"Medicine in the Developing Northwest and Montana", 29 September 1978

• Main Author: Bodemer, Charles W.
• Other Authors: University of Washington Libraries, Special Collections
• Format: Other/Unknown Material
• Language: unknown
• Subjects: Pacific; Indian; Northwest Passage; Seymour; St. Louis; Charity; Jules; Gulch; Mull; Saloon; Cape Horn; Perseverance; Yankee; Wendell; Verne; Great Falls; Lister; Sacred Heart; Perce; Bridger; Vigilante; Northwest passage
• Online Access: http://cdm16786.contentdm.oclc.org:80/cdm/ref/collection/pioneerlife/id/27199

In this paper, Dr. Bodemer outlines the history of the practice of medicine in the early days of the Pacific Northwest, from the 18th century through the 19th century. He gives special attention to the practice of medicine in Montana during that time, writing, "Many changes occurred between the time of the Association's first annual meeting a hundred years ago and the end of the century that witnessed Montana's transformation from an unexplored wilderness to one of the United States. At the beginning of the twentieth century, medicine in Montana rested upon an organized base, not only at the state, but at the county level. The conditions, existing institutions, and--importantly--the desires of the profession, favored the continued development of improved health care for the population." MEDICINE IN THE DEVELOPING NORTHWEST AND MONTANA •i;" "Today's ChMciiXfi' The trouble something right the firit time isE that nobody appreciates how^ hard it was, r -• - 29 September 1978 Charles W. Bodemer Biomedical History University of Washington Seattle, WA 98195 MEDICINE IN THE DEVELOPING NORTHWEST AND MONTANA In 1778 Captain James Cook entered the waters of the Pacific Northwest and accidentally discovered that furs purchased for trinkets later sold at great profit in China. The Great Fur Rush started by this discovery had a determining influence on the international balance of power and shaped the subsequent history of the Northwest. In the late eighteenth century the North Pacific lay open to the most aggressive of the three competing powers, Spain, Russia and England. The United States soon entered the contest, as American fur traders flooded into the area following the Revolution. One of the most important of these sea peddlers was Captain Robert Gray, whose voyages established the Yankee trade triangle, which sent ships from Boston to the Northwest, where gimcracks were exchanged for furs later traded in Whampoa for silks, porcelain and tea for transport back to Boston. Gray was important for another reason. In 1792, commanding the Columbia, Gray risked the bar and heavy breakers to enter the mouth of the Columbia River. His cool Yankee blood was more heated by the furs he obtained through this act of daring seamanship than by his discovery of the mightiest river west of the Mississippi. But, recognizing Spain's receding pretensions, in he landed, and, with characteristic New England clarity, resolved the ambiguous ownership of the region by claiming the entire valley of the Columbia for the United States. This act was of great significance within a few years, when the area the Spanish had not appreciated enough to name more than "the coast to the north of California" became "Oregon" and Britain and the United States competed for its control. The same year that Gray entered the mouth of the Columbia, Jacques D'Eglise, a French trader in the service of Spain, traveled to strategic villages of the Mandan situated on the Missouri River. He found that British Canadian traders had already entered the area, and he heard tales of an upper river and a mountain range to the west. The Missouri was the best remaining hope of a river route to the Pacific, a Northwest Passage. The Spaniards had now reached northward to the bend of the Missouri and British traders were within a hundred miles of the northern border of present Montana. Both countries were interested in extending the sphere of their activities and control, but it was the Americans who opened and pressed a claim for the Pacific Northwest. Thomas Jefferson had visions of a transcontinental national empire, and he therefore wanted to thwart British influence in upper Louisiana and to beat the Canadian explorers to the Pacific Northwest. Thus the Lewis and Clark Expedition, which crossed the Northwest and reached the Pacific Ocean in November 1805. The Expedition was of great significance to the future development of the United States. Among its accomplishments, the expedition countered the British Canadian thrust into thQ Northwest, and it gave the United States a valuable claim to the Columbia Valley, reinforcing that established by Gray. Finally, it ended the persistent hope for a Northwest Passage that had dominated thought since the sixteenth century. Importantly, it