L&C Information
   
  The Strange and Mysterious Death of Captain Meriwether Lewis

Over the past 200+ years,  many historians and amateur Lewis and Clark buffs have presented arguments regarding Lewis’s reported behavior and his presumed symptoms of illness just prior to his death.  Many devotees of Lewis simply refuse to believe that their hero of yesteryear would ever pull the trigger on himself.  Debate about the cause of his death rages on and on.  Some theories based on numerous and undocumented assertions that are great examples of nothing more than a fantasy and with seemingly complete denial about Lewis’s behavior in the last days of his life, have put great stock in the idea that he was murdered as the result of a great conspiracy, headed up General Wilkinson, an apparent self-serving narcissist.  Others “experts”  match up a list of Lewis’s reported end-line symptoms with a list of their chosen disease, and use this as a proof text for their theory.  But if we view the existing historical record with some clinical understanding based on  modern medicine,  seasoned with some clinical experience based on the treatment of people with similar problems, the evidence shows to a high degree the probability of what was the resulting fatal scenario for Lewis on that October night of 1809.

MALARIA
A belief that Lewis suffered form malaria is cited as a contributing factor in his death.  The two most common blood-borne parasites that caused malaria in early America were Plamodium vivax and Plasmodium falciparum.  These parasites are passed along to a human host through the bite of an Anopheles mosquito. 1 Malarial symptoms arise from the parasitic infection of our oxygen-carrying red blood cells  and its symptoms from destruction of the red blood cells which the human body continuously produces in bone marrow. As red blood cells travel through the body’s circulatory system, they can flatten and change shape, squeezing through the tiny capillaries to give off their life-sustaining oxygen, while the liquid portion of the blood (plasma) nourishes hungry cells with its energy-rich glucose.  These red cells live for several months cruising through blood vessels to every part of the body.  There are at any given moment in our blood, red blood cells from a few hours old, to a few months old.

The most severe form of malaria is generally caused by P. falciparum.  One reason for its severity is that, unlike P.vivax,  the parasite P. falciparum attacks red blood cells of all ages..  P. vivax infects only young RBCs.  In addition to infecting more red blood cells, P. falciparum also alters the  red cell’s membrane pliability, preventing the cell membrane from changing shape to allow the cell to easily slip through the microscopic capillaries.  These relatively stiff and rigid red blood cells can clog and thus stop blood circulating into capillaries supplying the brain, kidneys, and other organs with life sustaining oxygen and glucose.  This “roadblock” in the capillaries may lead to organ damage/death.

 
  1 – Stanley C. Oake, Jr., et. al., eds., Malaria: Obstacles and Opportunities (Washington, D.C.: National Academy Press, 1991), p. 38.  The disease spread by the Anopheles mosquito still kills two-three million people annually throughout the world
 
 

Malaria caused by P. falciparum is the only type of malaria that can result in “cerebral malaria.”2 which develops as brain capillaries become clogged with parasite-laden red blood cells.  These “traffic jams” are thought to produce impaired consciousness and coma. Victims of cerebral malaria usually suffer from low blood sugar, anemia, and kidney failure, dying within days.  A victim would have been unable to carry on the travel schedule that Lewis did in the days preceding his death.  This is not just my opinion.  This was the opinion of a leading world expert in infectious diseases, Dr. Lee Rickman of the University of California at San Diego.
Recently, a theory involving Lewis’s death has been put forth, that the term “hypochondriasis” as used at the time of Lewis’s death, referred to pain in the abdomen.  This theory also presents that Lewis had an incurable and untreatable case of malaria, resulting in such severe abdominal pain, that he shot himself in response to the illness.  This is a classic example of “connecting the dots” with facts that don’t exist in the historical record to other “dots” of the misunderstanding of the term “hypochondriasis”.
.   The origin of the modern meaning of “hypochondriasis” is generally thought to have occurred in the mid 16th century, which pertained to the upper abdomen as the supposed seat of the psychological problem of melancholy. This idea was a logical extension of the ancient Greek belief that an excess of bile (from the “hypochondrium” or abdomen) was associated with melancholy.
Thomas Jefferson’s referral of Lewis’s “hypochondriac affections” is made perfectly clear in Benjamin Rush’s lecture Phenomena of Fever, originally published  in 1815. In a subsection of his lecture he deals extensively with various types of nervous system “convulsions” that are responsible for fever.  Rush asked, “Are there certain grades in the convulsions of the nervous system, as appears in the hydrophobia, tetanus, epilepsy, hysteria, and hypocondriasis?” It is clear from this context that Rush includes a modern sense of the word hypocondriasis (sic) as one form of a nervous “convulsion”. Rush does not equate the term with malaria or with abdominal pain  but exclusively with a nervous system disorder directly preceded in the list by “hysteria”.  If we follow Rush’s thinking process, it is fairly clear that he connects the terms “hysteria” and “hypocondriasis”. 
Given the previous scenario Williams Clark’s meaning in his letter to his brother Jonathan becomes all too clear.  “I fear O’ I fear the weight of his mind has overcome him..”  It would seem that Clark and Jefferson clearly refer to their observations of Lewis’s mental condition and not to some theoretical abdominal pain brought on by a more fantastic case of untreatable and incurable malaria.
It is very unlikely that the probable symptoms of fever, chills, headache, and nausea, that result from the less severe form of malaria caused by P. vivax, would have resulted in Lewis’s death.  It is probably even less likely, that such symptoms would have initiated his suicide.  Lewis’s ability to withstand physical hardship is well documented.  A suicide caused by an uncomplicated case of malaria just does not add up
.
 
