Art. II. Medicine in the Northwest by J. Gottfred.

In which the author presents some insights on medical care in the northwest fur trade as gleaned from period journals.

The subject of medical care in the Northwest is one which is often given short shrift by re-enactors, yet it was an important facet of life then as it is now. Trained doctors ('surgeons') were employed at the major forts, and every post was equipped with a medicine chest. The senior man at the post had the responsibly of administering to the ills of his men— as well as to the natives in so far as aid was requested by them.

In this article, I will present some specific information gleaned from journals which will shed some light on the kinds of medicines that were available, their general uses, and by examples, illustrate the specific treatments that were administered.

I have only found a few references to doctors by name, and all were employed at the major posts. From 1771-1779, Edward Jarvis was the surgeon at Albany Factory. He was at Moose Factory in 1779, and again at Albany from 1782-1788 and from 1790-1792 (Tyrell, 262n). In 1799, Albany's surgeon was John McNab. Thomas Hutchin was surgeon at York Factory from 1766-1772 (Tyrell, 263n). In October 1795, John Wright was the surgeon at the Hudson's Bay Company's Cumberland House. Presumably this was only a temporary assignment as he returned to York Factory the following summer— presumably to be the surgeon at York (Johnson, 52n, 41n). In 1799 the North West Company employed a Dr. Munro as surgeon at Grand Portage (Mackenzie, 481, 481n, 496, 496n).

Perhaps the most famous medical man in the Northwest was Dr. John McLoughlin. He was born the son of a subsistence farmer at Rivière-du-Loup, Quebec, in 1784. He studied medicine at Quebec City and entered the employ of the North West Company as an apprentice doctor in 1803. He was soon posted to Fort William. In 1814 he became a wintering partner and the following year was placed in command of the fort. After the merger with Hudson's Bay Company he went on to become the Chief Factor at Fort Vancouver in 1824. He later became an American sympathizer and today is known as the 'Father of Oregon'.

Only the major posts seem to have had the luxury of a resident doctor. At the smaller posts, or while travelling, the senior man was responsible for treating the ailments of the men in his command. Ross Cox, a Nor'wester, noted that

'The principle trading establishments are supplied with well-assorted medicine chests, containing books of directions, lancets, &c. An assortment of the more simple medicines is made up for each out-post ; and as each clerk must learn how to bleed, we generally manage, between low diet, salts, castor-oil, opodeldoc, friar's balsam, and phlebotomy, to preserve their health unimpaired, and cure any common accident.' (Nute, 91).

The natives, too, were subject to the ministrations of the medically minded. Gabriel Franchère railed against the methods of the natives noting that :

'As soon as a native of the Columbia is indisposed...they send for the medicine man, who treats the patient in the absurd manner usually adopted by these impostors, and with such violence of manipulation that often a sick man, whom a timely bleeding or purgative would have saved, is carried off by a sudden death.' (Franchère, 194).

To give us some idea of the quantity of medicines traded to the native peoples, William Tomison noted that he had traded 100 made beaver worth of the stuff between the years 1779 to 1795 (Johnson, 25).

Medical theory of the time was governed by the so-called 'unity' theory of disease. The idea was that good health was a result of a harmonious balance between nervous simulation and the response of the blood vessels and muscles to this stimulation. An excess of nervous stimulation would lead to muscular spasm, and hence to disease, while a lack of stimulation would lead to lethargy & weakness (atony).

Should a patient be suffering from an excess of irritability causing fever, then the idea was to reduce the irritation by bleeding & purging, or by the use of locally applied counter-irritants, by restricting the diet &c. If the patient were lethargic & weak, then the body must be stimulated with food and stimulating drugs. The old wives adage of 'feed a cold and starve a fever' originated from the medical practice of the times.

Basic treatments to deal with an excess of tissue irritability were as follows :

Bleeding — This was usually accomplished by opening a vein in the arm using a lancet or fleam, and allowing anywhere up to a quart of blood to flow into a bowl. The cover illustration is of a museum quality reproduction of an automatic fleam. This spring loaded device was used to open a vein with less pain to the patient.

Bleeding was also accomplished by means of a method called 'cupping', where by many small incisions were made into the skin near the site of the irritation using a many bladed instrument called a scarifier, and a hot glass cup was placed over the site. As the glass cooled, the suction drew out the hot blood.

Blisters — Raising blisters to act as a counter-irritant was also a common treatment. Plasters of caustic materials were placed next to the skin to raise a blister. Such blisters were then kept open by inserting irritating substances under them.