revealed the immensity and the wealth of the far Northwest and advertised its potential to the nation and the world. Journals and reports of the expedition spoke with special enthusiasm about the lucrative resource of the region. The upper Missouri, they said, "is richer in beaver and otter than any country on earth." The early Northwest fur trade revolved about the sea otter and maritime traders, and it was therefore coastal in orientation. The sea trade remained, but there was now a rush into the Northwest from the east of individuals and organizations anxious to exploit the fur-bearing fauna of the inland region. The fur trade, developing and operating against a backdrop of international competition and maneuvering, determined the early development of the Far Northwest. * * * Montana was a late discovery. Lewis and Clark were the first whites to write of it, and most of the Indiana living there at that time had moved into the area only after 1600. The new interest in furs brought the region into prominence, and British and American interests competed for control of the Oregon country and what had heretofore been pictured as the Great American Desert. The Northwest Company did much to establish a British presence in the Northwest. Primarily as the result of the work of David Thompson, the Nor'westers had a network of posts extending west beyond the Rockies into the Lower Columbia Basin that placed them in control of the fur trade of the upper Columbia. After the War of 1812 eliminated brief American competition, the Nor'westers expanded in all directions. Eventually, in 1821, the Company merged with Hudson's Bay Company, and the newly organized Columbia Department included what is now Oregon, Washington and northwestern Montana. Thus during the second quarter of the nineteenth century, Montana was dominated by British fur trading elements in the west and in the east by American fur interests, especially Astor's monopolistic American Fur Company. The fur trade began to decline during the 1830s as changing fashions in Europe and the eastern United States reduced the demand for beaver pelts, By mid-century the fur trade was no longer the dominating force in Northwest history, but it had profoundly influenced the development of the region. It had contributed much to exploration and widening of geographical knowledge and to a limited development of the Northwest. As an instrument of empire, the fur trade gave the Americans firm control of eastern Montana, and, for a time, it gave the British control of most of the Oregon country. In 1846 the British government ceded to the United States all the land below the 49th parallel, but for decades before then British dominance of the Pacific Northwest was virtually complete. It was personified in John McLoughlin, Chief Factor of Hudson's Bay Company's Columbia Department from 1821 to 1846. For a time McLoughlin was the only bona fide physician in the entire Pacific Northwest, and he was the first resident physician in the territory during the nineteenth century. It might be supposed that McLoughlin developed some kind of medical service within the Columbia Department. He was, however, first and foremost a fur trader; medicine had never been more than a means of entry into the trade. His scale of values is perhaps best illustrated by an event in 1832, when, as the only physician in the Fort Vancouver area, he had to concern himself with treating large numbers of patients during an epidemic of fever and ague. A clerk wrote that McLoughlin had to function in this capacity, "although he greatly disliked it." McLoughlin's only comment upon this severe epidemic was that of a fur trader, not a healer. "For a time," he wrote, "it put a stop to our entire business." Most of McLoughlin's medically related activities was the composition of letters to the Company requesting relief from his medical duties, and when Drs. Tolmie and Gairdner arrived in 1833, he retired permanently from the profession, It's not surprising, then, that no well-defined medical service was established within the Columbia Department. People near Fort Vancouver or Fort Nisqually had access to a trained physician, but those located in the interior and the posts on the upper Clark Fork and Kootenai tributaries of the Columbia were left to their own devices. * * * The fur traders might be essentially businessmen with the charisma of an adding machine, but the trappers were a colorful breed. The exploits of such mountain as Jedediah Smith, Kit Carson and Hugh Glass captured the public imagination and placed them prominently and permanently in the national mythology. They spent most of their lives alone or in small parties hundreds of miles from any semblance of civilization and provided their own medical care. Their do-it-yourself medicine was as