Wilderness Medicine

Today we are at Travelers’ Rest, which was the Lewis and Clark Expedition’s campground, of early September 1805 and early July 1806. My name is David Peck. I am a practicing physician in San Diego, and I am the author of Or Perish in the Attempt: Wilderness Medicine in the Lewis and Clark Expedition.

This is a great site, not only for its historic value as a campsite, but it’s very interesting that they have recently established that there is a high level of mercury in the ground here, in an area where they believe that the latrine for the corps was located. This is an interesting aspect of the medical practice of Meriwether Lewis and William Clark, and the medical practice at that time in America. The reason for the high incidence of mercury in the ground was that one of the very popular medications that the Corps of Discovery was using at that time, and being administered by “doctors” Lewis and Clark, were the Bilious Pills of Dr. Rush. Dr. Rush’s pills included a mercury compound called calomel, which is mercurous chloride. It is a mercury salt. It was administered in combination with powdered jalap, which is a Mexican morning glory root. These were very, very powerful cathartics, or laxatives, and these were used to treat all types of different illnesses.

Now, this form of mercury, the mercurous chloride, is very poorly absorbed from the intestine. Probably only 15 percent of the amount that is taken orally would have been actually absorbed into the body, the rest would pass through the intestinal tract and out. In fact that is one of the main reasons this was administered, because of its potent irritation to the intestine and producing a laxative effect. So consequently, when these men would take these Bilious Pills of Dr. Rush, for a variety of reasons, ultimately most of it would pass out in their bowel movements and then it produces this high quantity of mercury that is still found in this latrine area of Travelers’ Rest.

The Lewis and Clark Expedition . . . in the medical bag that they took along on the expedition . . . interestingly enough, took along fifty dozen of Dr. Rush’s Bilious Pills. I think that is evidence that they used them for a variety of different illnesses. Captain Clark even took five, which is a potentially fatal dose, near the three forks, for what Dr. Ron Loge of Dillon, Montana believes was the first case of Colorado tick fever.

Treating Syphilis

The accepted treatment at that time, during Lewis and Clark, and really throughout the world, for the disease of syphilis, was mercury. It was administered both orally in the form of calomel, which was again an ingredient in Dr. Rush’s Bilious Pills, and it was also applied topically onto the skin. The mercury would be absorbed through the skin and would treat the syphilis.

Now, for a brief explanation of how the mercury would work in the treatment of syphilis we have to go to the field of biology. In order to understand the action of the medicinal mercury we have to take a look at some of the basic properties of all living things, human beings and bacteria as well. Now, of course, syphilis is caused by a bacteria called treponema pallidum,^[1]Pronounced tre-po-NEE-ma PAL-i-dum. It means “pale turning [wiggling] thread,” which describes the wormlike bacterial organism, or spirochete, as seen under a microscope. and this little bacteria has to carry on life processes just like we do. The key life molecules that allow these processes to occur and allow us to live, as well as the bacteria, often times are catalyzed by chemical reactions caused by small proteins within our body that we call enzymes.

Enzymes are made from small molecules called amino acids. There are 21 different types of amino acids. They are assembled within the body, not only ourselves, but also the bacteria, in chains. Each one of these little rings would represent an amino acid and as we put them together and form small chains like this, soon the body or bacteria can put them together in quite long chains containing hundreds, even thousands of amino acids in length. Now, these things allow us to live and allow the treponema syphilitic bacteria to live as well. These are very complex organic molecules and they have their ability to do their work, not only because they are long chains, but they also link to each other in very interesting three-dimensional ways. This can come over and link with this, this portion of the chain can come up and link with another portion of the chain. It’s very precise how this happens. In order for this enzyme to do its work within the body it has to assume this three-dimensional shape.