Cataplasms & Formentation — Cataplasms (poultices) of various substances were applied to wounds to relive pain. Warm wet cloths (formentation) were applied to ease internal pains.

Clysters — A clyster is any medication which has been applied rectally— often as a response to deal with patients unwilling to 'take their medicine'.

Diet — Food intake would be reduced, and bland substances substituted to reduce irritation. Tapioca was commonly used in this fashion.

To deal with the problem of decreased irritability, the following basic treatments were employed :

Anodynes — The anodynes were drugs such as laudanum and opium. When used in small doses they were thought to reduce irritability, and if applied in large doses to increase irritability.

Cathartics — Cathertics are medicines which scour the stomach and intestines. These include both vomits and laxatives.

Rubefacients — These were medications or other substances which were rubbed into the skin to irritate and redden it.

Stimulants & Diet — Medications or foods which irritated such as hot spices &c. Alcohol was also considered to be a stimulant.

In general, major surgery was not done, and minor surgery (other than blood letting) appears to have been used only in desperate cases such as tooth extraction and the removal of musket balls close to the skin.

Some or all of the following medicines were found either in the apothecary chest or in the local environment. These medicines were used as specified :

Anise — Used as a stimulant to counter atony.

Antiscorbutics — For the prevention of scurvy these items were tried : English porter, port wine, crystallized salt of lemon, essence of malt, cranberries (nearly equal to oranges) & spruce juice or spruce beer (E. Ross, 90).

Basilicon — Ointments containing garden or other basils which 'possess sovereign virtues', usually made with a wax or glycerin base. Ointments were kept in small earthen glazed pots called 'galipots.' In 1785, gallipot was a jocular term for an apothecary.

Camphor — Used as a sudorific (promotes sweating) often prescribed as a counter-irritant to a fever.

Chinchona or 'The Bark' — Contains quinine and was useful for malaria, ague, and as an anti-arthritic.

Eau de Luce, (aka aqua Luciae, Spiritus ammoniae succinatus) — It was made of 'aqua ammoniae', in alcohol with lavender, amber, and mastic (Henry, 731-2). (Unfortunately I have been unable to pin down what it was used for.)

Elixir Asthmaticum — An antidysentery made of 'opium, honey, licorice, benzoic acid, camphor, oil of anise, potassium carbonate and alcohol' (Wilbur, 12).

Epsom Salt — Used as an antiarthritic.

Glauber's Salts — Sulfate of sodium. First made in 1668 and used as a purgative and cathartic.

Hartshorn — An ammonia extract from the horns of deer. Probably used as a stimulant.

Ipecacuanha (Brazil root) — Used as an emetic (vomit), diaphoretic (promotes sweating), and as a purgative (laxative). A good general antidysentery.

Jalap — A mild purgative (laxative). It is the root of a plant found in Mexico.

Lavender — Used as a stimulant to counter atony.

Larch Tree Bark — The inner bark of the larch was used to 'stop or prevent a mortification' (E. Ross, 89). The fur traders learned about it from the Natives.

Liquor — High wine or beer, used in large doses as a stimulant to counter weaknesses or atony.

Opium (Extractum Thebaicum) & Laudanum (Opium and Saffron)— Used in small doses to ease pain, or in large doses as a stimulant.

Peppermint Oil — For stomach distempers of all sorts.

Rhuhbarb — The yellowish-brown rootstock of the Chinese rhubarb (not the garden variety). Used as a purgative (laxative) and as a sudorific (promotes sweating).

Spanish Fly — A strong blistering agent made from the mashed remains of a green beetle. Used as a local counter-irritant.

Sulphur — Used as a purgative, as a counter-irritant to promote sweating (sudorific), and as an anti-inflammatory (resolvent). It was provided in a refined form, usually as flowers of sulfur.

Turlington's Balsam of Life — This patent medicine (1744) contained some twenty-seven ingredients and was used for 'stone, gravel, cholic, & inward weaknesses'.

Wish-a-cuppuca Tea (Labrador Tea) — Used as a beverage, and to treat rheumatism, stomach ache, headache, 'promotes perspiration' (sudorific), gangrene (externally), contusions (externally), and as a powder to treat dysentery (E. Ross, 89).

Yarrow — Yarrow tea was used a as a sudorific (promotes sweating) as a counter-irritant to a fever.