rough-and-ready as their tumultuous—one might say bacchanalian--annual rendezvous on the upper Green, Snake or Bear rivers. From the Indiana the trappers learned of herb teas, poultices, sweat-baths, a hunting knife and, especially, whiskey: with these and an incredible sang-froid the mountain men faced disease and injury, generally alone in the wilderness, and got along as best they could. It seems that not much more was necessary, for they were generally young and very healthy. Ashley reported that the mountain men suffered only from "slight fevers produced by colds or rheumatic afflictions contracted while in the discharge of guard duty on cold and inclement nights." Their isolation certainly promoted their health; the influence of their diet can only be estimated. Mountain men substituted cherry root tea for coffee and ate thinly sliced bread root sprinkled with gunpowder. An early physician, Lewis Moorman, confirmed Ashley's remark that their primary diet was fresh meat. This meant, he wrote, "Panther meat, then beaver tails boiled, unborn buffalo calves before they hair over. rattlesnakes like a long chicken neck only thinner, skunks and goats. Then there Is buffalo. The whole critter, mind you, barring hide, hair, horns and hoofs. Red muscle meat will do you In the settlements, maybe, or where you can get plenty of greens and vegetables. But on the prairie you will have the cow's Insldes for choice marrow, lights, heart and tongue, warm liver spiced with gall, and best of all, guts--pla1n guts--and raw at that." The mountain men thrived on such a diet. Ashley commented that In one four-year fur expedition In the Northwest he didn't lose "a single man by death except those who came to their end prematurely by being shot or drowned," The trappers were apparently too tough and too mean to succumb to disease, and the failure of the fur companies to develop a recognizable medical system seems to have had little effect on the rugged Individualists operating at the beginning of the fur trading operation. * Christian missionaries had long been In the forefront of New World settlement, and seldom was the Impulse to heed the Macedonian Call felt more strongly than early In the nineteenth century. Thus It was that the vast unsettled Northwest became an arena where the bearers of white Christian civilization struggled for the souls of the Far Western Indians and, while they were about It, relieved them of the responsibilities of real estate management. Following a visit of some Northwest Indians to St. Louis during the 1830s, the Methodists sent Jason Lee and a small group to found the first Protestant mission In the Oregon country. This Willamette Valley mission became the nucleus of American colonization, and Its attraction started a slow stream of settlers westward across the plains. Some made the trip after reading The Far West, by the Reverend Samuel Parker, who. like Lee, believed that civilization follows Christianity. It was the Reverend Parker who recruited Marcus Whitman from his medical practice in upstate New York for missionary service in the Oregon country. In 1835, to confirm the desire of the Northwest Indians for Christian salvation, Parker and Whitman went up the Missouri with Fontenelle's brigade of fur trappers. The trappers found Parker's demeanor, appropriate to his schoolmaster coat and plug hat, and Whitman's teetotalling religiosity amusing, and, although Whitman did his share of the heavy labor, both men were subjected to considerable abuse. The trappers' attitude toward Whitman began to change in June, however, when they were faced with cholera. The physician diagnosed his first case of cholera there in the wilderness and so managed the outbreak that only three of the more than fifty men in the party died from the disease. Whitman's reputation among the trappers rose to even greater heights after the party had crossed the Continental Divide. They reached the Green River just in time for the annual rendez vous of the mountain men. Amidst a typical rendezvous scene, which surely impressed the two missionaries as a Cecil B. DeMille production of the last days of Sodom and Gomorrah, Whitman was asked to remove an arrowhead from the back of the legendary mountain man, Jim Bridger. Bridger had carried this memento of Blackfeet affection for three years, but Whitman was able to extract it with the aid of his surgical instruments and an ample supply of whiskey-qua-anesthetic. Parker described the operation: "It was a difficult operation because the arrow was hooked at the point by striking a large bone, and a cartilaginous substance had grown around it. The Doctor pursued the operation with great self-possession and perseverance, and his patient manifested equal firmness." A large crowd of trappers 8 watched the operation. They may not have