The Louisiana Purchase Expedition

Shortly after the Louisiana Purchase in 1803, President Thomas Jefferson commissioned an expedition whose primary objective was to explore and map the newly acquired territory and establish an American presence there before other European powers tried to claim it. It consisted of a select group of U.S. Army volunteers under the command of Captain Meriwether Lewis and William Clark. This two and a half year journey faced the obvious perils of inhospitable Native Americans, dangerous wildlife, and tortuous terrain. However, the one enemy this expedition encountered which was more ruthless than all the others was syphilis.
For several centuries before the expedition, syphilis had been a well identified disease in Europe where it swiftly spread

through the continent with shocking virulence. Although its exact origins are controversial, it is known that syphilis spread during the French invasion of Naples in 1495, decimating the French army and earning it the nickname, “the French disease.” However, one should note that the French legions had a large enlistment of mercenaries from various European countries, including men who had sailed as part of Christopher Columbus’s crew just a few years earlier. Therefore, it is possible that these men brought the infection with them from the New World. This Columbian vs. Pre-Columbian controversy is a subject that is still in contention today, with some scientists hypothesizing that syphilis was present in Europe as far back as ancient Greece and others believing it was a New World transplant.
Regardless, the strain of syphilis prevalent in Europe at the end of the 15th century was much more virulent than the disease is today. Unfortunate victims became covered with pustules, suffered flu-like symptoms, and, as the disease began to affect the internal organs and central nervous system, patients declined and died within a few months. This extreme virulence had moderated by Lewis and Clark’s day, but the disease was recognized as a serious problem that needed careful treatment. This is evidenced by how much Lewis and Clark anticipated that venereal disease might be a problem on their trip. Knowing that their men would likely have sexual contact with native women, they packed the medicine chest with several drugs to help combat syphilis and gonorrhea. Their medical supplies included mercury-laden calomel, copaiba, and mercury ointment. As it turned out, they were correct in planning for these situations, for Clark notes several occasions in which it was a tribal custom to offer women as a sign of hospitality. For example, it was noted that it was customary for a Sioux to offer a woman, especially in exchange for goods. As much as Lewis and Clark attempted to decline these offers, it was evident that by March of 1805 many of his men were generally healthy except for the same venereal complaints Native Americans had (Hunter).
Lewis recorded the incidences of venereal disease he found among the natives, along with the natives’ own remedies to cure the disorder. He penned this journal entry while living with the Chinnook tribe before their expedition:
Goodrich has recovered from the Louis veneri (syphilis) 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. I cannot learn that the Indians have any simples which are sovereign specifics in the cure of this disease; and indeed I doubt very much wheter any of them have any means of effecting a perfect cure. when once this disorder is contracted by them it continues with them during life; but always ends in decipitude, death, or premature old age; tho’ from the uce of certain simples together with their diet, they support this disorder with but little inconvenience for many years, and even enjoy a tolerable share of health; particularly so among the Chippeways who I believe to be better skilled in the uce of those simples than any nation of Savages in North America. The Chippeways use a decoction of the root of the Lobelia, and that of a species of sumac common to the Atlantic states and to this country near and on the Western side of the Rocky Mountains. this is the smallest species of the sumac, readily distinguished by its winged rib, or common footstalk, which supports it’s oppositely pinnate leaves. these decoctions are drank freely and without limitation. the same decoctions are used in cases of the gonnaerea and are effecatious and sovereign. notwithstanding that this disorder dose exist among the Indians on the Columbia yet it is witnessed in but fiew individuals, at least the males who are

always sufficiently exposed to the observations or inspection of the physician. in my whole rout down this river I did not see more than two or three with the gonnaerea and about double that number with the pox.

