In 1893, historian Elliot Coues wrote in his History of the Expedition under the Command of Lewis and Clark that “Jefferson gave you the country; Lewis and Clark gave you the way,” and surely, Lewis and Clark are to be counted among the world’s great explorers.

The country was new and so were 828,000 square miles of the Louisiana Purchase, an acquisition that had literally doubled the size of the United States overnight. Between 1803 and 1806, at the behest of President Thomas Jefferson, U.S. Army officers Meriwether Lewis and William Clark set forth to survey those lands, to tell the Indians of American sovereignty and to find an all-water “northwest passage” to the Pacific Ocean. They were to expand the American empire and the nation’s sense of Manifest Destiny. With their Corps of Discovery, Lewis and Clark ventured into uncharted territory in a way that even moon travelers did not have to.

For 28 months, traversing most of the North American continent and 8,000 miles of treacherous terrain, facing seasonal extremes from blazing sun and blowing sand to rain, hailstorms, punishing winter freezes and snow, 33 people – a small human community – moved by horse, foot, and boat through the lands and lives of other human and animal communities. The men were largely self-reliant, and they did not come unprepared. Yet no matter how carefully chosen the men were for their skills as hunters, blacksmiths, gunsmiths, mapmakers, master boatmen, or fishermen, the success of this long, historic expedition depended utterly on the ability of the men to withstand conditions and stay alive. And stay alive they did. Amazingly, only one man died.

To celebrate the bicentennial anniversary of the Lewis and Clark journey of discovery, the College of Physicians of Philadelphia, founded in 1787, has mounted “Only One Man Died: Medical Adventures on the Lewis and Clark Trail” – the only exhibit in the country devoted to the history of medicine on the trail – a small but revelatory exhibit that will remain in place through 2006.

Also, the Philadelphia chapter of the Lewis and Clark Heritage Trail Foundation, Inc. has compiled an extraordinarily detailed list of 34 Philadelphia suppliers and merchants who equipped the expedition, providing addresses and an accounting of every item purchased and its price. Several institutions in Philadelphia permanently hold primary artifacts associated with the expedition, from the original journals at the American Philosophical Society to the original herbaria collections at the Academy of Natural Sciences, to the original medical artifacts and records associated with Dr. Benjamin Rush.

Like any great exploratory expedition, this one was initiated long before that moment when Meriwether Lewis saddled his horse and belted on his gear and headed out. And if Jefferson’s priority was to find and map a water route across the continent, he also wanted information about the natural sciences, about herbs and about Indian cultures of the new West. To these ends, he personally chose, tutored and mentored Meriwether Lewis to lead the expedition, then sent Lewis on to Philadelphia, the largest city in the United States, to study with Dr. Benjamin Rush and to make the final trail preparations.

The Preparations

What did Lewis, who was an experienced military officer, need to anticipate in clothing and feeding his party? Along with the coats, woolen overalls, stockings, shirts, 48 calico ruffled shirts and 45 flannel shirts with linen collars and wristbands, extra fabric and buttons, there were tomahawks, rifle pouches with powder horns, canisters for gunpowder which, when empty, could be melted for gunshot, and 176 pounds of canister powder. Lewis bought for himself a pair of pocket pistols with secret triggers for $10. Philadelphia watchmaker Thomas Parker sold Lewis a gold chronometer for $250, the most expensive single item purchased for the expedition, and Lewis also purchased 500 brooches and 72 rings from a local goldsmith.

There were tents and lamps, linens and sheeting, grommets, hooks and eyes, ink, wire, awls, vises, chisels, adzes, handsaws, augers, whetstone, and brads. Needles, thimbles, scissors, and beads were toted as presents for the Indians whom Jefferson regarded as valuable potential trading partners. For surveying, there were compasses, quadrants, sextants, chains, and poles. There was fishing tackle, and there were 200 pounds of “portable soup,” plus brass kettles and a tin saucepan, along with 30 gallons of strong wine and six iron-bound kegs. There was salt, and there were 63 pounds of pigtail tobacco, which turned out to be not nearly enough to smoke among themselves, to trade with the Indians, and to use as an element of diplomacy – that is, the sharing of tobacco in a ceremonial smoke. In the end, Meriwether Lewis’ “make ready” ended when his 3,500 pounds of supplies moved out of Philadelphia’s Schuylkill Arsenal gates in a Conestoga wagon on June 10, 1803.

On the medical side, one thing was clear; no physician would accompany the expedition. So Jefferson, who had spent two long years tutoring Lewis in geography, botany, astronomy and ethnology, sent him to Philadelphia, the epicenter of American science and medicine, where Dr. Benjamin Rush, the most prominent of American physicians, was to be Lewis’ tutor.

