Rush and the Expedition

In 1803, Meriwether Lewis came to Philadelphia to receive scientific training. Thomas Jefferson, who besides being President of the United States was also President of the APS, had written to Rush, fellow APS member and as well as personal correspondent, saying that it would be “very useful to state for [Lewis] those objects on which it is most desirable he should bring us information” and asking Rush “to prepare some notes of such particulars as may occur in [Lewis’s] journey & which you think should draw his attention & enquiry.”^[1]Jefferson to Rush, 28 February 1803. In Donald Jackson , ed., Letters of the Lewis and Clark Expedition with Related Documents, 1783-1854. 2 vols. Urbana: University of Illinois Press, 1978), 19. Rush responded by preparing a list of questions that Lewis could use to determine the health and religious practices of Native Americans. Rush also prepared a list of health rules that Lewis could use to preserve the health of his men.

Letters and other documentation contain evidence of only one meeting between Rush and Lewis: 17 May 1803. Disappointingly for the historian, besides the lists of questions and health rules, a few brief comments in letters, and a note on a list of medical supplies that says 50 dozen Bilious Pills were obtained “to Order of B. Rush,”^[2]Jackson, Letters, 80. no documentary evidence exists about how other many times Rush and Lewis might have met or what specifically they discussed.

Jefferson’s Contrary Views

Jefferson, long acquainted with Rush, knew his merits, his interests, and his politics (Rush supported Jefferson), and deemed a trip to Rush useful for Lewis’s preparation. In one sense, however, it was out of character for Jefferson to send Lewis to Rush. Jefferson objected to the highly theoretical medicine of his time. Jefferson believed that medicine—indeed, all scientific endeavor—should have at its heart experimentation and observation. Theory should develop from facts rather than facts squeezed to support a theory. Lewis was undoubtedly aware of Jefferson’s belief that science has at its core observation and experimentation, with the aim toward discovering useful knowledge. As Courtney Hall has noted,

Two characteristics of Jefferson’s thinking led him to make some rather sharp criticisms of the medical thought of his time. The first of these mental traits was his firm belief in observation and experiment as sine qua non for any scientific inquiry. . . . Another firm belief which underlay much of his thinking was in the practical utility of a method or idea as a test of its value. Science should contribute to human welfare to be worthy of the thought of men, he once said.^[3]Courtney R. Hall, “Jefferson on the Medical Theory and Practice of His Day,” Bulletin of the History of Medicine, vol. “I (1957), no. 3, 239. Jefferson’s attitude toward … Continue reading

Jefferson made his thoughts about contemporary medicine explicit in a letter to Caspar Wistar, another of Lewis’s Philadelphia mentors, with whom he discussed fossils and mastodons. Wistar, author of the first American textbook on anatomy, was at one time a friend of Rush’s, but they had a falling out when Wistar “deserted” Rush by not enthusiastically endorsing Rush’s heroic bleeding and purging regime during the epidemic of 1793.^[4]J. H. Powell, Bring Out Your Dead: The Great Plague of Yellow Fever in Philadelphia in 1793 (New York: Time, 1965), 217-19. Jefferson wrote Wistar that he agreed that current treatments have some utility—bowel diseases being relieved by purgatives, inflammation by bleeding, syphilis with mercury, for instance—but “symptoms are so infinitely diversified” that it is difficult to establish they are for a specific disease. Jefferson goes on to say:

Having been so often a witness to the salutary efforts which nature makes to reestablish the disordered functions, [the physician] should rather trust to their action, than hazard the interruption of that, and a greater derangement of the system, by conjectural experiments on a machine so complicated & so unknown as the human body, & a subject so sacred as human life. Or, if the appearance of doing something be necessary to keep alive the hope & spirits of the patient, it should be of the most innocent character. . . . But the adventurous physician goes on, & substitutes presumption for knoledge. From the scanty field of what is known, he launches into the boundless region of what is unknown. He establishes for his guide some fanciful theory of corpuscular attraction, of chemical agency, of mechanical powers, of stimuli, of irritability & repletion by mercury, or some ingenious dream, which lets him into all nature’s secrets at short hand. On the principle which he thus assumes, he forms his table of nosology, arrays his diseases into families, and extends his curative treatment, by analogy, to all the cases he had thus arbitrarily marshalled together. I have lived myself to see the disciples of Hoffman, Boerhaave, Stahl, Cullen, Brown, succeed one another like shifting figures of a magic lantern, & their fancies . . . becoming, from their novelty, the vogue of the day, and yielding to the next novelty their ephemeral favor. The patient, treated on the fashionable theory, sometimes gets well in spite of the medicine. The medicine therefore restored him, & the young doctor receives new courage to proceed in his bold experiments on the lives of his fellow creatures. I believe we may safely affirm, that the inexperienced & presumptuous band of medical tyros let loose upon the world, destroys more of human life in one year, than all the Robinhoods, Cartouches, & Macheaths do in a century. It is in this part of medicine that I wish to see reform, and abandonment of hypothesis for sober facts, the first degree of value set on clinical observation, and the lowest on visionary theories.^[5]Jefferson to Wistar, 21 June 1807, in Albert Ellery Bergh, ed., The Writings of Thomas Jefferson, 20 vols. (Washington, D.C.: Thomas Jefferson Memorial Association, 1905), 14:426-28.

