed the existence of two diseases, syphilis and gonorrhea.21 Over the centuries, unscrupulous military contractors have made fortunes selling false anti-syphilitics. One of these was Jean Keyser, the inventor of the ‘‘anti-venereal dragée,’’ whose ‘‘secret formula’’ was mostly mercury mixed with vinegar (a dragée is a sugar-coated pill). In spite of a test on the syphilitics at Paris’s Bicêtre Hospital (a test that showed Keyser’s product to be utterly worthless), he succeeded, through influence at the French court, in obtaining a monopoly on the supply of anti-syphilitic medicines to all French military hospitals as well as to all the prisons throughout the country. Between 1759 and the French Revolution, Keyser became a very wealthy man. Another enterprising French charlatan was Denys BoyveauL’Affecteur, with his ‘‘anti-syphilitic nectar,’’ which he also termed ‘‘L’Affecteur’s Anti-syphilitic Rob,’’ rob being an archaic word designating a vegetable juice thickened by heat. He would not reveal the secret ingredients, but it seemed to contain fruit juice, cumin, sarsaparilla, and mercury. When Keyser obtained his army monopoly, he seems to have overlooked the navy. Not L’Affecteur! He became the sole purveyor of anti-syphilitics for the men afloat and made his own fortune. We will meet L’Affecteur again, in Thomas Jefferson’s library at Monticello.22 Before Lewis and Clark ventured into the upper Missouri River drainage, the area had already been visited by dozens of traders,

29 What Did Lewis and Clark Know?

trappers, voyageurs, and adventurers, mostly from Canada, over the course of several decades. The commerce between the voyageurs and the upper Plains Indians is part of the answer to the question of whether syphilis existed in the NewWorld before the coming of Columbus. Some light is shed on this question by the journals of Jonathan Carver. This long-neglected explorer was a native of Weymouth, Massachusetts, and the child of a prosperous gentleman who provided his son with a good education. Jonathan joined the colonial militia, and by 1761 he was a captain. Two years later he resigned his commission, studied cartography and surveying, and set off west. After spending many months with the Sioux along the Minnesota River, his supply of gifts ran out and he returned home. His published journal, a best-seller, was scoffed at by historians for its exaggerations. The recent discovery of his original notes showed that the errors had been introduced by the publisher, and Carver is now regarded as an accurate and informed observer. His statement that in 1766 the Sioux had no syphilis merits considerable credibility. While the upper Mississippi is not the same as the area explored by Lewis and Clark, French trappers on the way to the upper Missouri River may have passed through the area visited by Carver.23 TheVoyageurVisitor Center at Ely, Minnesota, commemorates this route. In 1801, as Lewis began his two years of tutelage under Jefferson’s supervision in preparation for the coming voyage, a French doctor, F. Swediaur, published a report declaring that fifty-eight hundred French-Canadians were infected with syphilis, many of them already in the tertiary stage. These late-stage cases strongly suggest that syphilis was widespread in Canada by the mid-1770s and that it was brought to the Plains Indians by traders from Canada between 1766 and 1801. It is a reasonable guess that Lewis, with his long frontier experience, had learned of the entry of syphilis into the Indian

30 What Did Lewis and Clark Know?

populations of the West. If Lewis knew, surely Jefferson also knew. Since the planned expedition would not have a doctor, medical care was to be provided by the captains themselves. Meriwether Lewis had spent two years with Thomas Jefferson, owner of one of the largest libraries in the Western Hemisphere. Among its 122 books on medical and surgical subjects were 3 that focused on venereal disease: John Hunter’s A Treatise on Venereal Disease, Daniel Turner’s A Discourse Concerning Gleets, and Denys Boyveau-L’Affecteur’s Observations sur l’Histoire et les Effects du Rob Anti-Syphilitique de Sieur Boyveau Laffecteur.24 In addition to these texts, Lewis may also have been familiar with a well-known army doctor’s manual, An Account of the Most Common Diseases Incident to Armies, With Method of Cure, by Baron Gerhard van Swieten. The original German text was translated into English and republished in 1776 in a pocket-sized format. Van Swieten devoted two pages to the well-known and dreadful effects of syphilis (e.g., ‘‘When the bones are corroded even to the marrow, the cure is extremely difficult’’) and the succeeding three pages to remedies. ‘‘For syphilis,’’ hewrites, ‘‘take one spoon of Medicine No. 66 twice a day, followed by a pint of barley water, with a third of milk in it. This medicine gives no manner of trouble to the patients; to some it procures some light stools, but this is seldom. Its use may be continued with the greatest safety till all the symptoms have disappeared. Sometimes a salivation comes on from the use of Medicine No. 66, but this is seldom and almost only to those who have before made use of mercury either internally or externally. Nevertheless, salivation not being necessary to the cure, the use of Medicine No. 66 is to be left off immediately on the first signs of a spitting coming on.’’ And how did one tell of an approaching salivation? ‘‘The gums begin to swell, to grow red, to itch and become painful and the breath to smell ill.’’

31 What Did Lewis and Clark Know?

For those who may have misplaced their recipe for ‘‘No. 66,’’ a handy appendix in van Swieten’s book provides it. ‘‘Take corrosive sublimate [mercuric chloride] 12 grains, rectified malt spirit two pints. Keep it in a glass vial until the mercury is quite dissolved.’’ In 1776, most doctors thought syphilis and gonorrhea were different manifestations of the same illness. For those unfortunates who had the painful urethral discharge of the latter, van Swieten urged the sufferer to drink plentifully of Decoction No. 67 and bathe the penis three times a day in a mixture of warm milk and water. (Decoction No. 67 was made with marshmallow root and ‘‘liquorice.’’) ‘‘If by a suppression of the Gonorrhea . . . a testicle becomes swelled and painful . . . let him be bled immediately. Apply Fomentation No. 12 to the testicle and let him drink plentifully of Decoction No. 1.’’ Sadly for our understanding today, Decoction No. 1 and Fomentation No. 12 contained things like ‘‘species for the emollient’’ and ‘‘species for the Pectoral . . . three ounces,’’ which have defied the author’s ability to translate.25 Not all of Lewis and Clark’s knowledge was carried in their heads. Among the tons of freight they hauled up the Missouri were several books. The explorers made little mention of them in their journals and letters, but fragmentary evidence names half a dozen reference books, including copies of the Nautical Ephemeris foreach of the three years they might be away. These, combined with Patrick Kelley’s A Practical Introduction to Spherics and Nautical Astronomy, were essential in their sightings of latitude and longitude. Benjamin Barton’s Elements of Botany and John Miller’s two-volume work on botanical classification were essential in the captains’ observations of plants. For zoology, the little library probably had a copy of Linnaeus’s Systema Naturae or a derivative of that work. In setting out on the voyage, Lewis had requisitioned a copy of Richard Kirwan’s Elements of

32 What Did Lewis and Clark Know?

Mineralogy, but the journals contain relatively few geological notes. For geography and ethnology, Lewis and Clark relied heavily upon thework of a French explorer, Antoine Simor Le Page du Pratz,whose 1758 Histoire de la Louisiane had been translated into English forty years before the Corps of Discovery set out. It is not entirelyclear, however,which of these medical books they might have carried. Clark, whose orthography was wondrously inventive, described ‘‘the 4 vols of the Deckinsery [dictionary] of arts an ciences.’’ This was probably A New and Complete Dictionary of Arts and Science; Comprehending all the Branches of Useful Knowledge – the full title runs over fifty words – prepared by ‘‘A Society of Gentlemen’’ and usually simply called Owen’s Dictionary after the publisher.The sections on medicine reflect the knowledge (and ignorance) of medical practice in the 1700s. And that is all we know of Lewis and Clark’s traveling medical library.26 What was in print in 1803 is one-third of the answer to the question, What did Lewis know about doctoring? Personal instruction was the other two-thirds. The captain’s mother, Lucy Meriwether Lewis Marks, was a most remarkable woman who died at age eightysix, having outlived two husbands. She had made a lifelong study of the medicinal values of the plants that grew inVirginia and used her nursing and doctoring skills on dozens of relatives and neighbors. It is highly likely that her son absorbed much of this knowledge. It is also nearly certain that Lewis’s long service as an officer along the frontier gave him firsthand experience in the treatment of many common maladies. The final portion of Lewis’s instruction came from none other than Dr. Benjamin Rush, the new nation’s best-known physician. In February 1803, President Jefferson wrote to Rush and asked him to give Lewis suggestions for collecting scientific information along the route. Rush, who had studied in Scotland, England, and France and was one of Philadelphia’s leading citizens, agreed.27

33 What Did Lewis and Clark Know?

The Corps of Discovery was a military expedition, with most of its members enlisted in the U.S. Army. Benjamin Rush had been an army doctor; in fact, he had been physician general for the Middle Department of the army under George Washington. His contributions reflected an understanding of prevention, which placed him ahead of many of his colleagues. He urged that the soldiers’ diet should ‘‘consist chiefly of vegetables,’’ which would have reduced the incidence of scurvy, the curse of all armies and navies in that century. He instituted army vaccination against smallpox, which reduced mortality from smallpox from 15 percent to 1 percent. He urged that the army camps, and the soldiers in them, be kept ‘‘free of filth’’ and noted that armies that moved more often had less sickness. He warned against the excessive use of rum. While doctors in 1803 lacked useful theories and knew nothing of bacteria or of the role of mosquitoes in the spread of disease, Rush’s contributions to commonsense public health measures were monumental. In retrospect, Rush was both a source of great usefulness (as in his advocacy of vegetables and vaccination) and a major proponent of the medical theories of the day. His regimens of bleeding, purging, vomiting, blistering, and salivation by mercury may seem strange to us today, but they represented the most advanced knowledge of that time. On June 11, 1803, Rush wrote to Jefferson, assuring him that he had given Lewis suggestions for preserving the health of the expedition and had provided Lewis with a list of questions for studying the customs and health of the Indians.28 Rush’s clearest contribution to the Corps of Discovery was ‘‘Dr. Rush’s Bilious Pills,’’ a mixture of ten grains of jalap and fifteen grains of calomel. The violent diarrhea from the jalap and the salivation from the mercury must have been startling enough to the patient to convince him that Rush’s pills were real medicine, not placebos. What good they did will be the subject of a later chapter.

34 What Did Lewis and Clark Know?

Did Benjamin Rush himself use mercury in the treatment of syphilis? In his writings there is little mention of the subject. However, on September 16, 1808, he wrote to Louis Valentin, a French physician who spent several years in Virginia, describing a case of syphilis treated with mercury in which only one side of the mouth salivated and only one side of the genitals was ‘‘cured.’’ 29 The recognized authority on Rush suggests that since mercury was universally recognized as the treatment for syphilis, there was little need to state such.30 Lewis had the full backing of the president of the United States, a fairly generous budget, and the advice of the country’s leading physician. With this support and counsel, with what did he choose to fill his medicine chest? To answer this question, we will look now at his famous shopping list.

3 The Famous Shopping List

On Pennsylvania Avenue, halfway between the White House and the Capitol, stands the National Archives, a vast granite-and-marble monument for the preservation of U.S. historic documents. All researchers leaving the building are searched at two different checkpoints by armed guards. Within this heavily defended repository are hundred of documents considered so valuable that the justdescribed security has been deemed insufficient. These papers, the cream of the crop, have been removed to the Treasure Room, a vault where only those with special security clearance and a need to know may enter. The vast holdings of the National Archives, measured in cubic feet of paper, are divided into record groups, which in turn are divided into entries. Among those Treasure Room papers is the original list of items purchased by Meriwether Lewis, their costs, and the purveyors who sold them (fig. 3).1 Any spouse today would feel challenged, if not alarmed, by this request: ‘‘Oh, honey, would you run down to the store and get everything the thirty of us will need for the next two years. Don’t forget anything, because there are no stores where we’re going. In fact, we don’t even know exactly where we’re going and none of us have been there before, and I’m not really sure what we’ll need. But you’ll know what to do.’’ We have Meriwether Lewis’s shopping lists, and they are monuments to foresight, care, and prudence. For our purposes, we will skip over the sextant, the chronometer, the spirit levels, and the quadrants, as well as the hundreds of 35

3. Meriwether Lewis’s famous shopping list. Before starting for St. Louis, Lewis visited a Philadelphia purveyor and ordered medicine for ‘‘his tour of the Mississippi.’’ (Record Group 92, Entry 225, Box 56a, National Archives)

37 The Famous Shopping List

pounds of camping gear and thousands of presents for the Indians, and confine ourselves to medical supplies. The list reproduced here can be seen to be somewhat faded, the handwriting is of a style not seen in two centuries, and many items are described in Latin abbreviations, well known in that long-ago time but a mystery to most modern-day pharmacists and physicians. Table 2 reproduces, in the same order as in the original list, the names as written, then a transliteration, and finally a modern equivalent. Following this table, in alphabetical order, we will present the origins, doses, and therapeutic uses of each substance. Finally, we will discuss the remedies that might have been dispensed by Lewis and Clark for the treatment of venereal afflictions. Most of the world today lives by the metric system. Americans use an awkward mixture of metric measurements, with its grams and kilos, and the avoirdupois system, which lives on in ounces and pounds. The weights and measures used in pharmacy practice in 1803 reflected yet a third system: the apothecary system, a holdover from the Middle Ages. The records of Lewis and Clark use three apothecary terms that need interpretation to be of use to today’s readers: grain, dram, and minim. A grain is 64 milligrams. A weight dram (or drachm) is 3.9 grams (or 60 grains), while a fluid dram is 3.7 cubic centimeters. A minim is .06 cubic centimeters (or .002 fluid ounces). The old systems died hard. When I was in medical school, antibiotics were measured in milligrams, while aspirin and morphine were commonly prescribed in grains, and I saw a child nearly die when a doctor confused grains and grams. Asafetid: a fetid gum from the root of Ferula asafoetida, used to treat spasms, chorea, and hysteria. Balsamum traumaticum (Turlington’s balsam, friar’s balsam): a compound of tincture of benzoin, storax,

Table 2: Lewis’s Medical Shopping List As Written

Without Abbreviation

Modern English

15 lb. Pulv. Cort. Peru

Pulvis Cortex Peru

Powdered Peruvian Bark

15 lb. Pulv. Jalap

Pulvis Jalap

Powdered Jalap

1/2 lb. Pulv. Rhei

Pulvis Rhei

Powdered Rhubarb

4 oz. Pulv. Ipecacuan.

Pulvis Ipecacuana

Powdered Ipecac

2 lb. Pulv. Crem. Tart.

Pulvis Cream of Tartar

Powdered Cream of Tartar

2 oz. Gum Camphor

same

same

1 lb. Gum Assafoetid.

Gum Assafoetidus

Asafetid Gum

1/2 lb. Gum Opii Turk. opt.

?

Turkish opium

1/4 lb. Gum Tragacanth

same

same

6 lb. Sal Glauber

same

Glauber’s salts

2 lb. Sal Nitri

same

Nitre salt

2 lb. Copperas

same

Copperas

6 oz. Sacchar. Saturn. opt.

Saccharum Saturnus

Sugar of Lead

4 oz. Calomel

same

same

1 oz. Tartar Emetic

same

same

4 oz. Vitriol Alb.

Vitriol Albus

White Vitriol

1/2 lb. Rad. Columbo

Radix Columbo

Calumba Root

1/4 lb. Elix. Vitriol

Elixir of Vitriol

same

1/4 lb. Ess. Menth. Pip.

Essentia Mentha Piperata

Peppermint Extract

1/4 lb. Bals. Copaiboe

Balsamum Copaiboe

Copaiba Extract

1/4 lb. Bals. Traumat.

Balsamum Traumaticum

Injury Ointment

2 oz. Magnesia

same

same

1/4 lb. Indian Ink

same

India Ink Powder

2 oz. Gum Elastic

same

same

2 oz. Nutmegs

same

same

2 oz. Cloves

same

same

4 oz. Cinnamon

Cinnamon

Cinnamon

4 oz. Laudanum

same

same

2 lb. Ung. Basilic

Unguentum Basilicum

Basilicon Ointment

1 lb. Ung. Calimin.

Unguentum Calaminae

Calamine Ointment

1 lb. Ung. Epispastic

Unguentum Epispastic

Blistering Ointment

1 lb. Ung. Mercuriale

Unguentum Mercuriale

Mercury Ointment

1 lb. Emplast. Diach. S.