There was hardly room for the polite conversation of distinguished scientists in drawing rooms. Instead, there were discussions of treatment for ailments from constipation to venereal disease. In the exhibition at The College of Physicians, of which Rush was a founding member, it is made clear that Rush centered his therapies on cathartics and “bleeding,” believing that bleeding specific amounts relieved a “convulsive excitement” in the walls of blood vessels, an “excitement” that was the root of all fevers and disease. Ideas about bleeding and purging have since been discarded, and the exhibition acknowledges that Jefferson, who owned a library of medical books, was suspicious of physicians’ claims to medical authority, finding American medicine more rooted in mythology than science.

photo, Art Danek

Dr. Rush gave Lewis a mini-survival list which included the wearing of flannel in wet weather, prescriptions of purges and “opening pills” for constipation, instructions to steep meat for a day or two in common lye if salt could not be obtained, to eat sparingly when on a long march, to wash the feet with spirits when chilled and every morning in cold water, to consume molasses or sugar water with all meals, and to wear shoes without heels.

For a total of $90.60, Philadelphia druggists Gillaspay and Strong provided the small sets of instruments for bleeding, plus 31 kinds of drugs – from cathartics (laxatives) to emetics to opiates, with a third of the expense for chinchona, or Peruvian bark, to cure fevers and ague (malaria). The drug list included laudanum, nutmeg, clove, cinnamon, gum camphor, ipecacuan, elixir of vitriol, and “50 dozen Bilious Pills to the Order of B. Rush.” Dr. Rush’s preoccupation with bowel health led the men on the expedition to call his “opening pills” Rush’s Thunderbolts, as the combination of calomel and jalap resulted in an explosive cathartic purported to rid the body of any “morbid“ elements in the blood.

Also among their medical supplies were clyster syringes for administering enemas, penis syringes for treating gonorrhea, lancets and a tourniquet used as part of a bleeding procedure, and patent lints for poultices and dressing wounds.

Reality Sets in

Once engaged in the actual journey, physical challenges were greater than anticipated because two of the guiding assumptions were erroneous. One was that a northwest passage was there. It wasn’t. The other assumption was that western mountain ranges were as low as eastern mountain ranges. They weren’t. This meant that everything was harder and took longer than expected, with more opportunity for microbial activity.

Lewis and Clark’s military training, woodsman’s abilities and experience on the frontier, bolstered by the medical expertise of the day, became critical elements in the safe return of all but one member of the expedition. The expeditioners were young, hearty, accustomed to a strenuous life and willing to proceed despite gastrointestinal upsets, painfully infected boils, debilitating fevers, sexually transmitted diseases, and badly cut and injured feet.

This issue of feet was no small matter. The portage over the Great Falls of Missouri, for example, was planned for half a day but took over a month as the men carried and pulled their boats and cargoes more than 25 miles. Unfortunately, the ground had prickly pears and needle grass, both of which pierced the men’s moccasins and leather leggings. Every member’s feet were cut and infected.

Infection also came in the form of boils, which Lewis called “tumors” and treated with “emollient poultices.” The men had a diet which was poor in vegetables, but the probable cause of the rampant boil was simple dirt. These men were in and out of rivers and streams, and the clothing purchased so much earlier in Philadelphia became filthy and rotted on their bodies, giving free rein to boils and carbuncles in every imaginable place.

President Jefferson had asked Lewis to carefully observe Indian medical practices as well as child-rearing styles and religious beliefs. During their journey, Lewis and Clark met with representatives from more than 50 different tribes to learn about their medicines and treatments, and, at the urging of Jefferson, gave smallpox vaccine to the Indians during the first six months; after that, the delicate vaccine lost its potency.

Of particular medical interest was the Indian “sweat hole,” and it is curious to note that in the 21^st century, American medicine is finally taking another look at the value of the sweat lodge. The exhibition at the College of Physicians reconstructs the sweat lodge built by Lewis and Clark where expedition journals report that an Indian would spend 20 minutes, naked, with water to sprinkle and create as much steam as he could bear, in the small, blanketed hole. Then he was plunged twice into cold water and returned to the sweat hole for 45 minutes more. He was then taken out, covered in warm blankets, and allowed to cool gradually. When the sweat hole practice was used for a seriously ill expeditioner, he recovered fully in just two days.

