Rush's Health Hints for Lewis
To see the text, point to the image.
American Philosophical Society, Philadelphia
Above is a page from Rush's "commonplace book"—a blank book in which notes, reflections, quotes, or other matters of importance were written down and perhaps organized for easy reference. Rush may have used this page as a reminder during his conversations with Lewis in 1803, or may have given him a clean copy of it. This version of his directions, as printed in Donald Jackson's Letters of the Lewis and Clark Expedition (No. 43, 1:54-55), is believed to be Jefferson's copy of Rush's original. Compare with Appendix Two.
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 (Appendix One) 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.1
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."2
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.3
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.
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."4 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 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."5 "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.
1. 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).
2. Quoted in Nathan G. Goodman, Benjamin Rush, Physician and Citizen, 1746-1813 (Philadelphia: University of Pennsylvania Press, 1934), 239.
3. 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.
4. The Journals of the Lewis & Clark Expedition, ed. Gary E. Moulton (Lincoln: University of Nebraska Press, vol. 6, 1990), 318.
Funded in part by a grant from the National Park Service, Challenge Cost Share Program