Empl. Diachylon Saturni

Lead Plaster

1 set Pocket Instruments

Surgical Instruments

same

1 set Teeth Instrs. Small

Teeth Instruments

Dental Instruments

1 Clyster Syringe

same

Enema Syringe

4 Penis Syringes

same

same

3 Best Lancets

same

same

1 Tourniquet

same

same

2 oz. Patent Lint

same

same

50 doz. Bilious Pills, Rush

same

Dr. Rush’s Pills

6 tin canisters

same

same

40 The Famous Shopping List

balsam of tolu, aloes, and alcohol, used for dysentery, skin ulcers, and chapped nipples. Some of the ingredients are derived from the resin of the Asian Styrax tree. Basilicon ointment (ceratum resinae) appears to be an all-purpose ointment, basilicon meaning important, royal, and/or sovereign. Borax: sodium borate, used to treat sore throats with a dose of five to thirty grains. Calamine ointment: zinc carbonate or zinc oxide, used for skin irritation. Calomel: mercurous chloride, written as Hydrargyri chloridum mite, used as purgative and anti-syphilitic; purgative dose is two grains. Calumba root (radix Colombo) is the root of Jateorrhiza palmata; in doses of fifteen grains it was used as a ‘‘stomach tonic.’’ (There is also an American calumba, Frasera walteri.) Cascara sagrada is derived from the shrub Rhamnus purshiana and is used as a laxative; the usual dose is two to eight grains of the extract. Cinnamon (Ceylon type) is derived from Cinnamomum zeylanicum and is used as a carminative (anti-flatulence drug) and astringent. Cloves: the buds of Eugenia aromatica, used for toothache and as a carminative.2 Copaiba (Balsamum copaiboe): the juice or balsam of Copaifera offinalis, used to treat gonorrhea. Copperas (Green vitriol): ferrous sulfate, used as antiseptic then, as a treatment for iron-deficiency anemia today. Cream of tartar: potassium bitartrate, used as a diuretic and cathartic; usual dose ranges from four to thirty-two grains. Flowers of sulfur (floris sulfuris): sulfur sublimed into a purified powder, used as a laxative and diaphoretic. Gum camphor: one of a dozen stearoptens from all over the world, toxic in large amounts, used in doses of two grains as a stimulant, irritant, diaphoretic, and narcotic. Glauber’s salts: sodium sulfate, used in doses of one to four drams, as a laxative. (Named for Dr. Johann Glauber, 1604–68.) Ipecac: the dried roots of Cephaelis ipecacuanha, a plant of tropical America, used to induce vomiting; the usual dose is seven grains.

41 The Famous Shopping List

Jalap: the root of Exogonium jalapa, a Mexican plant whose active ingredient is convolvulin; at doses of five to twenty grains it is a powerful laxative. Laudanum: a tincture (alcoholic solution) of opium, used for pain and/or diarrhea. Lead plaster (emplaste diachylon saturni), made of lead oxide and oil, used in the treatment of burns. Magnesia: magnesium oxide, used for acid stomach in doses of fifteen to sixty grains. Nitre (sal nitri, saltpeter): potassium nitrate, used as a diaphoretic and diuretic (that saltpeter is an anti-aphrodisiac seems to be an old wives’ tale). Nutmeg: the oil of nutmegs was used as an excipient, that is, a vehicle for compounding drugs. Opium, derived from the opium poppy, Papaver somniferum, has been used for at least four thousand years in the control of pain and/or diarrhea. Peppermint extract (essentia mentha piperita) was used to treat flatulence, colic, and headache, in doses of five to fifteen minims. Peruvian bark (cortex Peru) is the bark of the cinchona tree. The early Spanish explorers in Peru learned from the Indians that powdered cinchona bark, which contains quinine, alleviated the symptoms of malaria. Rhubarb, the root of Rheum officinale, is a laxative and stomach tonic in doses of twenty to sixty grains. Rush’s Bilious Pills contained ten grains of calomel and ten grains of jalap and were usually taken three times a day; they were intended to cure most anything. Sugar of lead (saccharum saturnus) is lead acetate, an astringent and anodyne (pain killer) used to irrigate the urethra infected with gonorrhea. Tartar emetic, a mixture of antimony tartrate and potassium tartrate, was used to induce vomiting and sweating and as a treatment for granuloma inguinale. Tragacanth, a gum derived from the Astragalus plant, was used to compound medications and make troches. Vitriol albus (white vitriol): zinc sulfate is emetic in doses of ten to thirty grains; a 1 percent solution was used in conjunctivitis and laryngitis.Vitriol elixir,

42 The Famous Shopping List

an alcohol solution of zinc sulfate, was used for diarrhea and as an ‘‘internal astringent.’’ Two points emerge from this exploration of medical supplies. First, it is obvious that Lewis and Clark, professional soldiers, were expected to function as pharmacists and physicians to a large expedition (and numerous Indian patients) for two years, without professional training in the medical arts. There were no medical schools along the Missouri River for second opinions, no drop-in clinics, no emergency rooms, no ambulances, no 911 telephone service, no poison-control hotlines. Not only did the two captains shoulder these medical burdens along with all their other responsibilities, but they seem to have done so with remarkable success. Their success is even more remarkable when we take into consideration the theoretical bases of treatment in 1803. Today we take for granted such events as the actions of cells and their complex membranes, the interactions of bacteria and immune systems, and the transmission of disease by such vectors as mosquitoes. A glance at theunderlying theories of health and sickness in Lewis and Clark’s time can tell us what fragile theoretical reeds they had to lean upon and the rationale of the apparently random assortment of medicines they carried. From 600 bc onward, medical thought was dominated by the theory of the ‘‘four humors.’’ The humors originated with the four ‘‘essential elements’’ – fire, air, earth, and water. In the same order, the elements gave rise to the four humors: yellow bile, blood, black bile, and phlegm. Each person’s constitution and temperament reflected the balance of the four humors within that person. Excess black bile produced melancholy and gluttony; excess yellow bile yielded anger and desire for vengeance. Rush’s Bilious Pills reflected the hope of regulating bile. Excess phlegm induced torpor and lazi-

43 The Famous Shopping List

ness, while excess blood led to a ‘‘plethora.’’ An attempt to integrate humoral concepts with more modern ideas was introduced by Friedrich Hoffmann (1660–1742), who envisioned a physiological scheme that began with God inspiring each person’s ‘‘anima.’’ The anima, in turn, controlled the ‘‘nerve spirits,’’ which regulated the ‘‘tone’’ of each bodily organ. Imbalances in tone were the origins of disease. In fact, our current term ‘‘tonic’’ is a remnant of Hoffman’s tone theory.The medicines prescribed, and the bleeding of patients, were thought to regulate the balance of humors and tone and to restore them to normal. In less than a century, all these theories would be swept away, but for the captains forging up the Missouri River they formed the science that guided their medical efforts, and those efforts seemed crowned with remarkable success. Success is hard to measure in the absence of modern double-blind studies and long-term follow-up.The captains provided encouragement and dedicated nursing care. It remains an open question to what extent the efforts of the explorers, or those of the best doctors, changed the course of illness. Along with celestial navigation, dispensing gifts to the Indians, anthropological and linguistic observations, journal keeping, and military defense, Lewis and Clark obtained the same degree of success with their patients as did the great physicians of downtown Philadelphia, as far we can observe. In addition to drugs, the list has six categories of medical instruments. The pocket surgical instrument kit would undoubtedly have had scalpels, suturing tools, and a probe and forceps for removing musket balls and projectile points. Civil War surgeons carried a nearly identical kit many years later. The dental instruments probably included a ‘‘key,’’ used for the extraction of infected teeth. The enema syringe reflected the turn-of-the-century faith in the benefits of washing out the lower colon. The penis syringes (described

44 The Famous Shopping List

elsewhere as made of pewter) were to treat gonorrhea, usually by internal irrigations. The lancets and the tourniquet were probably for the therapeutic bleedings so widely recommended by doctors at that time. The second point, central to our subject, is that 15 percent of the medical shopping list was made up of items for the treatment of gonorrhea or syphilis. Two items were earmarked for gonorrhea: sugar of lead was mixed with water and injected up the urethra with a penis syringe; copaiba was given orally. The next sixty years seem to have brought few changes in the treatment of gonorrhea. The 1864 edition of F. J. Bumstead’s text Pathology and Treatment of Venereal Disease, widely used by Union surgeons, recommended many types of urethral irrigations for gonorrhea, including this one: ‘‘Rx liq. plumbi. subacetatis  ss–j, Aquae  iv–vj. M.’’ In plain English, this prescription says, ‘‘Take one-half to one ounce of lead acetate liquid, four to six ounces of water, and mix them together.’’ Some surgeons injected this solution into the patient’s urethra every hour, while others thought that three times a day was sufficient. It is a medical adage that when many different remedies are recommended for a disease, none of the remedies is much good. Medical texts of the 1800s suggested the following for anti-gonorrheal urethral irrigations: silver nitrate, potassium bicarbonate, tincture of hyoscyamine, potassium chlorate, potassium acetate, ether, camphor, opium, glycerin, zinc sulfate, calamine, copper sulfate, lead acetate, alumina, rose water, red wine, tannic acid, tincture of aloe, and bismuth subnitrate, but not all at the same time. Another adage states that when experts differ, the ignorant may choose, and it seems equally applicable in the field of nineteenth-century venereology. In brief, urethral irrigation remained the standard treatment of gonorrhea from before Lewis and Clark to after Abraham Lincoln.

45 The Famous Shopping List

Copaiba was given by mouth for the treatment of urethral gonorrhea; it seems to have exerted its benefits as it passed out in the stream of urine. Copaiba is reported to have had such a vile taste that taking it plain induced nausea, belching, and vomiting. Mixing copaiba with magnesia powder yielded a puttylike substance that could be divided into pills; these were more tolerable to the sufferer. A liquid decoction, made with a flavored syrup such as licorice, was also useful in producing a less dreadful form of treatment. Meriwether Lewis’s shopping list contained three remedies that could be used for syphilis. Calomel (mercurous chloride) had been used for centuries for this purpose. The dosage seemed to have been calibrated by the degree of salivation. Dr. Rush’s Bilious Pills – sometimes termed ‘‘Rush’s Thunderbolts’’ – produced violent diarrhea as well as mercuric salivation. It was termed a ‘‘sovereign remedy,’’ meaning it would cure most anything. Since Lewis ordered fifty dozen of these pills, he must have agreed, although it is unknown whether he used both kinds of oral mercury – calomel and Rush’s pills – in the treatment of syphilis. Local lesions, such as the chancres of primary syphilis, were treated with mercury ointment. The Corps of Discovery fought syphilis with mercury, time-honored by three centuries of use, and endured a treatment that was almost as distressing as the disease itself. Few shopping lists in history have told us so much about the anticipated private miseries of an expedition. Malaria, starvation, fatigue, prickly pears, appendicitis, scurvy, grizzly bears, heat, and cold – all these awaited the Corps. The anticipated suffering caused by the afflictions of Venus emerged again and again in the record from the trail.

4 Indian Medicine

Lewis and Clark lived in a time unimaginable to us. It was not just the total absence of steam, gas, electric, or nuclear power, not just the absence of daily postal service, telegraph, radio, telephone, typewriter, computers, and television, but the painfully limited means of finding information. Today, data on nearly every subject can be found in milliseconds through Internet search engines. Public libraries are filled with reference works on hundreds of subjects. University and state libraries have periodicals in every imaginable area of knowledge. Bookstores are eager to sell or order any of one hundred thousand titles. Contrast this with Lewis and Clark’s database. In spite of access to the country’s best library and most knowledgeable consultants, the explorers’ sum total of knowledge of Native American remedies for venereal disease was merely Lobelia and sumach. Part of the problem was the limitations of local translation and the absence of uniform names for plants, but much of the problem was ignorance (of course unintentional) of what had gone before. And much had gone before. non-venereal remedies

In the bitter winter of 1535, Jacques Cartier and the ships of his expedition of French explorers were frozen in the ice near Montreal. By spring, twenty-five men had died of scurvy and the rest were near death from the same cause. The Indians showed the French 47

48 Indian Medicine

how to brew a tea from the bark of a certain fir tree, and the men were soon restored to health. Lawrence Bohun, the first physician at the English settlement at Jamestown, Virginia, extolled the virtues of sassafras and wild rhubarb for nearly every illness. Sixty-seven years before Lewis went up the Missouri River, Dr. JohnTennent was awarded one hundred pounds (a vast sum then) by the Virginia Assembly for his essay on Seneca snakeroot (Polygala senega).The Indian who taught Tennent how to treat lung disease with snakeroot got nothing.1 Almost two decades before the grim New England coast became home to the even grimmer Pilgrims, a Captain Goswold was harvesting shiploads of sassafras on those same shores and sailing home with enough to depress the London sassafras market. Sassafras, said to be curative of fevers, ulcers, seizures, dropsy, scurvy, malaria, gout, rheumatism, and the pox, was, in the early days of America, a more important export than tobacco. In the early 1700s, large quantities of Indian pinkroot (Spigelia marilandica) were exported from the Carolinas and used as a remedy for intestinal worms. Pinkroot continued to be an official remedy in the American pharmacopoeia until 1926. Many writers and explorers three centuries ago also made note of the medicinal qualities of tansy, white oak, cherry bark, dogwood bark, and beech leaves. Much more knowledge has probably been lost, partly from the Indians’ understandable reluctance to share hard-won knowledge with the often-hostile whites, and partly because the missionaries regarded the tribes’ medicine men as devil worshipers or agents of Satan. However, our arena here is not the whole scope of medical practice, but more specifically the ailments of Aphrodite. If Lewis and Clark had had full access to American Indian treatment of venereal diseases, here is part of what they would have known.Whether these

49 Indian Medicine

remedies actually cured venereal diseases is not easy to answer, but true cures seem unlikely, as with Anglo-American medical practice of the time. remedies for syphilis

In 1630, Martin Pring described sassafras (Sassafras officinalis) as ‘‘a plant of sovereigne vertue for the French Poxe.’’ 2 Benjamin Barton, a student of the ‘‘Northern Indians,’’ reported the use of a decoction of Indian snakeroot (probably Aristolochia serpentaria) as a treatment for syphilis. To further confuse these issues, at least nine different plants were commonly called ‘‘snakeroot.’’ Thomas Ash, in 1682, described the use of China root (Smilax tamnoides) as a remedy for the ‘‘lues venerea [syphilis] in the Carolinas.’’ 3 The earliest writings of the Spanish conquistadores mention guaicum as a treatment for syphilis, a disease that the Spanish themselves may have brought. Oviedo’s 1526 Natural History described large forests of the ‘‘holy wood’’ (guaic) in Hispaniola. John Lawson in his 1714 History of North Carolina described the Indians as curing syphilis with a berry that caused salivation and with the juice of the tulip tree (Liriodendron tulipifera). Peter Kalm, in 1770, claimed that the Indians had ‘‘an infallible art’’ in the curing of venereal disease and described a mixture of Lobelia and Queen’s root (Stillingia sylvatica) used for this purpose. The French botanist André Michaux, traveling through the American wilderness in 1775, recorded certain cure of syphilis by two plants: ‘‘Sanicula marilandia [possibly Spigelia] and the root of Veronica virginiana.’’ 4 Fifteen years after Lewis and Clark’s journey, Dr. Edwin James was retracing their steps up the Missouri and wrote that button snakeroot (Liatris psychostachia) was used to treat syphilis. In 1734, John Brickell reported of the red cedar ( Juniperus virginiana), ‘‘The wood of this tree is profitable against the French pox.’’ 5

50 Indian Medicine

Blue cardinal flower (Lobelia syphilitica) cured syphilis in less than a week, using a total dose of one ounce, according to New York’s Dr. Cadwallader Colden, in 1758. Samuel Stearns, in his 1801 American Herbal, also reported that the Indians were able to cure syphilis with Lobelia. In 1751, John Bartram published a paper describing the Iroquois’ use of Lobelia for syphilis. The Natchez used plants of the genus Asclepias, such as milkweed and silkweed, as anti-syphilitics. Several Mexican tribes used Yerba santa (Eriodictyon californicum) to treat the same disease. Brazilian Indians used manaca, the dried root of Brunsfelsia hopeana, as an aphrodisiac and also as an antisyphilitic, a rather useful combination. Meriwether Lewis himself had seen the Ojibwa use both Lobelia and sumach for the treatment of syphilis and gonorrhea. From this brief excursion into the history of herbal medicine, it is clear that Lewis and Clark might have had a large number of possible supplements or replacements for the highly toxic mercury in the treatment of syphilis. remedies for tetters and morphews

The history of disease recalls long-forgotten words, terms with an archaic ring, used as diagnostic labels.Tetters could be one of a wide variety of skin disorders with scabbing and crusting. The 1854 Webster’s dictionary defines a morphew as ‘‘a scurf on the face,’’ a scurf being ‘‘a dry scab or mealy crust formed on the skin.’’ Some of these tetters and morphews were almost certainly the dreadful lesions of secondary syphilis. Lawson’s 1714 History of North Carolina stated that the gum from the sweetgum tree (Liquidambar styraciflua) ‘‘cures the herpes and inflammations, being applied to the morphews and tetters.’’ 6 Sixty years before the Lewis and Clark expedition, Brickell wrote that a decoction of berries from the bayberry tree (Myrica cerifera) could