During the journey, there were constant threats to life and limb from grizzly bears, but even such seemingly tiny annoyances as gnats and mosquitoes had the impact of an Egyptian plague. Back in Philadelphia, Lewis had purchased mosquito netting, which helped the men to sleep at night, and a primitive insect repellent which was insufficient defense. Lewis’ Newfoundland dog, Seaman, who generally helped buoy the men’s spirits on the voyage, was driven by summer’s biting insects to “howl with their torture,” and so thick and numerous were the insects that men recorded in their journals that they “get in our throats as we breathe.”

If the summers were bad for health, how much more so were the winters, one in Oregon and one in North Dakota, where Lewis recorded temperatures plunging to 72 degrees below the freezing point. Frostbite didn’t have to wait, however, for such extremes of temperature. Sgt. John Ordway wrote that the men “had to be out on the water for about two hours, the ice running against their legs. Their clothes froze on them. One of them got one of his feet frost bit.” A month later, the journals of both Ordway and Clark report frostbite among members of a hunting party, and in the following days, as Clark led 15 men on a buffalo hunt in sub-zero weather, he reported “frostbite of the toes and of one man’s penis a little.”

On the latter subject, Lewis anticipated that his men would contract sexually transmitted diseases and was prepared. The Indian tribes they encountered were willing to share their women as a gesture of hospitality, and the men were not expected to abstain. Mercury was the standard treatment for syphilis, and the expeditioners were urged to “use the mercury freely” after contact with Chinook women. It was administered either as a salve or a pill, but treatment was stopped when the signs of mercury poisoning – excessive salivation and sore gums – became evident.

The Arrival of Sacagawea

A Shoshone Indian woman, Sacagawea, joined the expedition with her husband, French-Canadian trader Toussaint Charbonneau, in the winter of 1804-5, and to say that she was invaluable is an understatement. She spoke several Indian languages, was able to steer Lewis and Clark to Shoshone trails, to learn from the Shoshone how to cross the Rockies, and to negotiate provisions, tobacco and horses when the expedition ran out of essential supplies. Her presence also reassured Indians that this was not a raiding party.

At Fort Mandan in what is now North Dakota, when the pregnant Sacagawea had a long, difficult labor, Lewis dosed her with a concoction using rattlesnake rattles, and shortly after, she safely delivered the baby. Later, when the baby grew sick on the trail, Lewis administered a dose a cream of tartar and applied a poultice of onions, and the baby improved. Then, when Sacagawea fell ill of a fever, Clark first bled her, but she didn’t improve, so Lewis took over, administering “two doses of barks and opium” plus “diluted nitre” as a diuretic, and Sacagawea recovered. Lewis’ mother had a reputation as an herbal healer, and it is probable that Lewis had learned basic “recipes” from her.

On the subject of recipes, food was a major concern during the expedition, and the group quickly ran out of even the “portable soup“ purchased in Philadelphia. Ideally, for just 24 hours of adequate food supply, the party required four deer, one elk, and one buffalo. The men may have craved meat, but in winter, the men might chase one buffalo in the snow for days and come back to camp empty-handed.

Game was usually scarce, and the party was obliged to live on fish and roots procured from the natives. Lewis said “it was not a suitable diet for us, and fish without salt is insipid.” He reported that the morels he roasted without salt or pepper or grease “taught me the true taste of the morel – an insipid food.” In a notation from 1805, he said, “Provisions all out, which compels us to kill one of our horses to eat and make soup for the sick men.”

The men also ate dog, a favorite food, preferred “over elk and horse in any state,” and they ate burrowing squirrels (prairie dogs), noted as “tender and tasty as the gray squirrel.” One tribe showed them 387 different kinds of fish. Overall, the men expressed a liking for fine trout, buffalo humps, tongues and marrow bones. When there was buffalo, Sacagawea’s husband made them boudin blanc, using buffalo gut, pepper, salt and suet, dusted with flour and fried in bear oil. In leaner times, the party was reduced to eating a kind of bread made from camas root, but Lewis reported that it disagreed with him and, like other roots, “gave the men violent pains in their bowels.”

Most groups of army men, isolated and away from home for long periods of time, are subject to nostalgia, homesickness, melancholy and even despair. But the men of the Lewis and Clark expedition hardly had time for mental illness; they were always in motion, always busy. There was the constant exertion of traveling; there was the hunting, gathering and preparing of all their food, and the mending of their own clothes and shoes. For entertainment, they sang and danced to the music of the fiddle, they played games, and they had athletic and shooting competitions. And with just one exception, all the men returned home, having made history.

James Ronda, author of Lewis and Clark among the Indians, spoke recently at the College of Physicians of Philadelphia and closed his lecture with a nod of thanks to Philadelphia. “The people of Philadelphia did not make the journey,” he said, “ but they made the journey possible.”