  2 –Donald J. Krogstad, Chapter 264 “Plasmodium Species (Malaria), in Mandel, et al., eds., Principles and Practice of Infectious Diseases, 5th ed. (New York: Churchill Livingstone, 2000), vol.2, pp. 2819, 2821-2823.
3- Ibid, p.2822. .

 
 

SYPHILIS

Since we have already hiked the trail concerning the basic medicine of syphilis in Chapter 8, we will hike further ahead and visit some additional sites along the medical trail of this most interesting disease.

Medical author Reimert Thorolf Ravenholt has written that Meriwether Lewis suffered personality changes caused by neurosyphilis, and that Lewis realized he was suffering from neurosyphilis and committed suicide to avoid progression of the disease.  Neurosyphilis is a tertiary form of syphilis that causes progressive degeneration of the spinal cord and peripheral nerves, affecting both mind and body.  Ravenholt states that Lewis caught the disease during the corps’ stay with Shoshones, evidence by Lewis’s writing of skin eruptions several weeks later on September 19, 1805.  Raven hold also stated that a board of “world class epidemiologists” had concluded that neurosyphilis was the most likely explanation for the symptoms Lewis experienced during his final days.9 

Lewis could not have known for certain that he was suffering from neurosyphilis, because the condition was not  described in the world of medicine until 1882, when Bayle described “dementia paralytica,” or paretic neurosyphilis.  It was the first psychiatric disease for which a specific cause was found.10 This fact does not mean that Lewis did not have neurosyphilis, it just means if he did, he didn’t know it.

Although several Indian tribes offered young women to the captains for bed partners, there is no evidence in the journals that they ever took advantage of the opportunities.  In fact, the captains wrote about the Indians irritation at their refusals.  So it is very presumptive to assume that Lewis caught syphilis anywhere along the route.  Apparently there were others among the Corps who did not sleep with Indian women.  William Bratton was specifically mentioned as “having the strictest morals,” which suggests that he did not have sex with the Indian women.  In addition, very few of the men were mentioned as being victims of a “salivation,” the mercury treatment associated with “Louis Veneri”.

Lewis could have contracted syphilis after his return to civilization in September of 1806 and subsequently suffered from the effects of neurosyphilis in 1809.  However this diagnosis would have to be totally presumptive and not based on any evidence from the journals.  Edmond C. Tramont, writing in one of the most respected textbooks of infectious disease, noted that neurosyphilis mimics, 

“Any degenerative neurologic process, or disorder that cause chronic inflammation (eg tuberculosis, fungal or sarcoid meningitis, tumors, subdural hematoma, Alzheimer’s disease, multiple sclerosis, chronic alcoholism), or any disorder affecting the

 
  9 -  Reimert Thorolf Ravenholt, “Self Destruction on the Natchez Trace: Meriwether Lewis’s Act of Ultimate Courage, :”  Columbia: The Magazine of Northwest History, Vol. 13, No.2 (Summer 1999), pp. 3-6; Lewis wrote on September 19, 1805, “brakings out, or irruptions of the Skin, have also been common with us for some time.” Gary E. Moulton, Ed., The Journals of the Lewis & Clark Expedition, 13 volumes (Lincoln: University of Nebraska Press, 1983-2001), Vol. 5, p.215.