51 Indian Medicine

‘‘cure the falling out of the womb,Tettars and Scald Head.’’ Tar from the white pine, when dissolved in spirits, was used for ‘‘tetter and the itch.’’ 7 Philadelphia botanist Benjamin Barton, in the late 1700s, recommended sumach (Rhus glabra) ‘‘for removing warts and tetters.’’ 8 Tobacco, now considered noxious by most physicians, was once recommended as a cure for dozens of diseases, including ‘‘old sores, wounds, tetters and broad biles.’’ 9 Surely, some of these tetters were our old friend the pox. remedies for gonorrhea

Until the mid-1850s, most doctors assumed that syphilis and gonorrhea were two aspects of the same disease, but this did not prevent them from identifying the combination of painful urination and urethral discharge as something specific, variously termed gonorrhea or gleet. Colonel Winthrop Sargent, governor of Mississippi Territory, reported that some Indians treated gleets by eating turpentine from the southern pine. Barton wrote that a decoction of wild geranium (Geranium maculatum) was useful in ‘‘gleets and gonorrhea.’’ 10 In 1682, Thomas Ashe, a Carolina physician, wrote that China root was good for gonorrhea, and Jonathan Carver claimed that the Winnebago Indians cured gonorrhea with prickly ash (Zanthoxylum americana).11 The Comanches treated gonorrhea with a drink made from boiled thistle roots (Cirsium undulatum), while the Penebscots treated the same disease with a decoction of wintergreen, wild indigo, Cleaver’s vine, spikenard root, Solomon’s seal, moosewood, and boneset. The Ojibwas used the gum of the balsam fir as a treatment for gonorrhea. Barton, in 1800, used Bearberry (Arctostaphylus uva ursi) in ‘‘old gonorrhea.’’12

52 Indian Medicine

Goldenseal (Hydrastis canadensis) was used for gonorrhea, as was hardhack (Spiraea tomentosa). A decoction of wild ipecac (Euphorbia ipecacuanha) was used by the Cherokees. The Fox, Sauk, and Chippewa cured the same condition with pinesap. Traditional remedies vary widely from tribe to tribe, reflecting the enormous diversity within American Indian culture. Everett C. Rhoades, founder of the Association of American Indian Physicians, has remarked that ‘‘differences among Indian tribes can well be compared to differences among members of the United Nations.’’ With such diversity, any remedy may be characteristic of only one tribe or one region.13 indian medicine in american culture

At least four phases mark the relationship between Native healing remedies and northern European thought. The first colonists suffered from the epidemics and injuries so common in those centuries. They needed,wanted, and embraced the American Indian medicines that mitigated the multitude of ills that beset them. On the other hand, they were troubled by the Indians’ religious beliefs and the distinctly non-Christian assumptions of the Native healers. Most settlers, however,were happy to be cured and left the religious issues to the parsons.14 The second phase, which occupied much of the 1800s, was the era of ‘‘Indian doctors,’’ usually white men with a little herbal knowledge who peddled a strange amalgam of real botanicals, fraudulent concoctions, and a lively sales pitch.The apotheosis of ‘‘Indian’’ cures was reached around 1900, just before the pure food and drug laws, when ‘‘medicines’’ such as ‘‘Kickapoo Cough Syrup’’ and ‘‘Ka-TonKa’’ contained no herbal ingredients at all. Alcohol, molasses, and various commercial flavorings were the actual ingredients. This era of medicine shows, fake professors, and phony doctors

53 Indian Medicine

led to the third phase, in which all ‘‘Indian’’ remedies were looked upon as spurious nonsense, promoted by quacks and based upon the teaching of ‘‘ignorant savages.’’ The fourth and current phase of this history is a more rational one; competent pharmacologists are studying old remedies and finding that many of them have ingredients of genuine merit. Lewis and Clark lived during the first phase. They were happy to use anything that worked. If they had had available the full scope of Indian remedies already known in 1800, they and their men might have suffered less. But books were scarce, medical journals were nearly nonexistent, and these Indian cures were, for the Corps of Discovery, only one of the ‘‘what ifs’’ of history.

5 The Voyagers Speak

Manyof the men in the Corps of Discovery voluntarily kept journals. Lewis and Clark had been instructed by President Thomas Jefferson to do so. Sergeants Patrick Gass, Charles Floyd, and John Ordway kept journals, as did Privates Joseph Whitehouse and Robert Frazer (Frazer’s records are lost). The combined output of these six men forms a unique and stirring contribution to the history of adventure and exploration. The lists of observations they were to make were astounding; their success in collecting data was equally astounding. Though there are gaps and possibly lost documents, thousands of pages survived the rivers and rains and arrived home in readable condition. Patrick Gass published his account in 1807, much to the annoyance of Meriwether Lewis, who had made little progress in completing his own work on the official journals. Official or not, an unpublished journal is of little use, and when Lewis died in October 1809 not a single word of the manuscript had been prepared for publication. Who was to complete the work? William Clark felt inadequate to the task; he was not a literary man. Jefferson too declined this responsibility. Fortunately for Lewis and Clark’s posterity, this burden was taken up over the centuries by four dedicated and remarkable men. The first editor was Nicholas Biddle, the genius son of one of the new nation’s leading families. Nicholas entered the University of Pennsylvania at age ten and received his degree from Princeton at 55

56 The Voyagers Speak

age fifteen. During his long career, he was president of the Second United States Bank and a bitter opponent of the economic policies of Andrew Jackson. Biddle devoted two years of his life to the task of editing the journals, and in 1814, after an almost-surreal decade of bankrupt publishers, misplaced documents, confusion, and recriminations, published a two-volume narrative paraphrase. Biddle was not a scientist, however, and he largely omitted the natural history portions of the text.1 The second man to approach the texts was Elliott Coues who, at age seventeen, was such a recognized star in the world of ornithology that the Smithsonian Institution sent him on a scientific expedition to Labrador. Coues’s wide-ranging mind rested not just on birds. In 1863 he received his medical degree from New York’s Columbia College and was commissioned as a surgeon in the U.S. Army, which was not a state regiment as were most Civil War units. He served for years in remote frontier posts such as Arizona’s Fort Whipple, where his passion for solitary bird collecting often put him in danger from Indians. In the late 1880s Coues undertook a revision and annotation of Biddle’s narrative, working from the original journals. He was sharply criticized for ‘‘defacing’’ the journals, which he unbound by removing the brass clasps, trimming the ragged sheets, and renumbering the pages, using his own system of organization. His final product was a three-volume work with valuable annotation, published in 1893. The first complete edition of the journals appeared in eight volumes in 1905. The editor, Reuben G. Thwaites, was director of Wisconsin’s State Historical Society and the editor of many volumes of collected narratives of early western exploration. His word-for-word magnum opus, heavily footnoted, remained the standard text for more than eighty years. The final, and probably definitive, work on the journals was pub-

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lished during the 1990s by Gary Moulton, and it incorporates not only the writings of Lewis and Clark but also the journals of Patrick Gass, John Ordway, Joseph Whitehouse, and Charles Floyd. Dozens of experts contributed to the annotations. With the addition of Donald Jackson’s 1978 Letters of the Lewis and Clark Expedition, the corpus of writings about that momentous journey appears complete. The botanical and zoological observations, which formed a second body of data, lay unpublished for generations, not appearing until 157 years after the expedition.2 Several of the expedition’s enlisted men published accounts. The most accessible to the average reader is Patrick Gass’s Journals (1807), lightly edited by David McKeehan. The Gass recounting, which appeared in several languages, has been reissued and edited by Carol Lynn MacGregor. In this book I have relied most heavily on the classic edited compilations of Moulton and Jackson in presenting the journal entries relevant to the study of venereal disease. I have retained the inconsistent spelling found there – so common two hundred years ago – for the purpose of conveying the immediacy of the explorers’ attempts to put the West into words. We will follow their journey in the sequence in which it occurred. The voyagers departed from St. Charles, Missouri (now a suburb of St. Louis), on May 21, 1804, and began the exhausting struggle against the currents, sandbars, and snags of the powerful Missouri River. On June 26 they reached the mouth of the Kansas River, on July 12 they were into Nebraska, and a week later they were traveling through today’s Iowa. July 27 put them at today’s Omaha, where Lewis noted that the men were covered with boils; a few days later he lanced one that discharged half a pint of pus. In early August they met with the Otoes, but they had no exchanges of a carnal nature. That was about to change.

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A late-September meeting with the Sioux ushered in a new era for the travelers, one in which sex was never far from center stage. On September 26, as the captains left a dramatic nighttime dance put on by the Brulé Sioux, a chief offered Lewis and Clark twoyoung women to take to bed. The captains refused this offer. The following evening the same offer was made to Clark. He again refused, leaving his hosts both puzzled and insulted. Clark wrote: ‘‘They again offered me a young woman and wish me to take her & not Dispise them, I wavered the Subject.’’ 3 In mid-October the expedition spent time with the Arikaras, whom Patrick Gass, on the eleventh, described as having the bestlooking Indian women he had ever seen. The following day Gass wrote of the Arikaras’ ‘‘unusual custom of showing appreciation,’’ by which he meant the offering of the most comely women to their visitors. That day, Lewis wrote that ‘‘a curious Cuistom with the Souix as well as the rickeres [Arikaras] is to give handsome Squars to those whome they wish to Show Some acknowledgements to – The Seauex we got Clare of without taking their Squars, they followed us with squars 13th [sic] two days. The Rickores we put off dureing the time we were at the Towns but 2 Handsom young Sqars were Sent by a man to follow us, they Came up this evening and peresisted in their civilities.’’ 4 The Arikaras were fascinated by York, Clark’s African American slave, noting his dark color and immense strength. York was invited into one Arikara home to convey this ‘‘magic’’ to the wife, while the husband stood guard outside the door to prevent any interruption of the transfer. When Clark related this story to Nicholas Biddle, he wrote it down in French, perhaps out of reluctance to record such a narrative in plain English.5 On October 15, Clark made further observations on the same subject: ‘‘Rickara women better looking than the Sioux – both are lech[er]ous and the men by means of interpreters found no difficulty in

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getting women.This without the husbands knowledge – thewomen desire it to be kept secret – the husbds. & etc. give wives & sisters to strangers.’’ Lewis added, ‘‘Their women verry fond of carressing our men etc.’’ The apparent contradiction in the husbands’ behavior is not explained.6 The following day, Clark noted, ‘‘2 young Squars verry anxious to accompany us.’’ Was this just out of a sense of adventure on the part of the girls, or had they been sent after the explorers as a mark of continued hospitality? The written records leave these questions unanswered.7 In the following weeks they pushed on northward, eager to find a winter resting place before the icy Arcticwinds arrived, and on October 27 they came to the Mandan villages (see fig. 4). In Clark’s journal entry of November 12 we read: ‘‘3 men Sick with the [blank].’’ 8 The notation was crossed out in red ink, apparently by Biddle, and almost certainly referred to venereal disease. The Corps had been with the Mandans only three weeks when the first incident involving marital conflict was reported. Lewis’s note of November 22 shows him trying to quell the passions of an irate Mandan husband and keep his troops out of trouble: I was allarmed about 10 oClock by the Sentinal, who informed me that an Indian was about to Kill his wife in the interpeters fire about 60 yards below the works, I went down and Spoke to the fellow about the rash act which he was like to commit and forbid any act of the kind near the fort. Some misunderstanding took place between this man & his fife [wife] about 8 days ago, and She came to this place, & Continued with the Squars of the interpreters, (he might lawfully have killed her for running away) [Lewis’s emphasis]. 2 days ago She returned to the Villg. in the evening of the Same day She came to the interpeters fire appearently much beat, & Stabed in 3 places – We Derected that no man of this party have any intercourse with this woman

4. Aerial view of the Knife River Hidatsa village. Two centuries after Lewis and Clark visited, the imprints of the round Indian lodges and the long traces of travois marks are still visible. (National Park Service photograph, Knife River Indian Villages National Historic Site, North Dakota)

61 The Voyagers Speak under penalty of Punishment – he the Husband observed that one of our Serjeants Slept with his wife & if he wanted her he would give her to him, We derected the Serjeant Odway to give the man Some articles, at which time I told the Indian that I believed not one man of the party had touched his wife except the one he had given the use of her for a nite, in his own bed, no man of the party Should touch his Squar, or the wife of any Indian, nor did I believe they touch a woman if they knew her to be the wife of another man, and advised him to take his Squar home and live hapily together in future – at this time the Grand Chief of the nation [Black Cat] arrived, & lecturd him, and they both went off apparently dis [dissatisfied].9

On December 8 it was twelve degrees below zero. In a buffalo hunt that day, Clark’s slave, York, had his penis frostbit. If one can believe the numerous stories over the next forty years regarding Indians who looked a lot like York, it would appear that he made a full recovery.10 On January 5, 1805, the supply of buffalo meat was running low and the Mandans organized a ‘‘buffalo calling’’ ceremony.Theyoung married men prepared platters of food, tobacco, and pipes; their wives, each naked except for a robe, accompanied the men to the house where the ceremony was to be held. The old men of the tribe sat in a circle around the central fire.With them was a doll dressed as a woman. A young husband chose one of the old men, presented him with food, and smoked with him. When the smoking was done, the husband presented his wife to the old man and begged him to have sex with her. She went out the door, followed by the old man. Soon, all the young men led their wives up to the remaining old men, and each pair proceeded outdoors. There the women dropped their robes, which left them naked, lay down, and invited the embraces of the old men. Clark told Biddle, ‘‘If the o.m. [old man] cannot do the substantial service, he must go thro’ the forms which saves the

62 The Voyagers Speak

honor of the parties.’’ (The subzero temperatures may have played a part in any failure to ‘‘do the substantial service.’’) It would appear that members of the Corps contributed to the mystical calling of the buffalo, since Clark noted, ‘‘White men are always considered as o.m. & are generally preferred by the Squaws.’’ (The ceremony was apparently successful – buffalo were found on the next hunting expedition.) In Biddle’s notes, based on his talks with Clark, the description of this ceremony is in Latin, most probably out of a sense of delicacy.11 Clark gives us this description: a Buffalow Dance (or medison) for 3 nights passed in the 1st Village, a curious Custom the old men arrange themselves in a circle & after Smoke[ing] a pipe which is handed them by a young man, Dress[ed] up for the purpose, the young men who have wives back of the circle go [each] to one of the old men with a whining tone [request] the old man to take his wife (who presents [herself ] necked except a robe) and – (or Sleep with him) the Girl then takes the Old man (who verry often can scarcely walk) and leades him to a Convenient place for the business, after which they return to the lodge, if the Old man (or a white man) returns to the lodge without gratifying the man & his wife, he offers her again and again; it is Often the case that after the 2nd time (he) without Kissing the Husband throws a new robe over the old man etc. and begs him not to dispise, him & his wife. (we Sent a man to this Medisan (Dance) last night, they gave him 4 Girls) all this is to cause the buffalow to Come near So that They may kill thim.12

The Mandan term for a man’s spiritual guiding light, the divine essence that comes to him through vision quests or other transcendental experiences, is often translated as ‘‘medicine.’’ Clark described a Mandan ‘‘medicine dance’’ to Biddle, who put most of it into French, once again to avoid being considered prurient. Paraphrased by the author, with the rather difficult French translated (it is just as awkward in the original), it has this essence:

63 The Voyagers Speak When a man wants to honor his ‘‘medicine’’ he invites everyone who wishes to attend to come to an open field, where he will dedicate horses or other property to the virgins or young women of the village who will join in his medicine dance. The girls who wish to join dance perfectly naked. After dancing for some time the girl lies down and remains there.The reward of the girls’ boldness, if somebody has the audacity to consummate the [sexual] act in the presence of everyone (because it is not allowed to do the consummation in private) is to lie with the man. Sometimes a young man has the audacity to undertake this adventure, in order to distinguish himself among his comrades.13

Perhaps even more remarkable is Clark’s comment to Nicholas Biddle that ‘‘Thewomen of the Mandans stretch the clythoris [sic] for sake of ornament so that some have it as long as five or 6 inches.’’ 14 The anatomy of the part named by Clark would make such a result unlikely. The longest reported human clitoris was fifteen millimeters, the average being three to seven millimeters.15 The Nama of southwest Africa, the Jukun of Nigeria, and the Trukese of the South Pacific intentionally elongate the labia minora for cosmetic reasons; perhaps this was what Clark observed.16 On January 14, Clark tells us, ‘‘Several men with the Venereal cought from the Mandan women.’’17 A week later, he writes: ‘‘Nothing remarkable. One ban [man] verry bad with the pox’’ – meaning syphilis rather than smallpox.18 On March 30 the expedition was still at the Mandan villages. ‘‘All the party in high Spirits,’’ Clark writes, ‘‘but few nights pass without a Dance they [his men] 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 easyacquired.’’ 19 The following day, Clark writes: ‘‘All the party in high Spirits. They pass but fiew nights without amuseing themselves danceing possessing perfect harmony and good under-