appreciated the fact that they had observed the first operation west of the Rockies performed by an American-trained physician. Many of them, however, appreciated the fact that they, too, carried about in their bodies extraneous pieces of metal and that they could provide the necessary jugs of anesthetic. Thus Whitman was kept busy extracting bullets and arrowheads from the tough hides of the mountain men assembled at the rendezvous. Nonetheless, he was able to meet with some Flathead and Nez Perce Indians and to convince himself that they indeed desired Christian missionaries. The following year Whitman and his new wife, Narcissa, established a mission among the Nez Perce and Cayuse at Waillatpu, near Walla Walla. Whitman practiced much medicine there, but his greatest influence was in encouraging westward migration. The mission became an important rest stop for the increasing numbers of immigrants to the Northwest. Whitman contributed decisively to the westward movement when, in 1843, he organized a train of about a thousand people and led them from Missouri to the Oregon country. This migration opened the Oregon Trail and started the massive movement of people into the region. The flood of immigrants was one reason for the Whitman Massacre in 1847, when the Whitmans and fourteen other whites were killed in an Indian attack upon Waillatpu. This massacre ended the missionary period in Northwest history, but it also prompted Congress to creation of the Oregon Territory in 1848. * * •* The Roman Catholic Church, too, was active during the period of intense Protestant activity. Indeed, in that region destined to become Montana, they were more influential than the Protestants. The Flatheads were responsible for this. Many trappers and traders in western Montana after 1808 were French-Canadian Roman Catholics, and from the Iroquois they brought with them the Flatheads learned of the "black robes" and their religion. The Flatheads and the Nez Perce were both enthusiastic and persistent in their search for missionaries. Their trips to St. Louis for this purpose brought missionaries to the Oregon country, but not to the eastern Rockies. Their fourth trip, however, provoked the entrance of the Jesuits into their part of the Northwest. In 1841 Pierre-Jean DeSmet, Gregory Mengarini and Nicholas Point went to the Bitterroot Valley and started construction of St. Mary's Mission, one of the birthplaces of Montana history. Roman Catholic missions, unlike those of the Protestants, generally had no medical orientation. This may have reflected the primary thrust of each group's missionary effort. The Roman Catholics were interested in spreading the faith through conversions, whereas the Protestants were more oriented toward establishing Christian civilization through settlement. Consequently, the Protestant missionaries tended to establish a fixed base among the whites, and the Roman Catholics were somewhat more peripatetic and oriented toward the natives. The lack of medical orientation of Roman Catholic missions may also have related to the Order involved. The Franciscans, for example, were the vanguard of the Church in California, and they didn't do so much as develop a medicinal herb garden. In the Northwest, however, the Jesuits were the most prominent missionary influence, and directly or indirectly, they contributed to the development of medicine and its institutions in the region. The co-fQunders of St. Mary's Mission, Mengarini and Point, had some medical knowledge and made medicine part of their activity. Mengarini was mentioned for his skill in medicine and surgery, and Point gained a reputation 10 as a "medicine man" practicing among the Blackfeet and Gros Ventres. They were soon joined by an Italian Jesuit who had studied medicine at the University of Padua, Anthony Ravalli, the first physician to make Montana his field of medical service. After his recruitment by DeSmet in 1843, Ravalli sailed around Cape Horn to the Pacific Northwest. Working briefly with the Pend d'Oreille and Colville Indians, he arrived at St. Mary's Mission in 1845. He quickly demonstrated his multitalented facets, constructing the first flour mill and saw mill in Montana, and building a still to transform camas root juice into alcohol for "medicinal purposes." Ravalli's studies in chemistry and botany were applied in other ways to the natives' health. He learned the medical properties of indigenous plants and improved Indian remedies by standardizing them, preserving them in alcohol, and prescribing suitable dosages. He brought some traditional medicines with him and always included other remedies in orders for supplies. St. Mary's mission was closed in 1850, and Ravalli was sent to the Sacred Heart Mission, where he continued his medical work among the Coeur d'Alenes. Later he went to the