10 -  Lewis P. Rowland, Merritt’s Textbook of Neurology: 8th ed. (Philadelphia: Lea & Febiger, 1989), p. 152.
 
 

vasculature of the central nervous system.  The axiom that syphilis can mimic any disease is particularly apropos with regard to the central nervous system.” 11
Since it is very unlikely that Lewis was suffering from a subdural hematoma, MS, or Alzheimer’s we can effectively eliminate those from the list.
As noted earlier, the journals’ references to “skin eruptions” are cited as evidence of syphilis.  This generic description from the captains could mean any one of several hundred types of skin rashes, sores, or manifestations of myriad infectious diseases other than syphilis.  The early stages of syphilis were well known by the captains, so why didn’t they refer to these skin “irruptions” as the “pox” as they did on other occasions? 12  Lewis likely would have treated himself treat himself with mercury if he knew he had contracted syphilis, but there is no mention in the journals of Lewis using mercury for the several weeks that “salivation” would have required.  Perhaps Lewis did contract syphilis and did not treat himself or the treatment was ineffective.  Did Lewis forbid the reporting of his condition?  Did he do everything to hide the treatment?
If we assume for a moment that Lewis did contract syphilis and either did not treat himself, or the treatment he underwent was not effective, what could have been the outcome?
There have been two major studies on the progression of syphilis in untreated victims.  These were performed in Oslo, Norway and in the United States in the 20th century. 13 These studies showed that only about a third of those syphilis victims who were untreated progressed to having neurologic involvement.  Most people who die of complications of syphilis die from cardiovascular disease by developing inflammations in their aortas and accompanying complications.  Given this likely scenario, the chances that Lewis had tertiary syphilis have decreased.MERCURY AS A

MEDICATION

This leads us to the next logical question.  If Lewis treated himself for a presumed case of syphilis with mercury,  the accepted treatment of that time, could he have poisoned himself either to death, or into a neurological state that would have precipitated his suicide?

The iconoclastic physician, Paracelsus, popularized the use of mercury in the treatment of syphilis in the 16th century and it was a mainstay of treatment for this disease until the early 20th century.

 
  11 –Tramont, “Treponema pallidum (Syphilis)”, pp. 2474-2482.

12 – Moulton, ed., Journals, Vol 11 (1997), p. 356.

13 -  E.G. Clark and N. Danbolt, “The Oslo Study of the Natural Course of Untreated Syphilis,” in Mandel, et.al., eds., Principles and Practice of Infectious Diseases; 5th ed. (New York: Churchill Livingstone, 2000), Vol.2, p. 2477: D.H. Rockwell, A.R. Yobs and M.B. Moore, “The Tuskeegee Study of Untreated Syphilis: The 30th Years of Observation,” Archives of Internal Medicine, Vol. 114 (1964), p. 792; also cited in Mandel etal., eds., Principles and Practice of Infectious Diseases: 5th ed. (New York: Churchill Livingstone, 2000), Vol. 2, pp. 2477-2478.

14 The form in which it was administered during the time of the Corps

14 – Six video lectures presented by the author on various aspects of Lewis and Clark medicine, including the use, mechanism of action and side effects of mercury treatment are on The discovering Lewis & Clark Website at www.lewis-clark.org/content/content-channel.asp?ChannelID=281.
 