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standing toward each other. Generally healthyexcept venerials complains which is verry Commion amongst the natives and the men Catch it from them.’’ 20 After the explorers returned to the East Coast, Biddle spent several days in April 1810 with Clark, asking him to elaborate from memory in order to fill out the journal entries. The following, in Biddle’s hand, are relevant notes from the Clark interviews. ‘‘The Mandans had venereal. Ricaras too. Minitarees [Hidatsa] – Shoshones – Chopunnish [Nez Perces] – mouth of the Kooskooskee [River] – all the way down quite to the Sea Coast. They can cure not gon[orrhe]a, not lues [syphilis], which is excessively bad on Sea Coast. The Indians generally are not fond of women as we are. The women[,] those with whom we had anything to do[,] were not deficient in ardour.’’ 21 During the same visit, Clark gave Biddle more observations of Indian culture. ‘‘Polygamy is allowed among the Mandans. When a man becomes enamoured of a damsel, which the free intercourse between the sexes permits him to do without difficulty, her dispositions are learnt by means of a friend.’’ There is next an elaborate bidding war between prospective groom and prospective father-in-law, with the prospective groom raising the offer of additional horses until it is accepted. If the girl’s father finds the offer satisfactory, the couple is considered wed. If the bride is an eldest daughter, the new bridegroom also acquires all his bride’s younger sisters. Clark’s concluding comment: ‘‘The wom[e]n afflicted with both sorts of vl. [syphilis and gonorrhea?] which were given to the men.’’22 Patrick Gass celebrated New Year’s Day 1805 with a general statement in his journal. He noted that their experiences on the river the previous autumn and their winter with the Mandans ought to enable them ‘‘to give some account of the fair sex [Gass’s emphasis] of the Missouri; and entertain [future readers] with narratives

Riv er

6 7 Columbia

32

5 Sn

4

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Pla tte

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o

ad lor o C

1 Arikara 2 Mandan 3 Hidatsa 4 Shoshone 5 Nez Perce 6 Chinook 7 Clatsop

Tribes with venereal disease, as described by Lewis and Clark

r ve Ri

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River pi sip

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1 M iss ou ri

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Ri

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of feats of love as well as of arms.’’ Although ‘‘a sufficient number of entertaining stories and pleasant anecdotes’’ could be told, prudence called for only a brief entry. He did tell us that ‘‘Chastity is not very highly esteemed by these people, and the loathsome effects of certain French principles [venereal disease] are not uncommon among them.’’ Gass concluded with a story about one expedition member purchasing a chief ’s daughter for the night, payment being an old tobacco box.23 On April 7, 1805, the Corps of Discovery said goodbye to the Mandans and Hidatsas and started, once again, up the Missouri River. A summer of extreme hardship lay ahead. As the Corps begins the journey from Fort Mandan to the Great Falls, it seems time to introduce a few more recent observations of sexuallyoriented ceremonies among the explorers’ recent hosts.Two centuries of anthropological observation have added to what Lewis and Clark recorded. Among the Mandans and Hidatsas, nearly every male belonged to one of the many men’s societies. Entrance depended on both age and purchase. Age, of course, was a fixed quality; young men could join only a young man’s society. In addition to being the correct age, the applicant had to purchase membership. This purchase price often included the ceremonial surrender of the younger man’s wife to the sexual embrace of an older society member, a man of greater power and ‘‘magical’’ qualities. In contrast to the exploitative ‘‘right of the first night’’ found in feudal Europe, where the lord of the manor deflowered peasant brides, the Indian perspective on wife surrender was that the older man was conferring a favor upon the younger man.24 Three months after leaving the Mandan villages, Sacagawea’s health became a major concern. Although the journals tell us little of her as a person, she seems to have been highly regarded considering the fact that Clark later adopted her son. Her rescue of valuable

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papers during a canoe accident must have reinforced the men’s good opinion of her. In addition to her personal fortitude and physical strength, she was the only speaker of Shoshone on the expedition. The Shoshones had horses, and Lewis and Clark desperately needed horses for their trek to the Columbia. In early June 1805, just before the Corps began the exhausting portage past the Great Falls, Sacagawea fell sick. On June 10, Clark noted that she was ‘‘very sick’’ and bled her. She did not improve, so on the following day he bled her again, which Clark thought was of ‘‘great service’’ to her.25 On June 12 she was moved to a shaded area in one of the canoes. Two days later, ‘‘the Indian woman [was] complaining all night, and excessively bad this morning. Her case is somewhat dangerous.’’ On June 15, ‘‘our Indian woman Sick & low Spirited I give her the [Peruvian] bark and apply it exteranly [sic] to her region which revives her much.’’26 The somewhat euphemistic ‘‘region’’ most likely was the lower abdomen or pelvic area; no other reason for such vagueness suggests itself. A diagnosis of syphilis seems unlikely, since the captains did not give her mercury. On June 16, Lewis rejoined the group from a side trip. He took over Sacagawea’s care and wrote an extensive entry in which he acknowledged her importance to the expedition and noted finding her ‘‘extreemly ill and much reduced.’’ 27 He gave her two doses of Peruvian bark and opium (the amount is not quantified) and afterward found her pulse much fullerand more regular. Earlier that day, Lewis had observed twitching of the fingers and arm tendons, suggesting to a modern eye an electrolyte imbalance, such as a calcium deficiency. Such spasms can also be associated with an acid-base imbalance from hyperventilation, something often seen in patients with pain and severe apprehension. Certainly Sacagawea had pain and every reason for apprehension.28 Nearby was a spring whose waters seemed charged with sulfur

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and iron (and probably calcium). Lewis urged her to drink this mineral water, and it helped her considerably. Lewis concluded: ‘‘I believe her disorder originated principally from an obstruction of the mensis in consequence of taking coald.’’ He wrote that the girl had been ‘‘out of her senses’’ earlier in the day.29 Sickness severe enough to cause delirium is serious indeed. The next day, to the joy of the expedition (and of course the patient), Sacagawea was much improved. Her fever and pain were gone and her pulse was regular. Lewis gave her buffalo meat and buffalo soup.30 On June 18 she was able to sit up and walk. Lewis continued the bark and opium, adding fifteen drops of oil of vitriol.The next day she had a relapse after eating many ‘‘white apples’’ (most likely Psoralea esculenta), and Lewis sharply criticized her husband for not following the recommended diet.31 She was better the following day, or at least well enough to go fishing, and after June 20 we hear no more of illness with Sacagawea. A possible diagnosis was pelvic inflammatory disease, which is commonly a gonorrheal infection of the uterus and Fallopian tubes. Sacagawea’s husband, Toussaint Charbonneau, had several wives, and this would have increased her likelihood of infection. During the expedition itself she was closely supervised to keep her from the advances of the other men of the expedition. In the absence of a betterexplanation, Charbonneau may have given gonorrhea to Sacagawea and possibly his other wives as well. An argument against this diagnosis of gonorrhea is that her son Pomp’s eyes were normal, whereas babies born of infected mothers are often rendered blind by gonorrheal eye infections. Did she, indeed, suffer from gonorrhea? We cannot be certain. Sacagawea’s illness was not just a threat to her and to her newborn. She was almost certainly breastfeeding, and the men had no way of caring for an orphaned infant. She was vital as a translator

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with the Shoshones and, in one of the most astounding coincidences in history, the Shoshone chief Cameahwait turned out to be her own brother. Their unexpected and tearful reunion was extraordinarily beneficial in obtaining horses for the expedition. If she had died that June, the connection with the Shoshones would have been broken, and Mr. Jefferson might never have seen his explorers again.32 In the journals we find the entry ‘‘sore feet’’ over and over again. Of course there were many causes: the prickly pear cactus thorns that penetrated their moccasins, the sharp rocks that bruised their feet, and the simple pressure of walking ten to twenty miles a day. However, syphilis may also have been a factor. Secondary syphilis can cause painful lesions on the soles of the feet and the palms of the hands. The time from the Mandans to the mountains would have been enough for the symptoms of secondary syphilis to appear. In a literal sense, venereal disease may have dogged their every footstep. On June 16, 1805, the Corps began the first of several trulydreadful episodes: the one-month portage around the Great Falls of Montana. Literally tons of supplies were pushed, pulled, and carried for miles over precipitous terrain. On July 14 this ordeal was over, and five days later they passed their canoes through the narrow defiles of The Gates of the Mountain. After another eight days they reached the Three Forks of the Missouri River, in south-central Montana. August 9 brought the long-awaited first meeting with the Shoshones and Sacagawea’s brother. Many days passed before they encountered the main body of the Shoshones, days in which they crossed the continental divide at Lemhi Pass and had their first sight of the snow-capped mountain ranges still to the west of them. On August 13 they arrived at the Shoshone villages, where Sacagawea’s language skills and a lot of hard bargaining obtained the badly needed horses. The men of the expedition were exhausted, plagued with diarrhea, their feet in bloody tatters from cactus thorns and

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possible syphilitic sores. The Shoshones were starving, driven away from their customary hunting grounds by other, better-armed Indians. Now the situation improved for both whites and Indians. The Shoshones agreed to provide horses, and the expedition’s hunters brought in game. On August 18, Lewis’s birthday, the captain wrote a strangely self-critical note in his diary. He told himself that he had accomplished very little in his thirty-one years and resolved not to waste his remaining time in indolence.33 It seems the selfassessment of a man with depression. Or a man physically sick. Or was it only a literary affectation? By August 19, life was no longer just a desperate struggle to survive. There was time to consider sex – and to write about it. The day after his birthday, Lewis made an entry of several thousand words in his journal, including this reflection upon marital matters: ‘‘The chastity of their [Shoshone] women is not held in high estimation, and the husband will for a trifle barter the companion of his bead [sic] for a night or longer if he conceives the reward adiquate; tho’ they are not so importunate that we should caress their women as the siouxs were and some of their women appear to be held more sacred than in any nation we have seen.’’ 34 Lewis was amazed and perplexed that Shoshone custom denounced clandestine adultery but allowed sex with a wife if the matter had been submitted to her husband for approval beforehand. He described sex between his men and the Shoshone women as ‘‘this mutual exchange of good offices,’’ a term anticipatory of the Victorian age, and wrote of the difficulty of keeping the Shoshone women away from ‘‘our young men whom some months [of ] abstanence have made very polite to those tawney damsels.’’ 35 Lewis tried to learn more about venereal disease in the Shoshone culture. On August 19 he queried Toussaint Charbonneau in English. Charbonneau relayed the question to Sacagawea in French,

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and she asked the Shoshone in their own language. The answers came back through the same chain of translation, and Lewis wrote them down: ‘‘The information was that they sometimes had it but I could not learn their rememdy; they mostly die with its effects. This seems a strong proof that these disorders both gonaroehah and Louis venerae are native disorders of America.’’ Lewis’s recorded opinion demonstrated his familiarity with the Columbian theory of the origin of syphilis. It is impossible to know what was lost or added in this translation, but the room for error seems vast.36 Lewis made an extensive journal entry on Shoshone culture, noting that there were roughly one hundred warriors and three hundred women and children. A chief ’s only authority rested on his history of bravery in combat. The husband had absolute authority over his wives and daughters and could sell them if he wished. Men had many wives, but generally they did not marry their wives’ sisters, as did the Mandans. Girls came into puberty around age thirteen or fourteen and were married off at that point. They were frequently sold into marriage when very young, being delivered only upon maturity.37 On September 1 the party left the Shoshones and headed toward the Bitterroot Mountains, where five weeks of starvation and desperate struggle awaited them. A few days from the Shoshones, Lewis and Clark encountered the Flathead (Salish) Indians, who sold them better horses. It was just as well, since after a brief respite at Traveler’s Rest they began the worst part of their journey – weeks of struggle over the nearly trackless snows and precipitous slopes of northern Idaho’s Bitterroots, an area even today nearly uninhabited. Every day they looked for level ground, for grass for their horses, for game for their own stomachs. Every day for a month, they looked in vain. In the midst of the trek from the Shoshones to the Nez Perces nearly all of the men suffered from ‘‘brakings out, or irruptions of

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the Skin,’’ which Stephen Ambrose attributes to syphilis acquired from the Shoshone women.38 Other possible causes included scurvy, scabies, and the daily friction of heavy packs on unwashed skin.They staggered sick and exhausted into the arms of the Nez Perces, who were not very glad to see them. In fact, they considered killing the weakened explorers. No one would have ever known, and the Nez Perces, if they had killed the explorers, would have been the richest and best-armed tribe for hundreds of miles around. However, instead of killing the whites, they helped them. Legend has their salvation flowing from the intercession of a woman, Watkuweis, who earlier in her own life had been treated kindly by whites.39 Seventy years later, the United States repaid the Nez Perces in bitter coin by hunting down Chief Joseph and other leaders of the non-treaty bands, along with their starving, harassed followers. By October 6 the men of the expedition had strength enough to launch their newly built dugout canoes into the Clearwater River in today’s north-central Idaho. In spite of the white-water rapids sought by thrill-seekers today, the party in their hand-hewn craft survived several upsets and glided, still whole, on October 10, onto the waters of the Snake River, near the southeast corner of Washington State, their survival a tribute to their skills as watermen. By October 16 they were on the broad surface of the Columbia River, just north of the Washington-Oregon border, continuing to enjoy the delights of going with a river instead of against it. Villages lined the water.The explorers feasted on dog and salmon. Their strength grew. On October 10, Clark had found the energy to record what the women wore: a scrap of leather, tied to a leather waistband, ‘‘so as to barly hide those parts which are so Sacredly hidden and Scured by our women.’’ 40 This would not be the last journal entry to focus upon what hid (or revealed) the female pudenda. The Corps was delayed from October 23 to November 2 by a sec-

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tion of river that flowed verticallyas well as horizontally.They passed the great falls of Celilo, near The Dalles, and the thundering rapids (all submerged now beneath dammed waters) by a combination of portaging and daring canoe runs and emerged into the maritime climate to the west of the Cascade Mountains, traveling from a desert into one of the rainiest areas on earth. It was also a region that only twenty years earlier had been the happiest and most prosperous gathering of Indians in North America, and the most populous area north of the Aztec empire. The whites called them Chinooks. In this culture, finger-pointing was considered extraordinarily rude.When an early explorer violated that rule, the inhabitants commented, ‘‘He points!’’ – which sounded like ‘‘chi nook.’’ Chinook life was built around salmon, a delicious protein and fat source of almost unlimited abundance, now nearly destroyed by hydroelectric dams. This salmon-filled Arcadia was first violated in 1782, when a shipwrecked European sailor brought smallpox to the Chinooks. The diseasewas so horrible that wholevillages hanged themselves rather than die of the fiery pustules that raged across the victims’ bodies. Further epidemics of syphilis and measles weakened them for the final blow: the malaria epidemic of 1830 that killed nearly all the Chinooks and ravaged their culture.41 Jefferson’s explorers were not impressed with the Indians of the lower Columbia. Clark commented on their bad teeth, swollen limbs, blind eyes, pierced noses, filthy homes, and intentionally flattened heads (a ‘‘beauty’’ trait confined to the upper classes, who applied a board to the head of their infants).42 The sickly appearances noted by Clark are a puzzle.The Chinooks were well fed; perhaps the diseases brought by the English trading ships were already eroding Native vigor. Lewis had an eye for the Chinook women’s apparel: a skirt of tassels hung from the waist, ‘‘The whole being of Suffcent thickness

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when the female Stands erect to conceal those parts useually covered from familiar view, but when she stoops . . . this battery of Venus is not altogether impervious to the penetrating eye of the amorite.’’ 43 Lewis’s November 7 note was supplemented by Clark’s terser comment: ‘‘the Tosels [tassels] Separate.’’44 By mid-November the Corps was at the mouth of the Columbia River, challenged by its vast width, tossed by the ferocious waves and currents, battered by the roaring wind and soaked by never-ending rains. Still, on November 18, Clark found time to comment on his neighbors: ‘‘I saw 4 women and Some Children, one of the women in a desperate Situation, covered with Sores, Scabs and ulsers, no doubt the effects of venereal disorders.’’ 45 Three days later, in spite of their unsuccessful attempts to leave the north bank of the Columbia and find a safe winter site, Clark found time to record a somewhat startling visit by the Chinook: ‘‘Several Indians and Squars came this evening, I beleave for the purpose of gratifying the passions of our men. Those people appear to View (horedom) Sensuality as a necessary evile, and do not appear to abhore this as Crime in the unmarried females. The young women Sport openly with our men, and appear to receive the approbation of their friends & relations for So doing. Maney of the women are handsom.They are all low both men and women . . . Pocks and Venerial is common amongst them.’’ 46 Clark did not have the information he needed for a perspective on the situation.The Chinook aristocracy had flattened heads. Since Clark did not mention finding this deformity among his November 21 visitors, it is possible that the women who approached Clark’s men were slaves, unmarried women, and low-status wives, brought there by the men who owned or controlled them. The Chinooks had decades of experience with shipborne merchants who would trade sex for manufactured goods. Indeed, they were such skilled bargainers that several traders remarked that the ‘‘canniest Scot’’