In regards to syphilis, it is caused by a variety of bacteria called a spirochete, which enters the body during sexual intercourse and penetrates the mucous membranes, infecting the blood or lymph system. It can incubate in the body for weeks or even months before the infected person manifests any symptoms. There are three main stages of syphilis: primary, secondary, and tertiary.
Primary syphilis is typically acquired by direct sexual contact with the infectious lesions of another person. Approximately 3 to 90 days after the initial exposure (average 21 days) a skin lesion appears at the point of contact. This is classically a single, firm, painless, non-itchy skin ulceration with a clean base and sharp borders between 0.3 and 3.0 cm in size. In the classic form of the lesion, it evolves from a macule to a papule and finally to an erosion or ulcer. Sometimes, multiple lesions may be present which may indicate a coinfection with HIV. Lesions may be painful or tender, and they may occur outside of the genitals. The most common location in women is the cervix, the penis in heterosexual men, and anally and rectally in men who have sex with men. Around seven to ten days after the formation of a chancre, lymph node enlargement usually occurs around the area of infection. If untreated, the lesion may persist for three to six weeks (Kent).
Secondary syphilis occurs approximately four to ten weeks after the primary infection. Secondary disease is known for its various presentations, but symptoms most commonly involve the skin, mucous membranes, and lymph nodes. There may be a symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the palms and soles. The rash may become maculopapular or pustular. It may form flat, broad, whitish, wart-like lesions known as condyloma latum on mucous membranes. Other symptoms may include fever, sore throat, malaise, weight loss, hair loss, and headache. The acute symptoms usually resolve after three to six weeks; however, about 25% of people may present with a recurrence of secondary symptoms (Kent).
Tertiary syphilis may occur approximately 3 to 15 years after the initial infection, and is divided into three different forms: gummatous syphilis, late neurosyphilis, and cardiovascular syphilis. Without treatment, a third of infected people develop tertiary disease.
Gummatous syphilis usually occurs an average of 15 years after the primary infection. This stage is characterized by the formation of chronic gummas: soft, tumor-like balls of inflammation. They typically affect the skin, bone, and liver, but can occur anywhere.
Neurosyphilis refers to an infection involving the central nervous system. It may occur early, being either asymptomatic or in the form of syphilitic meningitis, or late as meningovascular syphilis, general paresis, or tabes dorsalis, which is associated with poor balance and lightning pains in the lower extremities. Late neurosyphilis typically occurs 4 to 25 years after the initial infection. Meningovascular syphilis typically presents with apathy and seizure, and general paresis with dementia and tabes dorsalis. Also, there may be Argyll Robertson pupils, which are bilateral small pupils that constrict when the person focuses on near objects, but do not constrict when exposed to bright light.
The first-choice treatment for uncomplicated syphilis remains a single dose of intramuscular benzathine penicillin G or a single dose of oral azithromycin. Doxycycline and tetracycline are alternative choices, but are to be avoided in pregnant women due to teratogenicity. Antibiotic resistance has developed to a number of agents, including macrolides, clindamycin, and rifampin. Some studies indicate that ceftriaxone may be as effective as penicillin-based treatment. Patients undergoing treatment should abstain from sexual intercourse until all sores are healed. On the other hand, because of the poor penetration of penicillin G into the central nervous system, those afflicted with neurosyphilis are recommended to be given large doses of intravenous penicillin for a minimum of 10 days. If a person is allergic, ceftriaxone may be used or penicillin desensitization attempted. Treatment at this stage limits further progression, but has only slight effect on damage which has already occurred (Mullooly).
These now preferred treatment methods were not available at the time of the Lewis and Clark expedition. The main method of combating syphilis at their disposal was mercury. Although mercury is toxic to the spirochetes which cause syphilis, it is also toxic to the patient that carries the disease. Historians suggest that when a member of the expedition complained of syphilitic symptoms, Lewis and Clark used topical mercury ointments applied for several weeks or until the patient began to salivate. In that time period, some physicians believed that salivation was a sign of disease expulsion from the body. Today, however, salivation is understood as one of the symptoms of mercury poisoning. Lewis and Clark did realize the terrible progression of the disease if left untreated, thus they took it very seriously. Mercury was freely given, but the dose never reached toxic levels.
There has been some speculation that Meriwether Lewis himself may have acquired syphilis during his journey to the Pacific, and that this disease led to Lewis’s mental illness and eventual suicide. His contraction of the disease was most likely due to his amorous encounters with Native American women. Although Lewis had considerable medical training and himself witnessed the prevalence and effects of syphilis before the expedition, he was still not deterred from engaging in sexual intercourse with Native Americans across the Louisiana Territory. Even Thomas Jefferson explicitly warned him of the dangers of sexual promiscuity with the tribal women, as the presence of syphilis among Native Americans was well known. Yet, in Lewis’s defense one can understand how he may have disregarded these warnings and succumb to the disease. There were months of arduous, celibate struggle that he and his men endured through the isolated territory. Moreover, as they encountered the native population, he could ill afford to show disrespect to the tribes by refusing the hospitable offer of pleasing female company, especially since they relied on bartering with these people for supplies. All in all, this could have caused him to relax his guard against the disease and we know that Lewis eventually became ill with a disabling illness as described in his journal:
Several of the men are unwell of the dysentery. brakings out, or eruptions of the skin, have also been common with us for some time.