The journals contain few references to the contents of medical chests and who had them, however a general impression can be made from the following quotes :

In 1796, a 'worthless medicine box' at Buckingham House contained :

'1 bottle hartshorn, 1 bottle Turlington, 1 bottle lavender, sm. bottle tincture of rhubarb, 1 lb. Jalap, Ipecacuanha ½ lb., 2 lbs Glauber salts, 2 lbs sulphur, 2 lbs basilicon, ¼ lb powder of rhubarb, 2 lbs Spanish juice, 4 oz strengthening plaster, 5 gallipots, 24 small vials, some corks, part of an old sheet, lint for dressings.' (Johnson, 25). Many of the medicines had dried out and were unusable.

Medical chests were carried on expeditions. David Thompson took the following medicines over Athabasca Pass in 1810-11 :

'1 oz brimstone; 1 bottle lavender; 6 bottles peppermint; 1 box drawing salves; 9 bottles Turlington; 10 vomits; ¼ oz. blue vitrol; 2 balls cotton wick.' (Thompson, Columbia, 255-257).

Simon Fraser, on his journey to the Pacific, noted on June 3, 1808, that : '...our medicine chest, tumbled, and (some papers and medicines) were lost' when the horse carrying them fell off a cliff (Fraser, 70).

Thompson and Fraser refer only to the medicines carried, and do not give any indication as to what instruments were carried. It is certain that some basic tools would have been included. This quote from Alexander Henry at Fort George (Astoria) in 1814 shows that some instruments were certainly carried :

'I opened a case of [the doctor's] medicines to get out mercurial pills, ointment, and a syringe ; found a three-pound bottle of opodeldoc broken.' (Henry, 907).

Syringes for the administration of clysters were standard tools, along with lancets for bleeding, and other commonly used tools.

Dr. John McLoughlin apparently left a complete description of his medical kit which now forms the basis for the interpretation of the doctor's office at the Old Fort William historic site. The fort staff stated that all of the items on display were specifically known to have been in Dr. McLoughlin's possession at Fort William. These included large and small syringes, lancets & fleams for bloodletting, probes, ball forceps, tooth keys, a goat's foot elevator for extracting incisors, retractors, catlins (surgical knives), tenaculums (tenaculi?) (used to hold on to slippery tissues) large and small capital saws, a sinister-looking device called a trephine which is used to saw a hole in the cranium to relieve the internal pressure after a concussion, blistering irons, a scarifier and cups, and a tube-like device designed to force pills down the throats of recalcitrant voyageurs.

Surgical Instruments— Museum quality reproductions of period instruments. Ball forceps, goat's foot elevator, tenaculum, catlin, probe.

The various medicines in these kits were put to use to treat a variety of complaints. The approach seems to have been largely of the 'shotgun' style — that is, each medicine was tried in turn until the patient recovered or succumbed. Much of the medical knowledge seems to have been of the general or folk type, with various suggestions for a cure being put forth based on 'common knowledge'. The following examples of actual cases will illustrate better than any commentary how medical practice was conducted in the Northwest.

Colic — In October of 1800, one of Alexander Henry's men is very sick 'with a colic'. On the first day Henry gives him essence of peppermint, sweet oil, Jalap, and Glauber's salts. On the second day, having had no result, he gives the man an emetic (vomit). Still no effect. Henry then tries each item in his medicine chest in turn — none help. Finally Henry puts him on a three day diet of luxuries : flour, sugar, & tea. Still no effect. Thirteen days later the man suddenly has a major attack of diarrhea, whereupon he fully recovers (Henry, 110-112, 122).

Henry also reports that in 1805, 'Bottineau's son, a boy of about seven years of age, died of a swelling of the belly and costiveness...clysters and purges had no effect whatever.' (Henry, 268).

Henry, again, notes that while crossing Howse Pass in 1811 '...I was taken with a colic, which made me weak and faint for some time; but fortunately I had some peppermint drops, a good dose of which relieved me...' (Henry, 679).

Coughs — In November, 1797, William Tomison, Factor at Buckingham House, noted that he had 12 men sick 'troubled night and day with a violent cough' for which they were treated with 'a little blister plaster and Spanish Flies' and 'a little opium for composing them to rest...' (Johnson, 128).

General Aches & Pains — In December of 1803, Alexander Henry suffered from a severe pain in the back and side, he rubbed it with camphorated spirits and warm flannel and soon felt better (Henry, 231).

Rashes & Itching — In December, 1800, when some of the men had a rash and itching, Alexander Henry gave them a compound of high wine and gunpowder to rub the rash with 'which appeared to ease them and dry up the sores' (Henry, 96).