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could not get the advantage of them. Perhaps the Chinooks hoped that these new strangers might have brought iron kettles, muskets, sheets of copper, or other desirable items. Lewis and Clark did not need otter pelts and had few trade good items left in their inventory. The notion of exploration as a goal in itself was utterly foreign to the natives of the Columbia River. For both the Chinooks and the Corps of Discovery, it was the beginning of a mutual misunderstanding. The north shore of the Columbia River offered little game or shelter, and on November 26 the Corps crossed to the river’s south shore, where, after nine days of exploration, they settled on their winter campsite and proceeded to build Fort Clatsop. It was not on the ocean’s shore, or even near the banks of the Columbia River, but the fort’s location – two miles south of the great river – gave them shelter from the ocean winds, ready access to trees for building the log fort, and a large enough elk population to sustain them for many months. They were to spend the winter among the Clatsop Indians, a subdivision of the Chinooks. On Christmas Eve 1805, enough of Fort Clatsop was completed to keep the rain off the men, and they slept in dry beds for the first time in weeks. That same day, Cuscular, a Clatsop chief, visited the fort with his brother and two women. The Indians had brought some food, which the explorers thought was a gift. Instead, the Indians wished to trade the food for two metal files. Lewis and Clark returned the food and kept the files. Again, the language barrier had transformed a simple transaction into a source of mutual suspicion and injured feelings. After the food-for-files swap had failed, the Indians offered the two women to the captains, who declined. This seemed to infuriate the four Clatsops. Clark write, ‘‘The female part appeared to be highly disgusted at our refuseing to axcept of their favours, etc., etc.’’ 47 What are we, two centuries later, to make of this? There are several possible reasons for the captains’ refusal: fear

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of venereal disease; loss of authority with their own men; setting a bad example; incurring a debt of unknown size and quality; disgust with the Indian moral code. The reasons were not recorded, and we are left with only speculation. Later, Clark had another visitor. He had successfully treated an ailing Indian man. The patient, pleased with the treatment, returned with his sister and offered her to Clark as a way of showing gratitude. ‘‘She was quite mortified at being refused,’’ Clark told Biddle years later.48 In a note of December 29, Lewis observed: ‘‘The Chin-nook womin are lude and carry on sport publickly the Clotsop and others appear deffident & reserved.’’49 The medical dangers of sex appear in Lewis’s note of January 27, 1806: ‘‘Goodrich has recovered from the Louis veneri which he contracted from an amorous contact with a Chinnook damsel. I cured him as I did Gibson last winter by the uce of murcury.’’ 50 Lewis notes that in the descent of the Columbia River he had seen three Indians with gonorrhea and six with syphilis. The Indians have no remedy for venereal disease, he adds; for them it always ends in death.51 A seemingly contradictory note, written the same day by Clark, claimed that the Chippewa used Lobelia to treat venereal disease, deeming it helpful with syphilis and even more useful for gonorrhea. Perhaps Lewis’s note about the fatality of venereal disease applied only to the Chinook, but in the absence of interpreters we can only guess at what was said. The Chippewa and the Chinook lived two thousand miles apart; little can be compared regarding health and disease with so much room for error. On February 20, Lewis provided an update on his patients: ‘‘Gibson is on the recovery fast . . . McNeal from inattention to his disorder has become worse.’’ 52 Had he not taken his pills? Had he failed to smear mercury ointment on his syphilitic sores? We do not know. A week later, Lewis recorded, ‘‘Gutridge and McNeal who

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have the pox are recovering fast, the former nearly well.’’ Unlike the blessing of penicillin, with its rapid and effective results, mercury treatment, whether it worked or not, seemed to take forever. An eighteenth-century witticism noted: ‘‘A night with Venus; a lifetime with Mercury.’’ On March 8, Lewis reported an apparent clinical success: ‘‘McNeal and Goodrich having recovered from the Louis veneri I directed them to desist from the uce of mercury.’’ 53 The ageold question as to whether mercury actually cured syphilis may have been answered nearly four months later in a journal entry for July 2: both ‘‘Goodrich and McNeal are both very unwell with the pox which they contracted last winter with the Chinnook women.’’ 54 Throughout the winter of 1805–6 the captains continued their ethnographic observations of the Clatsops: ‘‘Dec. 29, 1805. All go litely dressed . . . ware nothing below the waste in the Coaldest of weather, a piece of fur around their bodies and a Short roabe Composes the sum total of their dress.’’55 On March 19 Lewis noted: ‘‘The dress of the women consists of a robe, tissue, and sometimes when the weather is uncommonly cold, a vest. Their robe is much smaller than that of the men, never reaching lower than the waist nor extending in front sufficiently far to cover the body. It is like that of the men confined over the breast with a string and hangs loosely over the shoulders and back.’’ 56 Lewis describes the use of sea otter in vests of the wealthy Chinook and the use of raccoon or beaver pelts by those slightly less affluent: ‘‘One beaver skin . . . forms a vest and covers the body from the armpits to the waist, and is confined behind, and destitute of straps over the shoulder to keep it up. When this vest is woarn the breast of the woman is concealed but without it which is almost always the case they are exposed, and from the habit of remaining loose and unsuspended grow to great length particularly in aged women, in many of whom I have seen the bubby reach as low as the waist.’’ 57 Here he uses a word

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for ‘‘breast’’ that goes back to Samuel Johnson’s 1755 dictionary and probably far beyond. Clark was also taken aback by the ‘‘locker room’’ conversation of the Chinook, in which the niceties of east coast polite social discourse seemed absent. ‘‘Jan. 6, 1806. With us their conversation generally turns upon the subjects of trade, Smokeing, eating, or their womin; about the latter they Speak without reserve in their [the women’s] presence, of their every part, and of the most farmiliar connection. They do not hold the virtue of their women in high estimation and will even prostitute their wives and Daughters for a fishing hook or a Stran of beads.’’ 58 Sergeant Gass was also an enterprising observer of life with the Clatsops: ‘‘March 21, 1806. We were visited by some of the Clatsop Indians. These and the Chinook, Cathlamas, Calamex and Chiltz nations, who inhabit the seacoast, all dress in the same manner.The men are wholly naked except for a small robe; the women have only the addition of a small petticoat . . . the women are much inclined to venery, and like those on the Missouri are sold to prostitution at an easy rate. An old Chinook squaw frequently visited our quarters with nine girls which she kept as prostitutes.’’ 59 The captains noted two visits by this woman and her entourage. On March 15, eight days before the expedition left Fort Clatsop, Lewis wrote that they ‘‘were visited this afternoon by Delashshelwilt a Chinnook Chief his wife and six women of his nation which the old baud [‘‘a procuress’’ – Samuel Johnson, 1755] his wife had brought for market. this was the same party that had communicated the venerial to so many of our party in November last.’’ 60 Clark also described the visit, stating that ‘‘several of our party’’ had received venereal disease from this group.61 Lewis says ‘‘many,’’ while Clark says ‘‘several’’; the captains describe two visits, while Gass uses the word ‘‘frequently.’’ Today we can only guess at how often this

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flock of ‘‘tawny damsels,’’ as Lewis called them, came to visit, and how many of the Corps were infected. During the March 15 visit by the Indians, Lewis urged celibacy upon his Corps, fearing no doubt the hazards of recrossing the Rocky Mountains with sick men: ‘‘I therefore gave the men a particular charge with respect to them which they promised me to observe.’’ 62 The Indians camped near the gate for three days, apparently hoping for a final rendezvous, but it was not to be. At 1 p.m. on March 23 the Corps of Discovery left Fort Clatsop forever and headed east. The venereal diseases that the men may have carried with them fall into two very different categories. Gonorrhea may resolve even without specific treatment, but not so with syphilis, which may appear to go away while still lurking in the body. A month later, a year later, a decade later, syphilis can reappear in the vile afflictions discussed earlier. Mercury seems to suppress the syphilitic symptoms; by our modern standards of ‘‘cure,’’ however, it very doubtful that many patients were, in fact, cured. The first weeks of their return trip were perilous as the Corps dealt with the constant threat of theft by the Chinooks. From the Walla Wallas, however, the expedition not only enjoyed hospitality but received valuable information about passes over the Rocky Mountains. In early May the group passed from Walla Walla territory once again into the land of the Nez Perces, far upstream from the little fort near the ocean. On May 4 Lewis made an ethnographic note on Nez Perce customs surrounding menstruation: ‘‘At all these lodges of the Chopunnish I observe an appendage of a small lodge with one fire which seems to be the retreat of their women in a certain situation . . . the men are not permitted to approach this lodge within a certain distance and if they have anything to convey to the occupants of this little hospital they stand at the distance of 50 or 60 paces and throw it towards them as far as they can and retire.’’ 63

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On May 13, Lewis made notes regarding the unusual hair-removal practices of the Nez Perces.64 Gass had heaped praise upon the Flatheads, whom he had met earlier: ‘‘Theyare the only nation on thewhole routewhere anything like chastity is regarded.’’ 65 On March 28, while still in Chinook territory, he noted the change in women’s clothes: ‘‘Instead of the short petticoat, they have a piece of thin dressed skin tied tight round their loins, with a narrow slip coming up between their thighs.’’ 66 The Corps spent most of May and June waiting for the unusually heavy snows to melt. In those weeks with the generally friendly Nez Perces, the men of the expedition had many opportunities to interact with the women. However, not one of the journals mentions such activity. Did this simply reflect a time of trouble-free, mutually agreeable interludes between men and women? Considering the enthusiasm with which the men of the Corps spent time with the women of the Arikara, Mandan, Shoshone, and Chinook tribes, a sudden epidemic of celibacy would be unusual. The written record is silent, but the testimony of the earth may tell us more. In July 2002, archaeologists at the expedition’s campsite at Travelers’ Rest State Park, near Lolo, Montana, excavated the latrine trench dug by the explorers during their stays there September 9–11, 1805, and June 30–July 3, 1805. They found significant levels of mercury, which is absent in the surrounding soil. There seems little doubt that this is the residue of Dr. Rush’s mercury pills, or of calomel, excreted by Lewis’s patients.While mercury was deemed useful in many medical conditions, it is most often mentioned as the treatment for syphilis. However, soil samples at the Fort Clatsop site in Oregon have shown no mercury thus far.67 July and August 1806 were spent in the exploration of the Marias River and making fresh passes over the Rockies. After splitting into two groups, the Corps reunited on August 12 on the Missouri, near

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where the Little Missouri enters the larger river. The only contacts with the Indians were wary ones, and a brief gunfight with the Blackfeet left two Indians dead. Lewis had been wounded by one of his own men in a hunting accident. On August 14 they reached the Mandan villages. Here they stayed only three days. Their peace diplomacy had been a failure; all the tribes were at war. Pvt. John Colter asked for, and received, his discharge, and went off fur trapping. With no more need for a Shoshone interpreter, Charbonneau was paid off. He received $500.33, roughly $15,000 in today’s money. Sacagawea received no monetary reward. However, there is no doubt of the esteem in which she was held by the members of the Corps. When her son, Pomp, was three, she accepted Clark’s offer to raise and educate him.The young man went on to a life that seems almost fictional. He learned Latin and Greek, toured Europe with royalty, and joined the California gold rush. If the Mandan women offered their companionship again, we find no record of it in the journals of the eastbound voyage. The remaining men in the expedition hurried toward home as fast as the river could take them, covering seventy to eighty miles a day. On September 23 they reached St. Louis. The great journey was over. But was the journey over for the spirochetes that lurked in their weary bodies? Had the numerous doses of mercury killed or suppressed those microscopic agents of doom, or did the miseries of tertiary syphilis lie ahead for some (or all) of the Corps of Discovery? These brave and hardy men were heroes to their nation, feted at every stop with speeches, parades, banquets, grants of land, even political appointments. But, sadly, no man is a hero to the germs that lurk within him. We find evidence of sexual intercourse at many points in the westbound half of the expedition. Clark and Gass described such ac-

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tivities with the Arikaras. The ‘‘buffalo calling’’ ceremony with the Mandans showed that the Indianwomenoften chose European partners when they were available. Clark tells us that the favors of the Indian women were ‘‘easy acquired’’ and that they were ‘‘not deficient in ardor.’’ Gass speaks of ‘‘feats of love’’ but demurely avoids details. Lewis tells us of the Shoshone women and the ‘‘mutual exchange of good offices,’’ and he notes further that abstinence had made his men ‘‘very polite to those tawny damsels.’’ With the Chinooks, ‘‘the young women sport openly with our men.’’ The Clatsops frequently came with women, either to barter sex for goods or to reward the explorers for providing them with medical care. As to the associated health problems, we learn, as the Corps proceeded west, of many instances of infection. Clark first noted venereal disease in November 1804 at the Mandan villages, in an entry apparently scratched out by Biddle.The 1805 journals contain several relevant entries. In January, Clark wrote of ‘‘several men with thevenereal,’’ ‘‘One man very bad with the pox,’’ and ‘‘Venereal disease . . . communicated to many of our party.’’ A few days later he wrote of ‘‘venereal complaints which is very common amongst the natives and the men catch it from them.’’ Later he told Biddle that venereal disease existed among the Arikaras, the Mandans, the Hidatsas, the Shoshones, the Nez Perces, and the tribes ‘‘all the way down to the seacoast.’’ Gass wrote, while living among the Mandans, of ‘‘certain French principles which are not uncommon among them.’’ Lewis, in spite of translation problems, understood the Shoshone to be suffering from venereal disease. Clark described the Chinooks as ‘‘covered with sores . . . no doubt the effects of venereal disorders,’’ and later he noted that ‘‘Pox and venereal is common among them.’’ At Fort Clatsop, three named soldiers were treated at length for syphilis. In March 1805, Lewis noted six female visitors to Fort Clatsop, the same group that ‘‘gave our party the venereal last November.’’

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There are few numbers in these observations – hardly the stuff of today’s public health reports – but taken together they suggest that a considerable number of the men had become infected with syphilis in 1805 and 1806. Further, it would seem that the burden of proof would lie upon those who might assert that venereal disease was not a significant factor in the conduct of the expedition. The Corps was a military expedition, carried out by the U.S. Army. What is known of venereal disease in the U.S. Army between 1776 and 1825? At New York’s Albany Hospital in 1777, 14 of the 360 patients had syphilis. A March 1781 report listed 14 ‘‘venereal’’ cases among the 288 patients remaining in regimental hospitals. In July 1782, 38 of 225 patients in the hospital at New Windsor, Connecticut, had venereal disease. In the War of 1812, the War Office ordered that ‘‘women infected by venereal disease shall in no case be allowed to remain with the army,’’ adding that noncommissioned officers, musicians, and soldiers would not receive pay while under treatment for venereal disease.68 According to a longtime consultant on this period at the National Archives, comprehensive venereal disease statistics for this time period probably do not exist.69 Between 1818 and 1861 the number of cases of venereal disease in the U.S. Army seems to have decreased. In 1839 the newly completed hospital at Fort Columbus, in New York Harbor, was overwhelmed by desperately sick men from the Seminole Wars, shipped north from Florida, with a major increase in venereal disease cases. In 1836, as the hospital was being completed, 20 of the 120 men on the sick list had venereal disease. Two years later, 14 of the 57 men transferred fromTampa were sick with venereal disease.The 1848 incursion from Santa Fe, New Mexico, into Mexico resulted in nearly every soldier of the 1,100-man invasion force’s becoming ill with pneumonia, scurvy, or venereal disease. These fragmentary antebellum records were replaced by the far more comprehensive Civil War

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recording system, which reported more than 182,000 cases of venereal disease in the Union Army alone.70 And the incidence of venereal disease among American Indians? The statistics section of the U.S. Indian Health Service states that no figures exist prior to 1970 and that the ones since 1970 are unavailable, especially by tribe, because of the ‘‘sensitive nature’’ of the subject.71 Records of the Alaska Native Medical Center for the first six months of 1979 showed 220 patients treated for gonorrhea; 171 cases were studied in detail. Thirty-four percent of these were reinfected within eighteen months.72 Even recent data on Native American venereal disease is fragmentary and elusive. For the same questions two hundred years ago, the journals of Lewis and Clark may, indeed, be the most authoritative source we have.