Now, the way that mercury would work is, once a patient or victim came down with the signs of syphilis, Lewis and Clark would start to administer the oral or the topical mercury ointment. The mercury would be absorbed into to the body, and what mercury does is, it attacks chemical bonds in enzymes, specifically sulfur bonds within the enzyme. What happens is, the mercury actually comes in and attacks a bond where these chains are held together and causes it to break apart. So this three-dimensional shape of this enzyme, which was necessary for the life processes, not only of the human patient, but also the bacteria . . . this enzyme is no longer able to do its work. Consequently the bacteria dies. Also, this is responsible for the ugly side-effects that mercury had with the patients that it was administered to.^[2]Mercury poisoning through ingestion, inhalation, or absorption through the skin may range from asthma and hives, to weakening of muscles, loss of vision, kidney damage, paralysis, and death. It also … Continue reading

Mercury’s Side Effects

Oftentimes the mercury would be applied for a period of two to three weeks, until the patient would start to salivate excessively. Now, that was in part a poisoning action of some of this mercury that it had on these enzymes. For instance, a side effect of mercury poisoning is that the patient would slough oral tissue. This is a result of the mercury attacking the protein structure within our own body causing it to break down, causing some very ugly side effects. So, you can see that the treatment of mercury for syphilis was potentially curative because it could kill the bacteria by inactivating the enzymes and the protein within the bacteria, but at the same time it also attacks the protein structures within the human body. It is a very sharp double-edged sword. It kills the bacteria, but it also, unfortunately, does a great deal of harm to the patient.

Now, as I mentioned in my book, the side effect of salivation which occurred with mercury treatment for syphilis . . . Medical science in 1804 to 1806 believed that that was a sign that the patient’s body was expelling what they called a contagion. Or that whatever it was . . . they didn’t know at that time it was a bacteria . . . whatever it was that was causing the disease of syphilis, was being expelled, thereby producing these symptoms of salivation within the patient.

At that time they did not understand microbiology, they did not understand that syphilis was caused by a bacteria. It was over 60 years before medical science developed the germ theory of disease under the influence of Koch^[3]Robert Koch (1843-1910) was a German physician, and one of the founders of the science of bacteriology. In 1876 he discovered the anthrax disease cycle, in 1882 the bacteria producing tuberculosis, … Continue reading and Pasteur^[4]Louis Pasteur (1822-1895), was the French chemist and microbiologist who proved that diseases are caused by microorganisms. His major discoveries began as efforts to assist industries, such as the … Continue reading in Europe.

Bloodletting

Now, at that time in medical science there was believed to be contagion, which were things that could be caught from another person, and there were other diseases which were deemed to be not contagious. The treatments at that time for disease included sweating, which could be induced by various medications, or urination or diuresis produced by things like saltpeter. They also could blister a patient by applying ground up blister beetles onto their skin, which would produce blisters. They thought at that time that would relieve congested internal organs, which they had no idea of how they functioned in most cases. One of the very popular treatments at that time was bloodletting.

Now, bloodletting had been practiced for centuries, in fact, since ancient times. But, Dr. Benjamin Rush, who was the leading physician in America, had given a new justification for the practice. In the 1700’s the leading medical people of the world had made some elementary discoveries of the human nervous system. One of the leading men of the time was a medical professor at the University of Edinburgh, Scotland, named William Cullen. William Cullen believed that life consisted in what he called a “state of nervous excitement,” and that disease was a result of spasms of the nervous system. His protege, Dr. John Brown, developed a corollary to that theory. He stated that disease was either insufficient or excessive nervous excitation. His treatments were designed to correct those excesses or deficiencies. His two favorite drugs, in fact, were opium and alcohol. Unfortunately, John Brown died at the age of 53, a hopeless opium addict and alcoholic.

Benjamin Rush, in the early 1790’s developed his very own theory of disease. He took the teachings of Cullen and Brown and added to them his own bent on disease. He believed that the nervous system had a tremendous influence on disease, but, he believed that the nervous system excited the circulatory system and put it into a state of spasm which he called hypertension, which is our modern day word for high blood pressure. Rush believed that this was the cause of most illness. It didn’t matter what it was. It could be insanity or all the various fevers that existed at that time. But Rush believed that in order to successfully treat disease, some of that irritating substance within the blood vessels had to be removed, and of course that would be blood. So what he would do is, he would make an incision in a vein with a blade called a lancet, and remove a prescribed amount of blood that he thought was proper. His determination would be by feeling the patient’s pulse and also the pre-existing disease. He would often bleed his patients more than once a day. He would remove up to what he called four-fifths of a body’s blood in a series of bloodlettings. His proof that his bloodletting was working was that a patient who received this treatment would relax. In fact, he had a great quote, that said; “hemorrhages seldom occur where bleeding has been sufficiently copious.” If you bleed a patient out and there is no blood left, of course there is nothing left to hemorrhage. So, Benjamin Rush became an avid and aggressive blood-letter for a variety of reasons. Bloodletting continued in the United States almost up to the time of the Civil War, probably largely under the influence of Dr. Benjamin Rush.