Venereal Disease — Simon Fraser had some difficulty with one of his men in June of 1806. He writes that :

'La Malice paddled only at intervals today, he being unwell, and in the evening he declared himself disabled and told Mr. Stuart that he was enruptured, but by the medicine he takes (for I never heard of syringe being used for a rupture) it appears to me that it is the — disease' (Fraser, 207).

Two days later he notes that :

'As (La Malice) could not sleep for several nights past, last night Mr. Stuart gave him 30 drops of laudynum, and he complains of being worse since, on which account we gave him a vomit' (Fraser, 207).

In 1814 at Ft. George (Astoria), 9 men were bed-ridden with venereal disease (Henry, 868). Alexander Henry remarks that :

'...several of our men have venereal disease; two cannot walk. By spring, I fear, at least half our men will be disabled by this disease ; at present few are free from it, and some are far gone. This foul malady is so prevalent among our people and the women in this quarter that it may seriously affect our commerce' (Henry, 836).
He notes that the men were given mercury as a treatment.

Arrow Wounds — To treat an arrow wound, a poultice of biscuit and water was applied (Henry, 821).

Drowning — After Ignace the Iroquois nearly drowned in 1811, David Thompson bled him (Thompson, Columbia, 145).

(Incidentally, Alexander Henry met his end by drowning at Fort George in 1814.)

Blood Poisoning — In 1792, Alexander Mackenzie bled a voyageur who had blood poisoning . The man recovered, even though it was the first time Mackenzie had attempted such a treatment. He had previously tried 'a volatile liniment of rum & soap...to relieve the mind of the patient' (Mackenzie, 244).

Frostbite — When Robert Longmoor froze both his big toes at Cumberland House in 1774, Samuel Hearne treated it in the following manner :

'This morning I lay'd Rob't Longmoor's toes open which are froze to the bone, and as the medicine box which ware fitted up at the fort for this place is with Mr. Cocking we have not the least thing to apply to it, except the inner rind of the larch tree root which is generally us'd among the natives to stop or prevent a mortification' (Tyrell, 139).

Gangrene — In January of 1793, Alexander Mackenzie treated an Indian who had lost his thumb when his gun burst. The hand was gangrenous and the thumb dangled by a strip of flesh. He washed the wound with spruce-fir bark juice and then put a spruce-fir root bark poultice on it, which he changed three times a day. The gangrene cleared in a few days, and the loose skin was dried with a vitrol solution until Mackenzie could remove the thumb. After a month of treatments the patient recovered ( Mackenzie, 248).

Gunshot — William Tomison took 'several shot' out of the leg of one of his men (George Gun) in February of 1798 (Johnson, 109). The man had been hit by a 'set gun' designed to trap game. Precisely how Tomison treated it is, sadly, not recorded.

Alexander Henry noted that after his man Roussel shot himself while repairing a double-barreled gun in 1814 :

'the contents lodged in this right thigh; though the bone was not injured, he suffered much. The flesh was cut open opposite the wound, and the shot and wadding were removed' (Henry, 825).

Accidents with guns seem to have been quite common. Alexander Henry nearly shot himself in the hip when his horse stumbled as he was drawing his gun to shoot a buffalo. He also grazed himself (and put a hole in his capot) when the cock of his piece caught on a canoe gunwale as he was passing the gun behind his back. (Henry, 241).

One of Henry's men was killed while playing with a gun in 1804, while a second man was shot dead by his own piece as 'it was a fine gun, with extremely weak springs, and had been known repeatedly to go off in handling carelessly' (Henry, 249 & 271).

Phillip Turnor noted that in 1790, '[William Sabbiston is] very much wounded on the left side of back with Bristol Shot... by the man in stern of the canoe firing at some geese, and his gun hung fire'. It took over a month for the man to recover (Tyrell, 315-6, 319).

Even the intrepid Peter Fidler suffered at the hands of careless hunters, he was shot in the 'thigh' when the man walking behind him had his trigger snag on a branch. The rather coy description of this wound leads one to suspect that when asked 'where was he shot' he would probably have replied 'in the forest' to save further embarrassment. It took him a month to recover (Johnson, 269,273).

Mal de raquette (Snowshoe Sickness) —

'The remedy prescribed in the country, is that of laying a piece of lighted touchwood on the part, and leaving it there till the flesh is burnt to the nerve; but this experiment, though I frequently seen it attended with success in others, I did not think proper to make upon myself'' (Henry the Elder, 69).

So noted Alexander Henry the elder, in 1763.