6 Aftermath

Unlike a cold or the flu, syphilis is a gift that keeps on giving. The one-third of infected people who proceed on to develop tertiary (third-stage) syphilis carry a terrible burden. No one knows why two-thirds of syphilitics escape the curse of the tertiary manifestations; it is only certain that they are the fortunate ones. Here are some of the unlucky one-third. The brilliant French writer Guy de Maupassant died a raving madman in 1893, a victim of cerebral tertiary syphilis.1 Winston Churchill’s father, Lord Randolph, a brilliant orator and politician, died in 1895, reduced to a shambling and incoherent wreck by tertiary syphilis, although other authorities say he was felled by small strokes or perhaps by a brain tumor. Scott Joplin, the King of Ragtime and one of America’s most talented composers, went the same way in 1917. England’s Henry VIII died of either syphilis or diabetes. Many famous people may have been victims of late syphilis: Friedrich Nietzsche, Heinrich Heine, Henri Toulouse-Lautrec, and Al Capone. Karen Blixen, the author of Out of Africa, was infected by her husband and, in spite of treatment with Salvarsan, went on to develop tabes dorsalis.2 Surgeon Warren Webster, who had served at Fort Larned, Kansas, just before the Civil War, described the inroads of syphilis upon the Kiowas and Arapahos: ‘‘They are victims of the most desperate forms of constitutional syphilis, evidencing itself in lost noses, vacant palates and the vilest cutaneous affectations.’’ 3 In the spring of 1805, Lewis and Clark sent a delegation of Indian 85

86 Aftermath

chiefs to Washington dc in order to impress them with American power. As the chiefs were preparing to return west in February 1807, the famed painter and student of natural history Charles Wilson Peale wrote to his friend Thomas Jefferson: ‘‘In conversation with a friend this morning as the Indians were leaving this City [Philadelphia], he said they were sadly diseased; they had been with the women of bad fame in the lower part of the town and contracted the venerial [sic] disease. I have had no opportunity to enquire for the facts of this report, however I think it my duty to give you this notice, with the Idea that you will give orders for their cure before their departure.’’ 4 What about the members of the Corps of Discovery? As we have seen, the records suggest that nearly all of them had syphilis and/or gonorrhea at some time during the journey. Three men with venereal disease were identified by name: George Gibson, Silas Goodrich, and Hugh McNeal. The rest are a matter of informed conjecture. The histories of Lewis and Clark themselves, in the years after their return, have been well documented and will be discussed later. There have been several attempts to record what became of the enlisted and hired men (and one woman), those less-celebrated explorers who were so vital to the expedition’s success. The task of the detective of syphilis is made more difficult by two factors: poor records in years gone by and the difficulty in precise diagnosis before the introduction of reliable blood tests. Almost any diagnosis before 1910 is open to question, especially since syphilis can manifest itself in so many ways. The time of onset adds further confusion into the search: the first manifestations of tertiary syphilis may come in two years – or in twenty. With these limitations in mind, let us proceed on, commencing with the three named men who had the pox.5 Pvt. George Gibson, hunter, horseman, violinist, and Indian sign interpreter, married after the expedition and died in St. Louis in

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1809. The cause of death is unknown. Pvt. Silas Goodrich, a Massachusetts native, was the best fisherman of the Corps. At the end of the expedition Lewis made no special remarks about either Goodrich or Gibson. Goodrich reenlisted in the army around 1807. Clark noted his death as occurring shortly after 1825. The cause of death is unknown. Pvt. Hugh McNeal, a native of Pennsylvania,was still on the army muster rolls as of September 1811. Clark cites his death as occurring after 1825. The cause of his death is also unknown. It is immediately apparent that answers will be difficult to find, since there is not a single clue regarding tertiary syphilis in the few records that describe the three men positively identified as infected with syphilis. Let us consider the sergeants. Patrick Gass had served as a Ranger before joining the army in 1799. His carpentry skills benefited the expedition to the Pacific Ocean. He was discharged during the War of 1812 after losing an eye. He married at age sixty and died at age ninety-nine. If he had syphilis, it surely did not impair him. Charles Floyd died on August 20, 1804, before the expedition even reached the Mandan villages. The probable cause was appendicitis.6 John Ordway was another diarist. He was born around 1775 in New Hampshire. He was considered experienced and reliable, being a regular army man. After settling in Missouri in 1809 he became prosperous, married, and died by around 1817, at age forty-two. Once again, we do not know what killed him. Nathaniel H. Pryor was a married man when he joined the expedition. The captains described him as ‘‘a man of character and ability’’ and recommended him for an officer’s commission. He resigned his commission in 1810, worked three years in the Indian trade, and returned to the army in time to serve in 1814 as a captain at the Battle of New Orleans. Later, he resigned again, became a trader with the Osage, married an Osage woman, and stayed with the tribe until his death in 1831 at the age of fifty-

88 Aftermath

nine.Two towns, a mountain range, and a creek bear his name.There is nothing in the record to suggest disease or debility. This brings us to the privates. John Boley, who served in two of Zebulon M. Pike’s expeditions after returning with the Corps of Discovery, last appears in the records living with his wife near St. Louis in 1823.William E. Bratton was sick with a back ailment during much of the expedition; it sounds more orthopedic than bacterial. He was cured by an Indian sweat bath. He served in the War of 1812, married in 1819, and died in Indiana in 1841 at the age of sixty-three. John Collins must have had redeeming qualities, for the captains kept him on in spite of a court-martial and being labeled as a ‘‘black gard.’’ He was killed in 1823 in William Ashley’s battle with the Arikaras. His age and medical history are unknown. John Colter, whose name lives on at Colter Bay in Grand Tetons National Park, explored on his own after the expedition. His descriptions of the Yellowstone volcanic activity caused many to brand him a liar. He settled in Missouri around 1811, married, and died of ‘‘jaundice’’ in 1813. He was probably thirty-eight. Peter Cruzatte, half French and half Omaha Indian, was a renowned boatman, musician, and interpreter, in spite of being badly nearsighted in an age when corrective lenses were not widely available. He received no special commendation from Lewis, perhaps because he had shot the captain in the buttocks, mistaking him for a bear. In Clark’s later compilation he listed Cruzatte as killed around 1825.There is no medical history. John Dame joined the army in 1801 and was assigned to the expedition from Capt. Amos Stoddard’s artillery. Dame appears only once in the journals: he shot a pelican. Nothing is known of his life after 1805. George Drouillard, a civilian rather than an enlisted man, was half French-Canadian and half Shawnee. A skilled hunter, interpreter, and woodsman, he was valued highly by the two captains, Lewis calling him ‘‘A man

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of much merit’’ who ‘‘deserves the highest commendation’’ and who ‘‘uniformly acquitted himself with honor.’’ In 1810 he was a fur trader at the Three Forks of the Missouri, where he was killed by Blackfeet. We know nothing of his health. Joseph Field and his brother Reuben were born around 1772 and joined the expedition in August 1803. They were among the best hunters of the expedition, crucial skills when it came to feeding thirty men who could carry little food of their own. Lewis wrote that the brothers fulfilled their duties ‘‘with much honor.’’ Joseph was listed as ‘‘killed’’ a yearafter the expedition returned. Reuben settled in Kentucky, where he married. He was dead by early 1823. Again, no clear causes of death are recorded. Robert Frazer kept a journal, but it has been lost. Also lost are any personal records, other than a note that he died in Franklin County, Missouri, in 1837. Hugh Hall was a member of the Second Infantry Regiment when he joined the expedition in 1803. He was court-martialed once for getting drunk. In 1809 he borrowed money from Lewis at St. Louis. After that, Hall disappears from the records. Thomas P. Howard had also been a member of the Second Infantry. He was court-martialed once, for showing the Indians the vulnerability of Fort Mandan’s walls. He, too, is absent from the postexpedition records. François Labiche spoke French and English and several Indian languages; he was also a skilled trader and boatman. On the return to St. Louis he was recommended for a bonus, something quite unusual. He was still alive in St. Louis in 1828. John Newman (1785–1838) was court-martialed and expelled from the party for ‘‘expressions of a highly criminal and mutinous nature.’’ Because of attempts to redeem himself, Lewis later recommended Newman for some back pay and a land warrant. He was killed by the Yankton Sioux in 1838. He had married once, but there is no record of children. German-born John Potts was by trade a miller. There is

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little note of him in the journals. He was killed by Blackfeet while trapping at the Three Forks of the Missouri in 1808. This strenuous occupation suggests that he was still in good health. Moses Reed was convicted of desertion in August 1804 and given a dishonorable discharge. The following spring he came downriver with the return party and disappeared from the historical record. John Robertson had been a corporal, but he lost his stripes in some unrecorded manner. There is no mention of him after 1804. George Shannon (1785–1836) was lost once and nearly starved. In 1807, in the failed attempt to return Chief Sheheke to the Mandans, Shannon lost his leg to the Arikaras. After that, fortune smiled on him. He received a pension. He assisted Nicholas Biddle in preparing the printed journals. He studied law and eventually served in the Missouri state senate. His medical condition in later life is unknown. John Shields (1769–1809) had been married thirteen years when he joined the expedition. His skills as a blacksmith at Fort Mandan enabled the expedition to trade metal-working services for food and may have kept the entire Corps from starvation. Lewis recommended him for a bonus. Shields died in Indiana three years after his return from the Pacific coast, again of causes unknown. John B. Thompson left little trace in the records. Clark called him ‘‘a valuable member of our party.’’ He was ‘‘killed’’ sometime before 1828. Ebenezer Tuttle was born in 1773 and was recruited from Captain Stoddard’s artillery company. Other than that, his life is an unknown. Corporal Richard Warfington came from the Second Infantry. He was considered very reliable and commanded the return party that brought back the first nature specimens to Thomas Jefferson in the summer of 1805. Perhaps his greatest success was delivering a prairie dog and four magpies to Jefferson – still alive! After that, Warfington disappears from the records. Peter Weiser appears but little in the journals. He was probably killed around 1810 by Indians. He would have been around thirty years of age.

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William Werner left even fewer tracks than Peter Weiser. Werner was absent without leave once as the voyage began, and in 1807 was advanced some money by Lewis and given the use of a government horse.There are no other data. IsaacWhite joined Captain Stoddard’s artillery company in 1801; otherwise there is no record of him after 1804. Joseph Whitehouse kept a journal of the expedition and often served as a tailor. He otherwise is invisible until 1807, when he was arrested for debt. He later rejoined the army and fought in the War of 1812. He deserted in 1817, when he was forty-two, and vanished. Hamilton Willard received one hundred lashes for sleeping on sentry duty; he was an unlucky man, being the only soldier to lose his horse twice. After the expedition he was hired as a government blacksmith for four different Indian tribes. He married in 1807 and sired twelve children. He died in Sacramento, California, in 1865 at the age of eighty-seven. Richard Windsor was one of the expedition’s better hunters; he later served in the army until 1819. In 1828 he was living in Illinois. His birth and death dates and medical history are all unknown. So far we have very little on which to base any conclusions about tertiary syphilis. Will there be more in the records of York, Clark’s African American slave? His dark skin astonished the Indians. Might it have led to a more detailed record in the years after the expedition returned to St. Louis? We know that York was about thirty-five years old, of great strength, and carried a gun in his years of crossing and recrossing the West. He had served as well as any man on the expedition. He thought so, too. After they returned to St. Louis he wished to join his wife in Louisville and asked Clark for his freedom. Clark beat him and did not release him for another ten years.When York was finally freed, he operated a freight wagon business in Tennessee and Kentucky. The business failed; York died of cholera around 1831. Again, nothing is known that is relevant to the theme of this study.

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Along with the soldiers and York, there were ten engagées, men of French-Canadian descent who hired out their services to Lewis and Clark. One man, Pvt. Baptiste Deschamps, was patron (the head man) most likely because he spoke French and English. The last names of the ten were Malboeuf, Primaut, Hébert, La Jeunnesse, Pinaut, Roi, Collin, Carson, Caugee, and Rocque. Examination of their records reveals many tales of adventure but nothing that adds to our medical understanding. There was one married couple with the Corps of Discovery: Toussaint Charbonneau and his youngest wife, Sacagawea. He was born to French-Canadian parents around 1758; he spoke English, French, and several Indian languages and made his living as an interpreter. The captains admired little about him other than his interpretive skills, which were useless west of the Continental Divide. Lewis described him as ‘‘A man of no peculiar merit.’’ He supposedly was living among the Hidatsas in 1794 when hewon Sacagawea in a gambling game. Assuming the truth of this story, she would have been five or six years old at the time; he would have been thirty-six. After his employment with Lewis and Clark, Charbonneau worked as a government interpreter until he was eighty, a ripe old age and not one suggestive of debilitating disease. As we have seen earlier, he may have given gonorrhea to Sacagawea. His wife was, of course, the legendary guide and translator, and a following has grown up around her sufficient to generate several contradictory biographies and the issuance of a U.S. commemorative one-dollar coin. One source (apparently the better one) states that she died in 1812, while another claims 1884 as her final year. With such wild discrepancies in the most fundamental data, we once again are at a loss to make any statement about syphilis in this almost-mythic heroine.7 This brings us to the two captains.William Clark was born in 1770

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and died at St. Louis, Missouri, in 1838, at the age of sixty-eight. His respect for the Indians and his willingness to doctor them smoothed the way at many difficult moments. Sacagawea trusted him enough to commit her young son to his care, and Clark paid for the boy’s education. On his return from the voyage of discovery, Clark was appointed brigadier general of militia and principal Indian Agent for the Louisiana Territory. When he was thirty-seven he married sixteen-year-old Julia Hancock. In his role as Indian Agent he negotiated many treaties that were disasters for the Indians. His efforts to balance the demands of the settlers and the rights of the Indians were inherently flawed. In 1812 he was appointed governor of Louisiana, a vast territory. In spite of his deep disappointment with government policy toward the Indians as well as the death of his two wives and three of his seven children, Clark was described at age sixty-one as ‘‘hardy and vigorous as ever.’’8 This does not seem to describe a man with severe chronic disease, much less a man suffering from the ravages of late syphilis. Only one man remains for study: the expedition’s leader, Meriwether Lewis. Let us begin with his death on October 10–11, 1809. Some called it murder; others called it suicide. The issue is confused by the absence of firsthand testimony and the conflicts between the many second- and thirdhand stories. Capt. (or Maj.) Gilbert C. Russell, who commanded Fort Pickering, near today’s Memphis, Tennessee,wrote toWilliam Clark,who summarized Russell’s words in a letter of his own to his brother Jonathan dated November 26, 1809.While Russell’s original letter is lost, Clark told his brother that Russell had seen Lewis ‘‘in a State of Derangement’’ at Fort Pickering and that Russell had later heard from Lewis’s servant that Lewis had imagined the sound of Clark’s arrival along the Natchez Trace. Neither Clark nor Russell had any direct knowledge of the circumstances of Lewis’s death.9

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The servant was John Pernier, Lewis’s employee. Although Pernier spoke with someone in Nashville about the death and later spent four days with Jefferson at Monticello, no firsthand record of Pernier’s observations has ever been found and, most curiously, there is nothing in Jefferson’s own records. Lewis died at a tiny Tennessee settlement called Grinder’s Stand. This inn was simplya dogtrot structure – two crude log cabins joined by a covered breezeway.The proprietors, Robert and Priscilla Griner, had their names misspelled in the earliest reports, and their names have remained thus misspelled for two centuries. On October 10, 1806, Mr. Griner was away. Priscilla, one of the few actual witnesses, left no direct account in her own words. Eighteen months later, a close friend of Lewis’s, the noted ornithologist Alexander Wilson, visited Mrs. Griner and took notes of her story. The respected Lewis and Clark expert Elliott Coues had this to say of her account: ‘‘Her story is wildly improbable . . . not to be believed under oath . . . a concoction on the part of an accomplice in crime . . . until other evidence is forthcoming the victim of untimely fate should be given the benefit of the doubt.’’ Coues clearly felt it was murder, not suicide.10 James Neely, a government employee traveling with Lewis, had fallen behind looking for horses that had strayed. When he reached Griner’s, Lewis was dead. Neely told two versions of what he found. In one, a report to Jefferson, Neely said that Lewis had two gunshot wounds. In the other, published in the Russellville, Kentucky, Farmer’s Friend, Neely said that Lewis had not only shot himself twice but had also cut himself. Captain Russell, in a letter written to Jefferson on January 10, 1810, accused Neely of being an indirect murderer by interfering in Lewis’s travel arrangements. Conspiracy theorists have woven a wider web and suggested that Russell, Neely, Pernier, Aaron Burr, and Thomas Jefferson were all

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involved in an assassination plot, perhaps to silence Lewis for having known too much about some political skullduggery. The entirely disreputable General James Wilkinson is also put forward as a conspirator.11 In 1809, Meriwether Lewis was as famous as Stonewall Jackson in 1862 or Charles Lindbergh in 1927, yet there was no formal inquiry into his death. Equally strange is the fact that no serious attempt to mark his grave was made until many years after the event. What do we really know about what happened that October night? Perhaps Coues said it best when he wrote, ‘‘This death remains a mystery: but mystery should not be paraded as history.’’ 12 If it was suicide, why would a governor, a celebrated explorer, a favorite of Jefferson, kill himself – shoot himself twice and (possibly) slash his own body from head to toe? What awful state of mind must have overwhelmed him? And what could have been the cause of such a desperate end? At least four possibilities present themselves: an underlying disposition to melancholia; an excess of alcohol; the political pressures upon him as governor of Missouri; the mental effects of encroaching syphilis; or some combination of these factors. In attempting to examine the first possibility one must face the basic problem in psychiatric diagnosis: the basis is description, not laboratory numbers.While there are hints that such a day may come when a laboratory number, equivalent to blood sugar level or blood pressure, will distinguish between obsessive-compulsive disorder, bipolar disorder type II, and paranoid schizophrenia (to name just a few disorders), what we have today are elaborate paragraphs of behavioral criteria. Further, in the author’s long professional life the entire system of psychiatric diagnosis has been changed four times. The moral: take psychiatric labels with a grain of salt. They are the best we have, but they are not immutable.