The letter is a synopsis of theory of the previous 100 years. Perhaps he left Rush off the list out of kindness to his friend, whom he “greatly loved,” but “who has done much harm, in the sincerest persuasion that he was preserving life and happiness to all around him” with his theories about bleeding and purging.^[6]Jefferson to Thomas Cooper, 7 Oct. 1814. In Paul Leicester Ford, ed., The Works of Thomas Jefferson (New York: Putnam, 1905), 200.

Despite Jefferson’s antipathy toward academic medical theorists, he believed in medicine as a worthwhile pursuit. There was in fact a sacredness to it: the uncovering of the order of a God-created world by studying the human body. For Jefferson as for Rush, a healthy population was the sign of a healthy society.^[7]See George Rosen, “Political Order and Human Health in Jeffersonian Thought,” Bulletin of the History of Medicine, vol. XXVI (1952), no. 1, 32-44.

Questions for Indians

Does any medical theory show up in Rush’s advice to Lewis? The answer is yes, it is possible to infer Rush’s theories as the context of his advice to Lewis. However, the advice itself is not appreciably different from what other physicians might have recommended.

The questions Rush suggested Lewis ask Native Americans (see Rush’s Questions for Indians and Questions for Indians.) about their “Physical history & medicine” suggest Rush’s medical theories. For instance, Rush suggests finding out if any tribes use “artificial discharges of blood,” one of Rush’s basic therapeutic methods. Questions about voluntary fasting, diet, bathing, and food preparation hint at Rush’s concerns about how disease arises (that is, his concern with hygienic habits). One topic Rush covers at some length: how and when to take the pulse and suggesting that the pulse of different age groups be compared. In the questions for Native Americans this is the most direct link to Rush’s medical theory: the pulse was the most important diagnostic indicator. However, one should remember that taking pulse was—and remains today—a basic diagnostic procedure; it is for Rush a matter of emphasis.

The questions about “Morals” have a medical as well as moral component. Rush felt that the “moral faculty” was affected by diseases, both of the mind and body. Vices and the use of intoxicating beverages were predisposing causes of disease.^[8]For Rush’s ideas about mental disease in general see his pioneering work, Medical Inquiries and Observations upon the Diseases of the Mind (Philadelphia: Kimber & Richardson, 1812).

Rush’s Rules of Health

Rush’s rules of health for Lewis and his men are statements of preventive health measures: follow the advice and you will reduce your chances of getting sick. To avoid tediousness I won’t discuss all of Rush’s rules. One should keep in mind, though, that all the rules, in Rush’s system of medicine, address the predisposing causes of disease—that is, what Rush saw as the first step in the development of disease.

Rush pays close attention to the feet. Chilled feet should be washed in alcohol and acclimated to cold by washing them every morning in cold water. Both treatments alleviate cold as a predisposing cause.

Rush says that “the less spirit you use the better,” but goes on to state that three undiluted tablespoonfuls may be taken following getting wet, long exposure to night air, or when fatigue is extreme. Distilled spirits Rush saw as a curse on mankind. However, advocacy of alcohol as a preventive measure shows that Rush could view even demon rum as a potential good when used medicinally and correctly and indicates Rush wasn’t entirely inflexible in his medical and moral advice.

The recommendation of molasses (or sugar), water, and vitriol as a “pleasant & wholesome drink with your meals” shows Rush’s attachment to light foods and drink as good disease preventives. The harmless sweet and sour concoction is a kind of early sports drink.

Rush also advises eating sparingly after extended labors. Rush is warning of overeating when the body is broken down, probably sounder advice in a city than on the frontier and at any rate healthy young men laboring up rivers or crossing mountains all day will have no thought of limiting their food intake, especially with herds of hoofed animals to provide all the meat they can eat.

One interesting rule states that flannel should be worn next to the skin, especially in wet weather. Wool flannel was viewed at the time as an especially effective health measure, keeping warmth in and disease out by its very presence. As Rush himself says, “Flannel shirts worn next to the skin will prevent many diseases. I have known the use of flannel shirts to preserve the health of a whole army. No vermin are bred in it when worn months without washing.”^[9]Quoted in Nathan G. Goodman, Benjamin Rush, Physician and Citizen, 1746-1813 (Philadelphia: University of Pennsylvania Press, 1934), 239.