Wounds — Alexander Henry notes in 1800 that

'...another [man] had split his thumb with an ax in a shocking manner, and having neglected it, the wound was in a sad condition. I washed it with sal ammoniac until it bled, when the poor man was dancing with pain, and swore he would rather have it cut off' (Henry, 132).

Apparently the native people presented themselves for treatment on occasion. In 1808, Simon Fraser noted that :

'Three or four [Indian] children, who were unwell, were brought to me by their parents for medical assistance. As I did not think fit to disappoint them, I sent one of the gentlemen for a vial of Turlington. He brought me Laudanum....' (Fraser, 119).

Fraser mixed it with water and dabbed it on the children's foreheads.

While at Kootanae House in 1807, David Thompson noted that he 'gave Turlington to those [Indians] afflicted with this endemic distemper, which seems to relieve them a little' (Thompson, Columbia, 64). Alexander Mackenzie also used Turlington's to treat a sick Cree. (Mackenzie, 233n)

Alexander Henry the elder leaves us with this rather interesting comment from 1763 :

'Bleeding is so favorite an operation among the [Indian] women, that they never lose an occasion of enjoying, whether sick or well. I have sometimes bled a dozen women in a morning, as they sat in a row, along a fallen tree, beginning with the first—opening the vein—then proceeding to the second—and so on, having three or four individuals bleeding at the same time' (Henry the Elder, 115).

These examples from the journals record a litany of ills that one would expect from life in the wilderness—aches and pains, cuts, gunshots, broken bones, and frozen extremities. Scurvy is mentioned only once (at Astoria), and smallpox among the whites only rarely. It is interesting to note that venereal disease seems to have been the scourge of some of the posts.

In general, the men seem to have been remarkably healthy. The major cause of death seems to have been drowning. Accidental gun shots come in a distant second. The one cause of death which has not appeared in any of the primary sources that I have read is that of hernia, except as a passing reference to it made by one of Simon Fraser's men (Fraser, 207). I find it odd that if death by strangulated hernia was so common, then why aren't such deaths mentioned when deaths due to other causes are faithfully recorded?

Secondary sources tend to state that the most common causes of death amongst the voyageurs were hernia and drowning (Newman, 25-26, Nute 46-47, Morse 5). Unfortunately they do not cite their references. This makes me feel a little bit concerned that this 'everybody knows that voyageurs dropped like flies from strangulated hernias' might not stand up to closer scrutiny (like the 'pile the furs up as high as the gun' myth). At this point I don't have enough data to know what the truth is, however, I will keep looking. If any club members can shed some light on this subject (like 'read this, dummy...') then please let me know!

Franchère, Gabriel. A Voyage to the Northwest Coast of America. Milo Milton Quaife (ed). Lakeside Classics : Chicago, 1954.

Fraser, Simon. The Letters and Journals of Simon Fraser, 1806 - 1808. W. Kaye Lamb (ed.). Macmillan : Toronto, 1960.

Henry, Alexander (the Elder) Travels and Adventures in Canada and the Indian Territories Between the Years 1760 and 1776. James Bain (ed.) Hurtig : Edmonton, 1969.

Henry, Alexander (the Younger). New Light on the Early History of the Northwest : The Manuscript Journals of Alexander Henry... Elliot Coues (ed.) Reprint-Ross & Haines : Minneapolis, 1965. Originally published 1897.

Johnson, Alice M. (ed.) Saskatchewan Journals and Correspondence : Edmonton House 1795-1800, Chesterfield House 1800-1802. Hudson's Bay Record Society : London, 1967.

Mackenzie, Alexander. The Journals and Letters of Sir Alexander Mackenzie. W. Kaye Lamb (ed.) Cambridge University Press : London, 1970.

Morse, Eric W. Fur Trade Canoe Routes of Canada : Then and Now. University of Toronto Press : Toronto, 1969.

Newman, Peter C. Caesars of the Wilderness. Viking : Markham, Ontario, 1987.

Nute, Grace Lee. The Voyageur. Reprint - Minnesota Historical Society : St. Paul, Minn., 1987. Originally published 1931.

Ross, Eric. Beyond the River and the Bay : Some Observations on the state of the Canadian Northwest in 1811... University of Toronto Press : Toronto, 1970.

Thompson, David. Columbia Journals. Barbara Belyea (ed.) McGill-Queen's : Montreal, 1994.

Tyrrell, J. B. (ed.) Journals of Samuel Hearne and Philip Turnor. Reprint : Greenwood Press : New York, 1968.

Wilbur, C. Keith. Revolutionary Medicine, 1700 – 1800. Globe Pequot Press : Old Saybrook, Conn., 1980.