That these skin eruptions have been common with them for an extended period of time is significant because it may highlight the secondary manifestations of syphilis. After a primary chancre, which usually appears after ten days as a painless genital ulcer, the secondary stage of syphilis includes cutaneous lesions that appear approximately one month after infection. This secondary stage of syphilis incapacitated Lewis considerably as shown by his lack of journal entries for some time. He eventually resumed his diary on their way back to Washington, noting that he had been very ill, but offering no further explanations.
In their return voyage, Lewis and Clark spent a noteworthy amount of time in St. Louis. Although President Jefferson, Congress, and the nation were eagerly awaiting them, they decided to forsake the favorable traveling weather and prolong their return. One may explain this delay if they assume that all those who had acquired syphilis on the expedition would have required month long treatments before traveling again. Even more interesting was the fact that Dr. Antoine Francois Saugrain, one of the top syphilologists in America, resided in St. Louis and was a close friend of Lewis. Lewis and Clark had become well-acquainted with Saugrain during the five months they lived in St. Louis before their departure. Saugrain helped them prepare for the expedition, both medically and scientifically, improving Clark's knowledge of diagnosis and treatment, and preparing a medicine chest for the expedition (Ravenholt).
Eventually, Lewis and Clark left St.

Louis several months later and arrived in Washington to celebrate the new year of 1807 with President Jefferson. In March of 1807 Lewis's appointment as Governor of the Territory of Louisiana, and Clark's as Superintendent of Indian Affairs and a brigadier general of Militia, were confirmed by the Senate. In turn, Lewis returned to St. Louis to govern the Louisiana Territory. At the beginning he proved to be an effective civil servant, but after a year into his term it was noted that his reports to Secretary of War Henry Dearborn and President Jefferson were becoming increasingly insufficient. Others noticed that Lewis was making unwise and grandiose real estate investments and his relationships with friends and colleagues began to deteriorate. In 1809 Lewis's health deteriorated and he dived deeper in debt. In fact, it became evident that for over two years Lewis had been living far beyond his means. In an effort to appease his creditors he handed over what land he had acquired in Louisiana to settle his debts. Later on in that year, he prepared for a business trip to Washington and departed St. Louis by riverboat. When the boat docked, the ship’s captain gave a statement that Lewis was in a state of mental derangement, having made two attempts to kill himself. He remained in bad mental and physical health, but eventually showed no signs of derangement ten days later. Coupled with what we now know about syphilis, these acts of poor judgment

may be indicative of advancing neurosyphilis.
When one truly considers the reasons as to why a very intelligent 35 year old man of great fame and notoriety would attempt suicide while positioned in an office of great importance, one should not rule out mental illness caused by an infection. Neurosyphilis, as defined by the following meaning, seems to give a very convincing explanation of Lewis’s actions:
Paretic Neurosyphilis is a chronic spirochetal meningoencephalitis which severely disturbs the function of the cerebral cortex and thereby leads to a general dissolution of mental and physical capacities. Insidious Onset of Paretic Neurosyphilis: Often it is only in retrospect, after the nature of the disorder is apparent, that the slight defects in critical faculties and minor peculiarities of conduct are appreciated. Then the relatives remember numerous small incidents that take on a new meaning. They may recall that the patient may have been less aggressive, less competent, and less interested in his affairs. Mistakes in business will be found to have crept into this man's dealings for quite a little while before recognizable symptoms appear. Other symptoms of early mental deterioration may have been present, such as forgetfulness, tardiness, discourtesy, carelessness of personal appearance, unsound judgment, undue suggestibility, irascibility, and self-assertiveness. Periods of depression with undue sensitivity, suspiciousness, and ideas of guilt may occur and sometimes alternate with periods of elation, undue optimism, sense of well-being, and over-activity. Sleep is at times disturbed, restlessness appears, and bodily complaints are mentioned, occasionally leading to erroneous diagnoses of neurasthenia. These alterations of personality and conduct may be of a minor degree, occurring only at intervals and covering a time expanse of many months, or they may progress very rapidly.

As a pupil of Thomas Jefferson and a national hero after the epic Lewis and Clark Expedition, Lewis was well-positioned to compete for the presidency of the United States. However, he assumed that had he arrived in Washington and his disease progressed as it had during recent weeks, he would become an object of ridicule and contempt, an increasing burden to family and friends, and his lustrous reputation would be destroyed. In deference to his mentor, President Jefferson, and his loyal partner and friend, William Clark, he unfortunately saw but one fit solution (Ravenholt).
It surely was an agonizing decision for Lewis to make since he must have felt helpless. The symptoms of neurosyphilis and mental disease in general were not appreciated at the time and in order to preserve his reputation he concluded that there was no alternative solution to his problem. Lewis was most likely the victim of a syphilitic infection that had been festering in his body for over four years as he explored the American West.
In conclusion, there are some historians who claim that the death of Meriwether Lewis was a homicide. His curious personality, promising future, and glowing reputation as an American hero did not coincide with the profile of a suicidal man. Yet, when one considers his sexual promiscuity with Native Americans, that during his last several years, his personality, judgment, work effectiveness, and health deteriorated, and that he suffered increasing attacks of mental derangement and febrile disorientation, they would see that the diagnosis of neurosyphilis overcomes other theories.