 

The ointment was applied to the skin and the calomel was administered orally, often until the patient started to salivate excessively, a sign that medical practitioners of the early 1800s believed to denote the body ridding itself of the syphilis “contagion”. Today we now know this to be one sign of mercury poisoning. 
Calomel ionizes in the gut when administered orally, but is poorly absorbed, with only about 15% of the dose goes into the circulation.  Elemental mercury, (the elemental form is by definition, not ionized) is very poorly absorbed from the gut and is considered not toxic if ingested. 15 Given the manner in which mercury was administered during the time of Lewis and Clark, the toxic results of oral calomel would be associated with its caustic effects on the intestines and kidneys with short term use.  The intestinal effects may have produced nausea, vomiting, bloody stools and remarkable bowel movements.  Damage to the kidneys would produce increased urination, followed by kidney failure if the dose was massive. If toxic doses of calomel were discontinued, recovery of the intestines and kidneys usually occurs within 8-14 days. 16 Mercury absorption through the skin would have been a slower process than achieved through oral treatment.
It is entirely possible that the use of mercury in this fashion “cured” many cases of syphilis.  However it is also reasonable, given the probable variation in both the dose of mercury given, and the length of the treatment, that many patients did not experience a cure to their illness.  At best, this medication is a very sharp double-edged sword. Mercury as a medication, does its work by attacking and destroying the three dimensional structure of various enzymes/proteins in the body.  Enzymes are necessary for life, as they cause (catalyse) many important and necessary biochemical reactions.  Many of these reactions are also present within the syphilis causing Treponema bacteria.  Once the necessary enzymes are destroyed through the mercury’s attacking of their sulfur-sulfur chemical bonds,  life processes within the bacteria are unable to continue and it dies.  If sufficient numbers of the bacteria are involved, then the disease is “cured”.
It is clear that the normal treatment of early syphilitic symptoms during the Lewis & Clark era produced at a minimum, mild mercury poisoning.  The unfortunate side-effect for patients taking mercury, is that it attacks all proteins with sulfur-sulfur bonds.  This result in the tissue damage manifested by those taking mercury.  Structural proteins within the body are attacked and break down.  Proteins in the gum tissue weakens and often the patient’s teeth fall out.  Kidneys cells that produce urine are poisoned and an early mercury poisoning is manifest with an increased amount of urine.  Salivary glads respond with increased amounts of saliva, which led early clinicians to name this treatment a “salivation”.  These same clinicians thought this was a sign of treatment success.   Short term treatment would not normally produce a permanent effect on the tissues and if the treatment is stopped, the body can repair itself within days.    Neuropsychiatric manifestations of mercury poisoning would result from the prolonged and heavy use of oral calomel, beyond that dose which was normally

 
  15 – Richard C. Dart, et.al., eds., Medical Toxicology, 3rd ed. (Philadelphia: Lippincott, Williams & Wilkins, 2004), p. 1439.

16 – Ibid., p. 1442.
 
 

administered during a “salivation”.  Since members of the Corps, also took Dr. Rush’s “Bilious Pills” for numerous other illnesses for short periods of time, the more serious toxic side effects would likely not occur.  Fortuantely for those patients who took mercury for a short time, the mercury ion from calomel does not cross the “blood-brain barrier” readily, a physiological roadblock to this form of mercury entering the brain. 17 The psychiatric symptoms of mercury poisoning include attention deficits, anxiety, emotional lability, agitation, depression, impaired memory and learning, hallucinations and slurred speech, among other symptoms.  Although a case could be made that Lewis’s end-line behavior exhibited some of these signs, due to the strong evidence of other etiologies being more contributive to Lewis’s serious mental deterioration, it is not logical to primarily assign them to mercury poisoning.

ALCOHOLISM
There are references associated with alcohol-a dram, a drink of sperits, grog-throughout the journals and Lewis and Clark often described the “affect” it had on the men.18  Lewis was documented as a heavy drinker at times in his life, including the period immediately preceding his death.19
There are various types of alcohol molecules, some of which are poisonous for humans (methanol, isopropyl alcohol).  The type of alcohol that we are interested in is called ethanol, and is produced as a metabolic product whenever microscopic yeast cells come in contact with some type of sugar containing solution.  The sugar consumed by the yeast may be from fruit, honey, rice, sugarcane, various grains, etc.  The yeast takes in the sugar as a food and splits it into alcohol molecules and carbon dioxide molecules.  This process continues until the alcohol content of the liquid reaches about 15%, at which point the alcohol kills the yeast cells and the fermentation stops.  Stronger alcoholic beverages result from either distilling weaker alcoholic beverages or adding distilled ethanol to wines and other beverages.
Many physicians of that era believed that diseases such as “fever”, or “melancholy” were the result of  a state of “debility” brought on  by abnormally relaxed “fibers” that made up the body.  Both alcoholic spirits and opium were considered by many physicians of that day to be “stimulants”, and effective in treating these problems!  One of the most influential physicians of the late 18th century, and one whose medical philosophies directly influenced the thinking of Benjamin Rush, was the Scotsman, John Brown.  It is written that John Brown gave lectures in London regarding his system of medical care, while flasks of whiskey and  laudanum (opium mixed with distilled spirits) rested on his