The Captains’ Medical Training

Some people have stated that the Lewis and Clark Expedition would have been better off if they had taken a trained physician along to care for the numerous problems that they encountered.^[5]When Lewis stopped at Wheeling, West Virginia, on 8 September 1803, en route down the Ohio River with his military barge (called the ‘boat’ or ‘barge’ but never the … Continue reading I totally disagree. I think that the common sense that Lewis and Clark had as untrained physicians, given the treatments that they had which were woefully inadequate, I think actually produced better results maybe than a trained physician would have. I think a trained physician would have been overly confident and possibly would have been much more aggressive in their treatment of illnesses, often times to the detriment of the patient.

At least until the 1600-1700’s, there was a real distinction between physicians and surgeons. Surgeons were involved more in the actual manual application of medical practice. They treated gun wounds (gunshots), they treated abscesses—they treated tooth abscesses by pulling teeth. They were the ones that were responsible for doing human dissections. The physician was more the learned man who made mental decisions about treatment of diseases and didn’t ever get his hands dirty. But, in America there was some real differences, there was more of a combining of the two practices between physician and surgeon than there had been historically in Europe.

On 4 July 1804, Private Joseph Field was bitten on the ankle by what was probably a prairie rattlesnake. Rattlesnake, interestingly enough, have the ability to vary the amount of venom that they inject into their victims. This bite, for Joseph Field, was probably what we call a minimal envenomation bite. His symptoms were very slight, he probably had some bruising, pain, swelling of the ankle and foot. Lewis treated this with a topical application of Peruvian bark, which was the medicine that was actually effective against the signs of malaria, but probably totally ineffective for the treatment of a rattlesnake bite. But rattlesnake venom contains about five to fifteen different enzymes . . . these long chains of amino acids again. Some of these enzymes actually start to digest the victim. The walls of blood cells are damaged, they start to leak fluid into the tissue which results in swelling of the tissues . . . in Private Field’s case the swelling of his foot and ankle. These bites can be very serious. It is entirely possible . . . another case of extremely good luck for the Corps of Discovery . . . that Private Field didn’t suffer a severe envenomation, which probably would have resulted in his death on that 4th of July in 1804, in present day Kansas.

The rattlesnake that bit Private Joseph Field was probably a prairie rattlesnake. And when you look at the number of species of rattlesnake that live in the United States presently, the venom potency of that particular rattlesnake probably falls in the mid-range between very potent rattlesnake venom and the least potent rattlesnake venom.

Now, the rattlesnake story comes up again when at Fort Mandan during the winter of 1804-1805. Meriwether Lewis was called to aid in the delivery of a baby, the son of Sacagawea. When Lewis arrived at the delivery he probably wasn’t entirely sure of what to do because she was having a difficult delivery.

One of the French fur trappers in the area suggested a folk remedy that he said he had never seen fail to bring about the desired effect. Two rings of the rattlesnake rattle were broken up and given to Sacagawea with some water, and within ten minutes she delivered her baby boy, Jean Baptiste Charbonneau. That is a great story, but I don’t think that the rattlesnake rattle had anything to do with the stimulation of the uterus to contract, because rattlesnake rattles are made out of keratin,^[6]Keratin is the insoluble protein substance of which hair, nails, horns and hooves—as well as rattlesnake rattles—are made. and there is nothing there that would produce smooth muscle contraction.

The treatment that Meriwether Lewis employed for this rattlesnake bite with Private Field is very interesting . . . the topical application of Peruvian bark. Peruvian bark originally came to Europe about two hundred years prior to this, with the discovery by a Jesuit missionary in South America that the bark was effective against malaria. It actually contains quinine, which is effective against malaria; it’s not effective against rattlesnake bites. Modern day treatment for rattlesnake bites is produced by administering the victim what we call antivenin. This is a series of antibody shots that are administered to the victim, and these antibodies will interact with the enzymes that are active in the rattlesnake venom in terms of producing the illness symptoms: the oral numbness, the tongue tingling, the pain and the swelling and other severe signs and symptoms produced by rattlesnake venom.