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What used to be called manic-depressive disorder is now called bipolar disorder. It may come in many different patterns, including the most prominent three: recurrent excitements, recurrent depressions, and alternating excitement and depression. Of course, there may be symptom-free intervals. Bipolar disorder seems to run in families. Whole textbooks of psychiatric genetics exist. For our purposes, families with bipolar disorder tend to produce children with bipolar disorders. What is the evidence for mood problems in the case of Meriwether Lewis? The captain was the product of a confluence of two old Virginia families, the Lewises and the Meriwethers. Jefferson noted that the family was ‘‘subject to hypocondriac affections. It was a constitutional disposition in all the nearer branches of the family.’’ 13 The eleven marriages that joined Lewises with Meriwethers between 1725 and 1774 most likely deepened any such vulnerability to mood disorders by inbreeding. As Lewis came under Jefferson’s tutelage, the president noted, ‘‘While he lived with me in Washington, I observed at times sensible depressions of mind.’’ Having observed the same bouts of melancholia in Lewis’s father, Jefferson traced it to a ‘‘constitutional source.’’ 14 Jefferson had ordered Lewis to keep a daily log, yet he wrote scarcely a word between September 1805 and January 1806. This had been a direct order by the nation’s commander in chief, but it was not obeyed. There is no hint of strange behavior by Lewis in other men’s journals. Lewis continued his other duties on thewaydown the Columbia River, but he did not write.The simplest explanation is depression. On February 27, 1807, Jefferson appointed Lewis governor of Louisiana, yet Lewis did not even arrive in St. Louis until late in the winter of 1808.Where was he all those long months? Some of the time he could be found drinking and embarking on failed courtships, but much of the time he seems to have disappeared. This would cer-

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tainly raise the question of another paralyzing depressive episode.15 During his governorship he made a number of financial decisions that suggested the overoptimism and expansiveness of a mild manic episode. If he was ‘‘up,’’ it didn’t last. Equally possible is that the invisible governor of Missouri was in hiding, enduring the long and troublesome mercury treatment for syphilis. Then as now, syphilis was a low-prestige diagnosis, certainly something that a national hero and a newly minted governor might wish to conceal. In early September 1809,with his finances and public life in shambles, he left St. Louis for Washington dc, hoping to untangle his affairs and explain matters to President Madison. He planned to travel to New Orleans and there take an oceangoing vessel to Philadelphia. On the way down the river toward New Orleans he attempted suicide. He got off the boat at Fort Pickering and wrote an incoherent note to Madison that he feared going by sea, lest the British seize his journals. After seven days, Captain Russell, commanding the fort, reported that ‘‘all symptoms of his derangement disappeared.’’ 16 Lewis and his party headed east up the Natchez Trace. He told his companions that Clark was just behind him on the trail and would soon catch up with them. This, of course, was more than a melancholic sadness; it was a psychotic delusion or perhaps delirium tremens from alcohol withdrawal. Clark was hundreds of miles away. There had never been a plan for Clark to meet them. A few hours later, Lewis was dead. On hearing the news, Clark exclaimed, ‘‘I fear, O I fear, the weight of his mind has overcome him.’’ 17 Certainly a depressive illness could explain all his troubles, but three other possibilities need to be explored. Alcohol has been the ruin of many men. In 1805, Americans drank a lot. The average citizen of drinking age consumed seven gallons of pure alcohol a year, or fourteen gallons a year of 100-proof whis-

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key, or almost five quarts of whiskey a month.18 Several English travelers to postcolonial America noted that Virginia gentlemen began the morning with a large glass of rum and remained ‘‘in a state of stupefaction’’ until bedtime. Lewis was certainly from that social class. In the early summer of 1807, when he was supposed to be in St. Louis governing a vast territory, he was in Philadelphia, out drinking every night with his friend Mahlon Dickerson. He attended numerous balls and testimonial dinners in his role as one of America’s most famous men. Drinking was always a part of such gatherings. In the early summer of 1809 he was in St. Louis, where he consumed large quantities of opium ‘‘for the malaria.’’ This was nonsense; Lewis knew full well that the symptoms of malaria were treated (and treated successfully) with quinine, in the form of Peruvian bark. When he had ‘‘a fever’’ he took three grams of opium at night and two more in the morning. Even if this were a translation error,with grains rather than grams, it was far too much. In September he was drinking and taking opium. He was also telling people that his work on the journals was complete and the long-awaited compilation was ready for the printer – which was either a lie or a delusion. Lewis lived generations before Alcoholics Anonymous or Antabuse. There was no ‘‘cure’’ except ‘‘taking the pledge,’’ which rarely worked. He lived in an age when gentleman drank heavily but were supposed to function anyway. Alcohol may well have played a part in his self-destruction.19 Who was running government affairs in the vast Louisiana Territory during Lewis’s long absence? It was Frederick Bates, with the titles of secretary and acting governor, and Bates was desperate for Lewis’s arrival. St. Louis was torn in every direction. The wealthy Spanish and French families, with their vast estates and trade monopolies, were deeply resentful of the influx of Americans, who in turn resented the wealth, privileges, and hauteur of the old fami-

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lies. Hordes of slaves, boatmen, renegades, and Indians flooded the streets. The question of Indian trade and who was to reap the imagined fortunes in that trade had lead to endless quarrels, plots, and factions. Meanwhile, Jefferson was out of office and the Madison administration was much less sympathetic to Lewis. As an explorerhero, he was one thing. As a governor, he was quite another and subject to the political intrigues that always surround such a post. Furthering the already muddy waters were plots to detach the West from the United States, plots hatched by General Wilkinson, commanding general of the U.S. Army, who was also a paid agent of the Spanish government, working in collusion with Aaron Burr. Bates, an experienced bureaucrat, was unable to manage the situation. What was Lewis to do, a man with almost no real political experience and a tendency to give orders in situations where no man would obey? Lewis bought things, thinking the government would pay. The two-month turnaround time for correspondence and the tendency for the new administration to refuse payment of even the most reasonable expenses left him stuck with the bills to pay out of his own pocket. And that was already empty from his business speculations. The new governor was soon a candidate for debtors prison! His already precarious mental balance was strained by a situation that would upset even the calmest man. And there was a fourth factor, one that may have been entangled in the other three – a possible syphilitic deterioration of his brain. Earlier we saw that neurosyphilis can cause poor judgment, paranoia, irritability, emotional overreaction, personality changes, depression, inappropriate gaiety, and the delusion of being healthy. Certainly many of these describe the last two years of Lewis’s life. If he knew that he had progressive syphilis, he might have drunk more and taken more opium to dull the horror of witnessing his own deterioration. If he was unaware of his own impending col-

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lapse, it might explain his cavalier approach to being governor, in which he demanded his salary but didn’t even bother to go to St. Louis for almost a year. He rarely wrote to Clark and had estranged himself from Jefferson. In those lost months, was he hidden away, taking mercury in an attempt at cure? We don’t know.We will never know. But a scientific assessment of the disintegration of a brilliant young man requires an honest look. And as we have seen earlier, the moral stigma of venereal disease is both harsh and unwarranted, but the biological stigmata are inexorable. From the journals it would appear that neither captain had a female bed partner during the two-year journey. Lewis, as first among the two equal captains, may have felt the greater need to set an example of good behavior.When could he have had a sexual connection without having it easily noticed? Epidemiologist Reimert Ravenholt suggests the night of August 13, 1805. Lewis had only three men with him; the rest of the expedition was fourdays’ march away.They had just encountered the Shoshones and were being welcomed by them. ‘‘This evening the Indians entertained us with their dancing all night. At 12 o’clock [midnight] I grew sleepy and retired to rest leaving the men to amuse themselves with the Indians . . . I was several times awoke in the course of the night by their yells but was too much fatigued to be deprived of a tolerable night’s repose.’’ Ravenholt’s speculation is based on a single written record, one that makes no mention of sexual contact on Lewis’s part, a slender reed indeed.20 Four years after meeting with the Shoshones, Lewis was dead. Four years is long enough for tertiary syphilis to work its dreadful effects on brain and personality. What a witches’ brew may have felled the great captain: a powerful familial trait of depression; years of heavy drinking and opium use; a very difficult political situation; and syphilis of the brain. The records of two hundred years ago are

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insufficient to untangle the cause or cluster of causes of his tragic end. Medical records as we know them today were nearly nonexistent. It is ironic that some of the best clinical notes of the era were those kept by Lewis himself in treating members of the Corps. A summing up will show several key points. Lewis’s shopping list shows that he anticipated venereal disease among his men. There is evidence in the records that syphilis was already widespread among the villages that the expedition visited, although whether the Corps brought further venereal disease to the Indians is unknown. There is evidence that there were sexual relations between many of the men of the Corps and some of the Indian women. There is evidence that many, perhaps all, of the men received mercury treatment. In the records of the expedition after its return there is almost nothing to prove or disprove tertiary syphilis. In Lewis’s tragic death there is the distinct possibility that syphilis played a part. On a wider scale, it would seem that the role of venereal disease has been given insufficient weight in understanding the challenges and dangers faced by the justly famous Corps of Discovery.The hardships they endured and the completion of their trip with only one death are almost unparalleled in the history of exploration. Whatever pain and disability the men suffered from venereal disease were wounds received in the service of their country. For every aspect of their immortal journey, they deserved and still deserve the thanks of a grateful nation.

Notes

introduction 1. Richard Godbeer, Sexual Revolution in Early America (Baltimore: Johns Hopkins University Press, 2002), 144–46. 2. Alana Crawford, Unwise Passions (New York: Simon and Schuster, 2000), 15–24. 3. Thomas P. Lowry, The Story the Soldiers Wouldn’t Tell: Sex in the Civil War (Mechanicsburg pa: Stackpole Books, 1994), 93–98. 4. Allen C. Guelzo, Abraham Lincoln: Redeemer President (Grand Rapids mi: Eerdmans, 1999), 10–15. 1. venereal disease today 1. ‘‘Trafficking in Persons,’’ U.S. State Department Report, June 5, 2002. 2. Mark H. Beers, ed., The Merck Manual (Whitehouse Station nj: Merck Research Books, 1999), 1327–33. 3. Deborah Hayden, Pox: Genius, Madness, and the Mysteries of Syphilis (New York: Basic Books, 2003), 28–43. 4. Hayden, Pox, 61–62. 5. Hayden, Pox, 63. 6. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (Washington dc: American Psychiatric Association, 1994). 7. United Nations World Health Organization, http://www3.who. int/whosis/menu.cfm, 2002. 103

104 Notes to Pages 15–29 2. what did lewis and clark know? 1. Bruce S.Thornton, Eros: The Myth of Ancient Greek Sexuality (Boulder co: Westview, 1997), 53–55. 2. Claude Quétel, The History of Syphilis (Baltimore: Johns Hopkins University Press, 1990), 3. 3. Quétel, History of Syphilis, 10. 4. Quétel, History of Syphilis, 11. 5. Quétel, History of Syphilis, 13. 6. Quétel, History of Syphilis, 15. 7. Hayden, Pox, 12–21. 8. Quétel, History of Syphilis, 36. 9. Quétel, History of Syphilis, 34. 10. Quétel, History of Syphilis, 37. 11. Bruce M. Rothschild, Fernando Luna Calderson, Alfredo Coppa, and Christine Rothschild, ‘‘First European Exposure to Syphilis: The Dominican Republic at the Time of Columbian Contact,’’ Clinical Infectious Diseases 31 (October 2000): 936–41. 12. Quétel, History of Syphilis, 73. 13. Donald J. Ortner, Identification of Pathological Conditions in Human Skeletal Remains (New York: Academic Press, 2003), 273–317. 14. Quétel, History of Syphilis, 29. 15. Quétel, History of Syphilis, 23. 16. Quétel, History of Syphilis, 29. 17. Quétel, History of Syphilis, 60. 18. Quétel, History of Syphilis, 13. 19. Otis Historical [Photographic] Archives, National Museum of Health and Medicine, Washington dc. 20. National Archives Record Group 153, mm1430. 21. Hayden, Pox, 30. 22. Quétel, History of Syphilis, 90. 23. Jonathan Carver, Travels through the Interior Parts of America (Dub-

105 Notes to Pages 30–49 lin, 1779), 365–68, cited in Virgil Vogel, American Indian Medicine (Norman: University of Oklahoma Press, 1970), 478. 24. E. G. Chuinard, Only One Man Died (Fairfield wa: Ye Galleon, 1999), 411. 25. Gerhard van Swieten, An Account of the Most Common Diseases Incident to Armies, with Method of Cure (Philadelphia: R. Bell, 1776), 93–98. 26. Donald D. Jackson, ‘‘Some Books Carried by Lewis and Clark,’’ Bulletin of the Missouri Historical Society 16 (October 1959): 3–13. 27. Chuinard, Only One Man Died, 121. 28. Donald D. Jackson, ed., Letters of the Lewis and Clark Expedition with Related Documents, 2 vols. (Urbana: University of Illinois Press, 1978), 1:157–61. 29. Lyman Butterfield, ed., Letters of Benjamin Rush (Philadelphia: American Philosophical Society, 1951), 981–82. 30. Charles B. Greifenstein, Curator of Archives and Manuscripts, College of Physicians of Philadelphia, and Gretchen Worden, Director, The Mütter Museum, Philadelphia, personal communication, 2003. 3. the famous shopping list 1. National Archives Record Group 92, Entry 225, Box 56a. 2. Much of this chapter is based on W. A. Newman Dorland’s The American Illustrated Medical Dictionary, 22nd ed. (Philadelphia: W. B. Saunders, 1951), with assistance from Guy Hasegawa, Pharm.D. 4. indian medicine 1. Vogel, American Indian Medicine, 38. 2. Vogel, American Indian Medicine, 39. 3. Vogel, American Indian Medicine, 51. 4. Vogel, American Indian Medicine, 212. 5. Vogel, American Indian Medicine, 289.

106 Notes to Pages 50–63 6. Vogel, American Indian Medicine, 379. 7. Vogel, American Indian Medicine, 279. 8. Vogel, American Indian Medicine, 377. 9. Vogel, American Indian Medicine, 382. 10. Vogel, American Indian Medicine, 390. 11. Vogel, American Indian Medicine, 352. 12. Vogel, American Indian Medicine, 280. 13. Everett C. Rhoades, personal communication, 2004. 14. Vogel, American Indian Medicine, 130–38. 5. the voyagers speak 1. Paul R. Cutright, A History of the Lewis and Clark Journals (Norman: University of Oklahoma Press, 1976). 2. Raymond D. Burroughs, The Natural History of the Lewis and Clark Expedition (East Lansing: Michigan State University Press, 1961); Paul R. Cutright, Lewis and Clark: Pioneering Naturalists (Urbana: University of Illinois Press, 1989). 3. Gary E. Moulton, ed., The Definitive Journals of Lewis and Clark, vols. 2–8 (Lincoln ne: Bison Books, 2002), 3:116, 121. 4. Moulton, Definitive Journals, 3:163. 5. Jackson, Letters, 2:503. 6. Jackson, Letters, 2:537. 7. Moulton, Definitive Journals, 3:175. 8. Moulton, Definitive Journals, 3:233. 9. Moulton, Definitive Journals, 3:239. 10. Moulton, Definitive Journals, 3:255. 11. Jackson, Letters, 2:538. 12. Moulton, Definitive Journals, 3:268. 13. Jackson, Letters, 2:532. 14. Jackson, Letters, 2:531. 15. Robert L. Dickinson, Human Sex Anatomy (Baltimore: Williams and Wilkins, 1949), fig. 77.