 
  17 -  Ibid. After the time of Lewis and Clark, some medical therapies involved the inhalation of  organic mercury fumes , which are more toxic to the brain than either calomel or elemental mercury.  Chronic exposure to mercury, and the resulting neurological symptoms suffered  by 19th century hat makers, led to the saying, “mad as a hatter”. The hat manufacturers used mercury in making their hats due to its poisonous and toxic effects on microorganisms that untreated, caused their hats to rot.

18 – Examples of this appear in Vol. 4, p.291, Clark’s entry for May 29, 1805, Vol.4, p.362, Lewis and Clark’s entries for July 4, 1805, the day their supply ran dry.

19 –Captain gilbert Russell to Thomas Jefferson, January 31, 1810, Thomas Jefferson Papers, Library of Congress.
 
 

podium.  Brown was reported to seldom get through a lecture without taking at least 4 doses from each flask!20
Early manifestation of ethanol intoxication often are viewed as positive behavioral traits. some characteristic behaviors. Loss of social phobias, relaxation, hypersexuality and increased gregariousness have been sought after since man took his second drink.
The chronic use of alcohol by an individual over time, produces a tolerance for the drug.  A person who habitually drinks will have to drink more and more ethanol to get the same result   This tolerance results because various enzyme systems within the body increase their activities in metabolizing the ethanol, and are able to rid the body of ethanol more efficiently after prolonged use.  The central nervous system’s neurons, are also able to adapt their function in the presence of chronic alcohol, and change their neurotransmitter functions.  Alcoholics are also able to modify their behavior patterns as the result of repeated alcohol abuse. .  This was never so effectively illustrated to me as when I saw an elderly alcoholic woman one day, who had a .35% blood alcohol level which is about 4 times the legal definition of intoxication in most states.  She was walking and talking nearly as well as I was in my non-drugged state!
Humans who repeatedly drink to excess can develop a physical dependence to ethanol that results in serious and even life-threatening symptoms if they abruptly cease drinking. Ethanol withdrawal produces the “shakes”, high anxiety, high blood pressure and heart rate, excessive sweating, rapid breathing, nausea and vomiting.  The most severe type of ethanol withdrawal is called the DTs (Delirium Tremens) and can include headaches, irritability, agitation and confusion, delusions and hallucinations. Severe post-drinking depression and anxiety with sleep disturbances and panic attacks can last for weeks.
Addiction specialists today view alcoholic and other addictions as the result of unhealthy interpersonal attachments.  One addiction specialist recently stated that,  “not everyone with inadequate attachment experiences will become addicted, but everyone with an addiction suffers with attachment difficulties.” 21The term “attachment” is a way in which mental health professionals refer to the ability of an individual to make meaningful emotional connection with others.  In short, to make true friendships and have positive connections with other human beings.
.    Young men in late 18th century Virginia were taught that they were superior, and should never take any insult from any inferior being.  One young boy in colonial Virginia was praised by his father for hacking to death a goose that had bitten him.  This capital offence perpetrated by the poor goose had insulted the honor of the boy, and thus the goose deserved its gruesome fate.22 Some of Lewis’s adult behaviors could easily be interpreted as manifestations of these 18th century Virginia societal attitudes in child rearing. Lewis faced a court martial early in his career for an incident fueled by alcohol, though he later was “acquitted with

 
  20 – for numerous sources for Dr. John Brown, please do an internet search for “John Brown + Brunonian Medicine”. 

21 –Philip J. Flores, Ph.D., An oral presentation at the American Psychoanalytic Association meeting entitled, “Addiction as an Attachment Disorder-Implications for Group Therapy,” Atlanta, Georgia, (June 2008).

22 –Darren Staloff, Ph.D., The History of the United States, Women and the Family (Springfield, Va: The Teaching Company, 1998).