The first rule is the longest. In its entirety it reads:

When you feel the least indisposition, do not attempt to overcome it by labour or marching. Rest in a horizontal posture. Also fasting and diluting drinks for a day or two will generally prevent an attack of fever. To these preventatives of disease may be added a gentle sweat obtained by warm drinks, or gently opening the bowels by means of one, two or more of the purging pills.^[10]Donald Jackson , ed., Letters of the Lewis and Clark Expedition with Related Documents, 1783-1854. 2 vols. Urbana: University of Illinois Press, 1978), 54-5.

The rule mentions purging as a preventive (two other rules advise purging), a key Rush therapy. As a preventive only “gently opening the bowels” is recommended, although it was likely a subjective judgment how gentle Rush’s powerful Thunderclappers were. Warm drinks induce a sweat—again, a mild treatment. Fasting, resting lying down, and “diluting”—that is, diluted—drinks are other suggested, mild preventives.

All the treatments recommended are presented as mild preventives; there is nothing about Rush’s violent cures. All the recommendations address predisposing causes of disease.

Lewis and Clark’s Medical Practices

Did Lewis and co-captain Clark follow Rush’s health advice, using the recommended preventive measures so well that, as a result, only one man died? For the most part probably not. Feet that spent the whole day in cold streams were not going to be washed with good whiskey and would be kept out of the water as long as possible. Food intake was never limited except by necessity. No one had to advise the men to lie down, but there were plenty of times when they pushed themselves beyond “the least indisposition.”

Purging was used when disease was evident, though also to a degree as a preventive. The captains also practiced bloodletting. These two treatments, so often associated with Rush, who practiced them in extreme form, were basic to medical practice of the 18th century, used by the vast majority of physicians. Thomas Jefferson even believed in their efficacy. But neither Jefferson nor Lewis nor Clark clouded their minds with medical theory.

In the journals is at least one example that shows that Lewis might have had some familiarity with theory, a familiarity he could have picked up from Rush. William Bratton is stricken with a painful back and other symptoms. Lewis notes that his illness “I suppose procedes from dability.”^[11]The Journals of the Lewis & Clark Expedition, ed. Gary E. Moulton (Lincoln: University of Nebraska Press, vol. 6, 1990), 318. Bratton became sick while at the salt works, under the harsh coastal climate and with inadequate shelter doing the hard labor of boiling salt water. “Dability” likely refers to the fact that the conditions and work brought on Bratton’s illness. Rush had warned against excess fatigue and cold; he believed that cold and such activities as lifting heave weight were predisposing causes of disease, causing debility. Lewis’s use of “dability” is probably as close as he gets to theoretical medicine in the journals.

In the same passage, Lewis refers to his treatment of George Gibson. Lewis writes that “Gibson’s fever still continues obstenate tho’ not very high; I gave him a doze of Dr. Rush’s [pills] which in many instances I have found extremely efficatious in fevers which are in any measure cause by the presence of boil.”^[12]Ibid. “Boil” may be “bile,” which would be an oblique reference to the humors. However, what is significant about the passage is that it is an example of clinical history. Lewis is noting his success in the past, something any good physician should do to assist in future treatment.

For what counted for Lewis, Clark, and Jefferson was what worked. What worked (or, given the actual medical value of bleeding and purging, what seemed to work) could easily have been recommended by physicians other than Rush, who may have talked about practical medicine but whose judgment was affected by an adherence to theory and whose extremes of practice were seen as dangerous by many contemporaries. Without the dubious benefit of steeping himself in the latest medical theories, Lewis—and Clark, too—administered treatments as credible as any physician of the time—only one of the many tributes that can be given to the two captains.

Conclusion

Although details are lacking, it is likely that at their first meeting Rush took good measure of Lewis, understood his military and frontier training, and could have learned of Lewis’s knowledge of medicinal herbs, gained under his mother’s tutelage.^[13]Stephen Ambrose, Undaunted Courage: Meriwether Lewis, Thomas Jefferson, and the Opening of the American West (New York: Touchstone, 1997), 90. Rush wrote Jefferson to say that “Mr. Lewis appears admirably qualified” for the Expedition.^[14]Lyman H. Butterfield, ed., Letters of Benjamin Rush. 2 vols. (Princeton: University Press, 1951), Rush to Thomas Jefferson, 11 June 1803. The advice Rush had given Lewis often sounds rather odd or useless by modern standards, and wasn’t followed to the letter by the captains, but it fulfilled Jefferson’s request. Although there is no reference in Rush’s collected letters to the return of Lewis and the Expedition, or of Rush and Lewis meeting again, undoubtedly Rush’s millennial faith in America’s destiny would have been renewed by the heroic success of the Corps of Discovery.