107 Notes to Pages 63–72 16. Clellan S. Ford and Frank Beach, Patterns of Sexual Behavior (New York: Harper and Brothers, 1951), 176. 17. Moulton, Definitive Journals, 3:273. 18. Moulton, Definitive Journals, 3:277. 19. Moulton, Definitive Journals, 3:322. 20. Moulton, Definitive Journals, 3:324. 21. Jackson, Letters, 2:506. 22. Jackson, Letters, 2:521. 23. Carol Lynn MacGregor, ed., The Journals of Patrick Gass (Missoula mt: Mountain, 1997), 85. 24. Alice B. Kehoe, ‘‘The Function of Ceremonial Sexual Intercourse among the Northern Plains Indians,’’ Plains Anthropologist 15 (1970): 99– 103. 25. Moulton, Definitive Journals, 4:276. 26. Moulton, Definitive Journals, 4:297. 27. Moulton, Definitive Journals, 4:299. 28. Thomas P. Lowry, Hyperventilation and Hysteria (Springfield il: Charles C. Thomas, 1967), 25–28. 29. Moulton, Definitive Journals, 4:301. 30. Moulton, Definitive Journals, 4:303. 31. Moulton, Definitive Journals, 4:309. 32. Moulton, Definitive Journals, 5:109. 33. Moulton, Definitive Journals, 5:118. 34. Moulton, Definitive Journals, 5:121. 35. Moulton, Definitive Journals, 5:121. 36. Moulton, Definitive Journals, 5:122. 37. Moulton, Definitive Journals, 5:120. 38. Moulton, Definitive Journals, 5:215; Stephen E. Ambrose, Undaunted Courage (New York: Touchstone, 1996), 295. 39. James P. Ronda, Lewis and Clark among the Indians (Lincoln: University of Nebraska Press, 1984), 159. 40. Moulton, Definitive Journals, 5:289.

108 Notes to Pages 73–80 41. Rick Rubin, Naked against the Rain: The People of the Lower Columbia River, 1770–1830 (Portland: Far Shore, 1999). 42. Moulton, Definitive Journals, 5:367. 43. Moulton, Definitive Journals, 6:32. 44. Moulton, Definitive Journals, 6:30. 45. Moulton, Definitive Journals, 6:65. 46. Moulton, Definitive Journals, 6:73. 47. Moulton, Definitive Journals, 6:136. 48. Jackson, Letters, 2:503. 49. Moulton, Definitive Journals, 6:142. 50. Moulton, Definitive Journals, 6:239. 51. Moulton, Definitive Journals, 6:239. 52. Moulton, Definitive Journals, 6:330. 53. Moulton, Definitive Journals, 6:391. 54. Moulton, Definitive Journals, 8:79. 55. Moulton, Definitive Journals, 6:144. 56. Moulton, Definitive Journals, 6:434. 57. Moulton, Definitive Journals, 6:435. 58. Moulton, Definitive Journals, 6:190. 59. MacGregor, Gass, 169. 60. Moulton, Definitive Journals, 6:416. 61. Moulton, Definitive Journals, 6:418. 62. Moulton, Definitive Journals, 6:418. 63. Moulton, Definitive Journals, 7:206. 64. The imprecision of Lewis’s grammatical construction would distress most English teachers: ‘‘In common with other savage nations of America they extract their beards but the men do not uniformly extract the hair below.This is more particularly confined to the females’’ (ibid., 252). Did Lewis mean that the Nez Perce women plucked out their pubic hair or left it undisturbed? 65. MacGregor, Gass, 170. 66. MacGregor, Gass, 171.

109 Notes to Pages 80–96 67. The Orderly Report, October 2002, 3. 68. Rudolph Kampmeier, ‘‘Venereal Disease in the United States Army,’’ Sexually Transmitted Diseases 9 (April 1982): 100–110. 69. Michael P. Musick, personal communication, 2003. 70. Mary C. Gillett, The Army Medical Department, 1818–1865 Washington dc: Center of Military History, 1987), 3–25. 71. Karen Carver, Senior Statistician, Patient Care Statistics Team, Indian Health Services, personal communication, 2003. 72. Larry C. Blackwood, ‘‘Repeated Infections with Neisseria Gonorrhoeae in a Population of Alaska Natives,’’ Sexually Transmitted Diseases 9 (April 1982): 89–92. 6. aftermath 1. Quétel, History of Syphilis, 164. 2. Hayden, Pox, 229. 3. Lowry, Story Soldiers Wouldn’t Tell, 105. 4. Jackson, Letters, 2:373. 5. Charles G. Clarke, The Men of the Lewis and Clark Expedition (Lincoln ne: Bison Books, 2002), 237. 6. Ambrose, Undaunted Courage, 160. 7. Ella E. Clark and Margot Edmonds, Sacagawea of the Lewis and Clark Expedition (Berkeley: University of California Press, 1979). 8. Landon Y. Jones, ‘‘Iron Will,’’ Smithsonian, August 2002, 106–8. 9. James J. Holmberg, ed., Dear Brother: Letters of William Clark to Jonathan Clark (New Haven: Yale University Press, 2002), 207–32. 10. Elliott Coues, The History of the Lewis and Clark Expedition, vol. 1 (New York: Francis Harper, 1893), xliv–xlvi. 11. David L. Chandler, The Jefferson Conspiracies (New York: William Morrow, 1994), 278–301. 12. Coues, History, xlv. 13. Ambrose, Undaunted Courage, 21.

110 Notes to Pages 96–100 14. Ambrose, Undaunted Courage, 63. 15. Ambrose, Undaunted Courage, 440. 16. Holmberg, Dear Brother, 210. 17. Ambrose, Undaunted Courage, 476. 18. Mark E. Lender and James K. Martin, Drinking in America (New York: Free Press, 1982), 196. 19. Ambrose, Undaunted Courage, 31, 436, 460, 471. 20. Reimert T. Ravenholt, ‘‘TriumphThen Despair: TheTragic Death of Meriwether Lewis,’’ Epidemiology 5 (May 1994): 366–79.

Bibliography

Ambrose, Stephen E. Undaunted Courage. New York: Touchstone Books, 1996. Beers, Mark H., ed. The Merck Manual. Whitehouse Station nj: Merck Research Books, 1999. Blackwood, Larry G. ‘‘Repeated Infections with Neisseria Gonorrhoeae in a Population of Alaska Natives.’’ Sexually Transmitted Diseases 9 (April 1982): 89–92. Burroughs, Raymond D. The Natural History of the Lewis and Clark Expedition. East Lansing: Michigan State University Press, 1961. Butterfield, Lyman, ed. Letters of Benjamin Rush. Philadelphia: American Philosophical Society, 1951. Carver, Jonathan. Travels through the Interior Parts of North America. Dublin, 1779. Chandler, David L. The Jefferson Conspiracies. New York: William Morrow, 1994. Chuinard, E. G. Only One Man Died. Fairfield wa: Ye Galleon Press, 1999. Clark, Ella E., and Margot Edmonds. Sacagawea of the Lewis and Clark Expedition. Berkeley: University of California Press, 1979. Clarke, Charles G. The Men of the Lewis and Clark Expedition. Lincoln ne: Bison Books, 2002. Coues, Elliott. The History of the Lewis and Clark Expedition. 4 vols. New York: Francis Harper, 1893. Crawford, Alana. Unwise Passions. New York: Simon and Schuster, 2000. Cutright, Paul R. A History of the Lewis and Clark Journals. Norman: University of Oklahoma Press, 1976. 111

112 Bibliography . Lewis and Clark: Pioneering Naturalists. Urbana: University of Illinois Press, 1989. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington dc: American Psychiatric Association, 1994. Dickinson, Robert L. Human Sex Anatomy. Baltimore: Williams and Wilkins, 1949. Dorland,W. A. Newman. The American Illustrated Medical Dictionary. 22nd ed. Philadelphia: W. B. Saunders, 1951. Ford, Clellan S., and Frank A. Beach. Patterns of Sexual Behavior. NewYork: Harper and Brothers, 1951. Gass, Patrick. The Journals of Patrick Gass. Ed. Carol Lynn MacGregor. Missoula mt: Mountain Press, 1997. Gillett, Mary C. The Army Medical Department, 1818–1865. Washington dc: Center of Military History, 1987. Godbeer, Richard. Sexual Revolution in Early America. Baltimore: Johns Hopkins University Press, 2002. Guelzo, Allen C. Abraham Lincoln: Redeemer President. Grand Rapids mi: Eerdmans, 1999. Hayden, Deborah. Pox: Genius, Madness, and the Mysteries of Syphilis. New York: Basic Books, 2003. Holmberg, James J., ed. Dear Brother: Letters of William Clark to Jonathan Clark. New Haven: Yale University Press, 2002. Jackson, Donald D. ‘‘Some Books Carried by Lewis and Clark.’’ Bulletin of the Missouri Historical Society 16 (October 1959): 3–13. , ed. Letters of the Lewis and Clark Expedition with Related Documents. 2 vols. Urbana: University of Illinois Press, 1978. Jones, Landon Y. ‘‘Iron Will.’’ Smithsonian Magazine, August 2002, 106–8. Kehoe, Alice B. ‘‘The Function of Ceremonial Sexual Intercourse among the Northern Plains Indians.’’ Plains Anthropologist 15 (1970): 99–103. Lender, Mark, and James K. Martin. Drinking in America. New York: Free Press, 1982.

113 Bibliography Lowry, Thomas P. The Story the Solders Wouldn’t Tell: Sex in the Civil War. Mechanicsburg pa: Stackpole Books, 1994. . Hyperventilation and Hysteria. Springfield il: Charles C. Thomas, 1967. Moulton, Gary E., ed. The Definitive Journals of Lewis and Clark. Vols. 2–8. Lincoln ne: Bison Books, 2002. The Orderly Report, October 2002, 3. Ortner, Donald J. Identification of Pathological Conditions in Human Skeletal Remains. New York: Academic Press, 2003. Quétel, Claude. The History of Syphilis. Baltimore: Johns Hopkins University Press, 1990. Ravenholt, Reimert T. ‘‘Triumph Then Despair: The Tragic Death of Meriwether Lewis.’’ Epidemiology 5 (May 1994): 366–79. Ronda, James P. Lewis and Clark among the Indians. Lincoln: University of Nebraska Press, 1984. Roscoe, Will. Changing Ones: Third and Fourth Genders in Native North America. New York: St. Martin’s Griffin, 1998. Rothschild, Bruce M., Fernando Luna Calderson, Alfredo Coppa, and Christine Rothschild. ‘‘First European Exposure to Syphilis: The Dominican Republic at the Time of Columbian Contact.’’ Clinical Infectious Diseases 31 (October 2000): 936–41. Rubin, Rick. Naked against the Rain: The People of the Lower Columbia River, 1770–1830. Portland: Far Shore Press, 1999. Ruby, Robert H., and John A. Brown. The Chinook Indians. Norman: University of Oklahoma Press, 1976. Sturtevant, William C., ed. Handbook of North American Indians. 17 vols. Washington dc: Smithsonian Institution, 1988. Thornton, Bruce S. Eros: The Myth of Ancient Greek Sexuality. Boulder co: Westview Press, 1997. Thwaites, Reuben G., ed. The Original Journals of the Lewis and Clark Expedition. 8 vols. New York: Dodd, Mead, 1905.

114 Bibliography Van Swieten, Gerhard. An Account of the Most Common Diseases Incident to Armies, with Method of Cure. Philadelphia: R. Bell Press, 1776. Vogel, Virgil J. American Indian Medicine. Norman: University of Oklahoma Press, 1970. Williams, Walter L. The Spirit and the Flesh: Sexual Diversity in American Indian Culture. Boston: Beacon Press, 1992.

Index

alcoholism, 97–98 Arikara Indians, 58, 64, 82 army hospitals, venereal diseases in, 83–84 attitudes toward venereal diseases, 1–2, 16–17 balsam fir, 51 bayberry tree (Myrica cerifera), 50 bearberry (Arctostaphylus uva ursi), 51 Biddle, Nicholas, 55–56, 58, 62–64, 90 bipolar disorder, 95–97 blue cardinal flower (Lobelia syphilitica), 47, 49, 50, 76 Boley, John, 88 books taken on the expedition, 31–32 Bratton, William E., 88 Buffalo Dance, 62–63, 82 button snakeroot (Liatris psychostachia), 49 calomel (mercurous chloride), 27, 31, 33, 45, 80 Cameahwait, 69 Carver, Jonathan, 29 Charbonneau, Toussaint, 68, 70, 81, 92 China root (Smilax tamnoides), 49, 51 Chinook Indians: early contact with Europeans, 73; sexual practices of, 74–75, 76, 78, 82; and venereal disease, 82

Clark, William, life after expedition, 93 Clatsop Indians, 75–78; sexual practices of, 78, 82 clothing, Indian women, 72, 73, 77–78, 80 Collins, John, 88 Colter, John, 81, 88 Columbus, Christopher, 15, 20–23 Copaiba, 44–45 Coues, Elliott, 56 Cruzatte, Peter, 88 Dame, John, 88 deism, 2–3 Drouillard, George, 88–89 Field, Joseph, 89 Field, Reuben, 89 Flathead (Salish) Indians, 71, 80 Floyd, Charles, 55, 57, 87 Fort Clatsop, 75–79, 80, 82 Frazer, Robert, 55, 89 Gass, Patrick, 55, 57, 58, 64, 66, 78, 80, 81–82, 87 Gibson, George, 76, 86–87 goldenseal (Hydrastis canadensis), 52 gonorrhea: remedies for, 6, 44–45; remedies for, non-Native, 51–52; symptoms of, 5–6, 79

115

116 Index Goodrich, Silas, 76–77, 86–87 Griner, Robert and Priscilla, 94 guaiac, 24–25, 49 Hall, Hugh, 89 hardhack (Spiraea tomentosa), 52 Hidatsa Indians: 60, 64, 66; and venereal disease, 82 Howard, Thomas P., 89 humors, medical theory of, 42–43 Indian pinkroot (Spigelia marilandica), 48 Indian snakeroot (Artistolochia serpentaria), 49

Neely, James, 94 Newman, John, 89 Nez Perce Indians, 64, 70–71, 72, 79; menstrual customs of, 79; and venereal disease, 64, 82 Ordway, John, 55, 57, 61, 87 Peale, Charles Wilson, 86 Pernier, John, 94 Pomp (Sacagawea’s son), 68, 81 Potts, John, 89–90 prickly ash (Zanthoxylum americana), 51 Pryor, Nathaniel H., 87 Queen’s root (Stillingia sylvatica), 49

Jefferson, Thomas, 2–3, 30–31, 86, 94, 96 Labiche, François, 89 L’Affecteur, Denys Boyveau, 28 Lewis, Meriwether: death, circumstances surrounding, 93–95; death, possible causes of, xiii, xv, 95– 101; life after expedition, 93–101; medical knowledge of, 32 Lobelia. See blue cardinal flower manaca (Brunsfelsia hopeana), 50 Mandan Indians, 59–66, 81, 82; and venereal disease, 63–64 Marias River (Montana), 80 McNeal, Hugh, 6–7, 86–87 medical instruments, 43–44 medicines, list of, 35–42 mercury, as treatment, 25–27, 28, 33, 45, 77, 80 milkweed and silkweed (Asclepius), 50 Moulton, Gary (Lewis and Clark scholar), 57

red cedar (Juniperus virginiana), 49 Reed, Moses, 90 remedies, for non-venereal diseases, 47–49 remedies, Native, 52–53 Robertson, John, 90 Rush, Dr. Benjamin, 32, 33–34, 45 Rush’s Bilious Pills, 42, 45, 80 Russell, Gilbert C., 93, 94, 97 Sacagawea, 81, 92; health of, 66–69 Sanicula marilandia (Spigelia), 49 sassafras (Sassafras officinalis), 48–49 Seneca snakeroot (Polygala senega), 48 sexually transmitted diseases: causes of, 4 Shannon, George, 90 Shields, John, 90 Shoshone Indians, 64, 67, 69, 70; sexual practices of, 70, 82; and treatment for venereal disease, 70–71, 82 Sioux Indians, 58 sumach (Rhus glabra), 51

117 Index sweetgum tree (Liquidambar styraciflua), 50 syphilis: existence among North American Indians, 23–24, 29; first European appearance of, 17–20; geographic origins of, 17–24; nonNative remedies for, 12, 24, 28, 30, 45, 97; remedies for, Native, 49–50; symptoms of, 7–12, 79, 85, 99 tetters and morphews, 8, 50–51 thistle root (Cirsium undulatum), 51 Thompson, John B., 90 Thwaites, Reuben G., 56 tobacco, 51 tulip tree (Liriodendron tulipifera), 49 turpentine, 51 Tuttle, Ebenezer, 90

Veronica virginiana, 49 Walla Walla Indians, 79 Warfington, Richard, 90 Weiser, Peter, 90 Werner, William, 91 White, Isaac, 91 Whitehouse, Joseph, 55, 57, 91 white pine tar, 51 wild geranium (Geranium maculatum), 51 wild ipecac (Euphorbia ipecacuanha), 52 Willard, Hamilton, 91 Windsor, Richard, 91 Yerba santa (Eriodictyon californicum), 50 York, xiv, 58, 61, 91