 
 

honor.”23 In spite of being arguably the most eligible bachelor in the nation in 1806, by his own admission he was not able to find a suitable wife.24  His talent and ability as an explorer and naturalist, both solitary jobs, did not translate well into a talent for working with other people.  He seemed poorly suited to a political life and may have been unhappy and felt isolated in his life as a governor.  This unhappiness may have contributed to his inability to finish work on the expedition journals in spite of Jefferson’s repeated urgings.  His frustrations resulted in an ungracious lashing out at Patrick Gass when Gass published his journals prior to Lewis. 25 A man with a history of alcohol abuse likely would drink even more in a state of extreme unhappiness.   His brain chemistry, and thus his emotions would have been changed so that when any of these frustration “triggers” were pulled, his response would have been the same, to have another drink. This addiction scenario is  consistent with the historical record and the probability that Lewis suffered form alcoholism seems very high.  Unfortunately for Lewis, it is highly likely that alcohol was not the only chemical causing him horrendous problems.

OPIUM
A very popular medical treatment during this era was the oral use of opium.  It was used not only for control of pain, but as a general “tonic” for the system!  It certainly had some profound effects on the body as any “tonic” might be expected to produce, but the overwhelming effect on anything but pain is virtually entirely negative.
Lewis took opium pills toward the end of his life for self-diagnosed malarial “fevers”. 26  Opium was used in that time for pain relief, “fevers”, and what amounts to mental depression among other uses.  During their return trip from the Pacific, in present-day Idaho, the captains treated an apparently mentally ill native American woman with some of their opium. 27
Opium is a milky substance obtained from the immature flower pod of the opium poppy (Papaver somniferum). Opium contains dozens of  pharmacologically active substances (alkaloids), the most abundant being morphine and codeine.  Morphine was identified and isolated from raw opium in 1803, but its spectacular efficacy in relieving pain did not come into general use until the 1830s.  In addition to relieving pain, morphine causes intense euphoria and tranquility as well as the less desirable side effects of depressing the drive to breathe and producing severe constipation.  Opium products

 
  23 -  Eldon G. Chuinard, “The Court-Martial of Ensign Meriwether Lewis,” We Proceeded On, Vol. 8, No. 4 (November 1982), pp. 12-15.

24 -  Donald Jackson, ed., Letters of the Lewis and Clark Expedition with Related Documents, 1783-1854, 2 volumes (Urbana: University of Illinois Press, 1978), Vol.2, p. 720, Lewis to Mahlon Dickerson, November 3, 1807.

25 –Ibid., Vol.2, pp. 385-386, Lewis to the Public.

26 –Stephen E. Ambrose , Undaunted Courage: Meriwether Lewis, Thomas Jefferson and the Opening of the American West (New York: Simon & Schuster, 1996), p. 450.

27 – Moulton, ed. Journals, Vol 7, (1991), p. 272.
 
 

were included in over-the-counter tonics, elixirs, cough drops and medication to calm down unruly babies in the United States until the early 20th century.28
Although Lewis reported that he was taking opium pills weighing one gram, it is highly doubtful that those pills actually contained a gram of opium, which would have been a potent dose.   Lewis took his three opium pills at night and, if they did not “operate him”, he took another two in the morning29.  With this dosing regimen he was ingesting a significant quantity of morphine, codeine, and the other alkaloids active in the poppy. 
Morphine from raw opium was readily absorbed from Lewis’ intestine into his bloodstream, where it then flowed to his liver.  The liver inactivated a good deal of the opium before it entered his central nervous system and general circulation. Given that fact that opioids are among the most easily addictive drugs known to man, Lewis would have become sufficiently addicted to opium within a few weeks to experience symptoms of irritability and aggression if he had tried to discontinue the medication.  Opium withdrawl would have produced an intense craving for more of the substance, nausea, cramps, a depressed mood, inability to sleep, increased sensitivity to pain and increased anxiety.
If we believe Lewis’s own account that he was taking opium and others accounts of his heavy drinking after his return to civilization, there is an overwhelming case for Lewis’s addiction to these substances and the PROFOUND effect that these addictions would have on his personality and judgment. It would have produced behavior  completely consistent with the reported historical record of his final days.  The use of these chemicals could easily have produced a significant clinical depression in Lewis’s mind even without any other underlying medical problems.     Most amazing of all, this could have all occurred with the possible blessing of the medical community of the day.

CLINICAL DEPRESSION

The modern medical view of depression is that it results from the inadequate or imperfect function of special biochemicals in the brain called neurotransmitters which allow us to think, move, and have emotions.  Effective modern-day treatments for depression include medications that improve the function of various neurotransmitters such as serotonin, norepinephrine, dopamine and others.  Additionally, psychotherapy is considered a beneficial adjunctive therapy.30
Clinical depression can affect people who seemingly have no “reason” to be depressed.  A familial factor is often present in clinical depression.  The correct function or the deficient and imperfect function of neurotransmitters is largely genetic.
Thomas Jefferson and  William Clark recorded observations of Lewis’s personality, that when viewed from a modern medical perspective, would strongly suggest depression.  Lewis’s personality, when viewed from a modern medical perspective, would strongly suggest depression.  It is likely that Lewis had a constitutional/genetic

 
  28 – Internet search for “use of opium in baby medications in 1800s”.  See the first “Google” listing for Illicit drugs: use and control-Google Books Result.

29 –Ambrose, Undaunted Courage, p. 450.

30 –www.nimh.nih.gov/health/topics/depression/index.shtml
 
 

tendency towards depression.  This was beyond his conscious control.  If one asks, “what did Lewis have to be depressed about?”, the answer is overwhelmingly obvious.  He had a underlying depression that was greatly aggravated by his personal circumstances upon his return:  a job he probably disliked, failure in various personal relationships, resulting isolation, the federal government slandering his name and refusing to pay his invoices, etc.   He returned to society from an exploration for which he was immensely well-suited, and found a life in St. Louis for which he was probably poorly suited.  This is a  perfect and very likely scenario for developing a clinical depression.  If one mixes this clinical depression with alcohol and opium the outcome would likely end in catastrophe.    One can not possibly overemphasize these factors!  This combination of factors is overwhelming evidence for a case of depression that could easily lead Lewis to a state of confusion, anxiety, hallucinations, anger, poor judgment, pacing around a room while talking to himself,  then shooting himself in the head,  and within a short time, in the chest.  I can guarantee the non-medical reader that the effects of opium on a normal brain can produce some very bizarre results

GUNSHOT SUICIDE

Gilbert Russell, in 1811, wrote a letter to the first superintendent of the U.S. Military Academy describing Lewis’s death:
“Some time in the night he got his pistols which he loaded, after everybody had retired in a separate building (at Grinder’s Stand on the Natchez Trace near today Hohenwald, TN) and discharged one against his forehead without much effect—the ball not penetrating the skull but only making a furrow over it.  He then discharged the other against his breast where the ball entered and passing downward thro his body came out low down near his back bone.”
Lewis reportedly lingered for some hours.  One Lewis and Clark scholar of the past, Dr. Eldon Chuinard, an Orthopedic Surgeon,  asserted that if Lewis had shot himself in “the breast”, the slow death “is totally unbelievable!”  Chuinard raised the interesting question, “The second shot would be expected to have killed Lewis instantly, or have disable him,” adding “What do the supported of suicide think that this second shot would have done to the heart, lungs, aorta and/or intestines?  Certainly Lewis would have been in dire shock and soon have bled to death or perhaps paralyzed from spinal cord injury.”
In answer to  Dr. Chuinard’s conclusion concerning the implausibility of Lewis’s shooting himself and surviving for two hours, I present the following observations which are not just my opinion, but the opinion of several trauma surgeons with whom I have consulted regarding this issue.
We may interpret the nonspecific term “breast” as meaning somewhere on the chest.  If Lewis held a pistol to his chest, with the muzzle aimed at a slightly downward angle as is suggested by the description of the resulting wound, the bullet probably entered his chest, passed through his lung, penetrated the thin muscular diaphragm, and wounded either his spleen or his liver depending on whether the bullet entered his left or right chest.  The lungs, spleen, and liver all have remarkable blood supplies and, if wounded, can bleed to the point of causing death.  As the bullet passed into Lewis’s chest, it would have created a totally or partially collapsed lung from the introduction of atmospheric pressure into the thoracic cavity.  The wound probably resulted in a slow rate of bleeding into his chest and abdominal cavities.  This process could have continued for two hours until it resulted in loss of blood volume and thus blood pressure, which would have ultimately caused his death. This scenario would  not cause the “instant death” that Dr. Chuinard believed it would have.  I believe that it is less likely, but still possible, that the bullet could also have wounded the heart superficially, resulting in the sac surround the heart slowing filling with blood (hemopericardium) and the resulting increase in pressure surrounding the heart (pericardial tamponade), which would ultimately cause it to stop beating
Any trauma surgeon could tell you stories of talking to gunshot victims who are carrying on conversations and seemingly stable for hours, then suddenly lose consciousness and die as the result of bleeding in the chest, abdomen, or sac surrounding the heart. Mortally wounded victims can continue to speak and consciously move until the effects of their internal wounds result in excessive blood loss, loss of blood pressure, unconsciousness and ultimately death. This would certainly fit the picture of Meriwether Lewis’s survival of two hours after he shot himself.  With such a gunshot today, it is likely that a trauma surgeon could save the victim’s life. 
It is not out of the realm of possibility, that given the wounds described, that Lewis’s may not have even required a surgical procedure that opened up his chest.  There are gunshot victims in the present time who have penetrating chest wounds who do not even require opening their chests to surgically intervene to save their lives.  Some gunshot wounds to the chest that do not produce severe internal hemorrhage that are treated by inserting a chest tube into the thoracic cavity, recovering any blood in the area, running that blood through a filter and giving it back to the victim in a vein! Now those are some modern medical marvels!

We now arrive at the end of this medical expedition into the unknown with perhaps more questions than when we started.  Did Lewis have neurosyphilis?  Maybe, but not likely.  I think this theory is an example of constructing a desired conclusion and then fitting the data to support your theory. If you choose this road to travel, you must realize that even though the medical symptom list may suggest this as a decent possibility, the historical evidence in the expedition’s journals is at best,  threadbare!
Did Lewis have syphilis and poison himself with mercury?  Maybe, but not likely. He probably would have died sooner from other effects of mercury poisoning, prior to exhibiting the usually chronic neuropsychiatric behaviors associated with chronic mercury poisoning.
Could Lewis have shot himself in the manner recorded by history and survived for two hours?  Absolutely.
Was Lewis an opium addict? He was probably using opium and could have become addicted to it within a couple of weeks.  Opium was readily available and its spurious use was sanctioned by physicians of the day.  I think it is a certainty,that at the very least opium significantly affected his mental state in the last days of his life.  
Was Lewis constitutionally depressed and did he have personality traits that would predispose him to the use of alcohol and become subject to alcoholism?  From my admittedly inadequate ability to discern a man’s personality from reading about his adventures and some of his behaviors, I still think this is a good bet. I have seen far too many alcoholics in my professional and personal life and the destruction they often leave in the wake of their behaviors.  Without question, Lewis’s reported heavy alcohol use had a  very negative influence on his life. I would not bet my retirement account on it, but nevertheless, I think at the end of his life he was depressed, discouraged, angry and drinking entirely too much.  If you mix this with the problems that his opium use would create, this scenario provides a compelling and overwhelmingly convincing scenario for suicide. 
Could Lewis have had neurosyphilis, poisoned himself with mercury, been addicted to opium and alcohol, in addition to being genetically prone to clinical depression and still  have been murdered?  Why not?
Could the captain have had recurrent malarial fevers?  Certainly.  But I doubt that this would have led him to suicide, or resulted in a natural death.  The current theory of Lewis having an incurable and untreatable case of malaria/ coupled with a “creative” use of the term “hypochondriasis” is in my opinion, a very weak argument.   Based on his activity level at the time of his death, Lewis clearly did not have cerebral malaria.
Regardless of your own speculation regarding Lewis’s death and the uncertainty of what actually happened that day in October of 1809, the accomplishments of Captain Meriwether Lewis continued to stand untarnished in our collective experience.  His short life was highlighted with position and achievements that few of us will ever experience.  Unfortunately, he became a victim of the medical problems he faced during his life and very likely the unknowing victim of a medical system that was at best, inadequate and at worst, incompetent.

Article by David J. Peck, D.O.  copyright 2010
   
 
 
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