Colville Mission, winning a great reputation as a "medicine man" before he was transferred to California. In 1863 he returned to Montana, serving the medical needs of a large area around St. Peter's Mission in Sun River. Finally, in 1866, he returned to the Bitterroot Valley and re-established St. Mary's Mission. He visited patients in the immediate vicinity and operate a dispensary until his death in 1884. He was eulogized by the Butte Miner as "the grand old physician and religious healer of the Bitter Root Valley," a splendid example of a dedicated medical missionary important to early Northwest medical history. It seems appropriate 11 that Washington has a Whitman County and Montana a Ravalli County, contemporary reminders of the missionary physicians in the Northwest. Physicians other than those associated with the fur companies and missions periodically filtered into the Northwest during the early nineteenth century. Actually, the first trained American physicians to arrive in the Oregon country were physicians for government exploring expeditions. They were transients and contributed little to the development of medicine within the area. Thus the first physician to enter the boundaries of present-day Idaho was Jacob Wyeth, who arrived with an expedition at Pierre's Hole in 1832. His two-fold problem, dislike of the area and diarrhea, made him literally run from the country. In 1853 General Isaac Stevens was appointed Governor of the Washington Territory, and he was instructed to explore for a railway to the Pacific on the way to his assignment. William Stuckley, later assistant surgeon of the army, accompanied the expedition as "surgeon and naturalist," but his reports reveal that he was more dedicated to collecting "fauna and flora" than to treating patients. A final noteworthy example of the military surgeon is James A. Mull an, who was sent to the Northwest in 1860 to care for men building the Fort Benton and Walla Walla Military Road, commonly known as the Mull an Road. He dealt with scurvy among the men in an effective manner, using fresh vegetables and vinegar; other than that, there seems to have been little challenge to his abilities, * * * At mid-century there was still little inducement for physicians to settle at the fringes of Washington Territory. This began to change during the 1860s. The California Gold Rush brought many people to the West, and its effects were felt far to the norlh and east. In the Oregon Territory there was a new demand for lumber and foodstuffs, and white settlement 12 increased as many immigrants chose to develop their futures in that region. Neveda and Colorado, too, experienced gold rushes, and men crisscrossed the intermountain west with increasing frequency. These early centers of gold mining opportunity began to fade after a few years, and by the 1860s prospectors were clambering about the western slopes of the Rockies looking for gold and short-cuts through the Bitterroot barrier. Thus it was that Montana's first major gold rush began in the summer of 1862, with the discovery of sizable deposits of placer gold in a tributary of the Beaverhead River. Here, at "Grasshopper Diggings," sprang up Montana's first boom.town, Bannack City. Bannack was crowded by the end of that first summer, and newcomers, seeking their own diggings, soon struck deposits at Alder Gulch, seventy miles to the east. The opening of Alder Gulch prompted the greatest placer rush of Montana's history and, along with later discoveries, left an indelible mark on the territory. The gold rush lasted only a few years. Towns came into being and as quickly died. Centers of population shifted as new diggings and new technologies developed. Eventually gold gave way to silver, and silver to copper. At the end of several decades, Butte and Helena remained as major communities, and a well-defined community had come into being in the territory. Fifteen hundred physicians joined the California Gold Rush, not to practice medicine, but to strike it rich. The mining camps of Montana also became a magnet to physicians, almost all of whom were prospectors who incidentally practiced medicine. They followed the settlements that accompanied the discovery of gold. Thus, among the thousand prospectors in Bannack during 1962-63, there were twelve men who called themselves 13 "doctor." Following the Alder Gulch strike, Bannack was quickly deserted, and the twelve healers followed the crowds to the richer strike. By 1865 there were 15,000 miners in the Gulch, and the Bannack physicians had been joined by ten more practitioners. Last Chance Gulch, to which the miners gave the name Helena, became the trade and medical center for mining camps extending along the eastern slope of the Rockies and west of the Missouri. More than twenty physicians lived in the settlement of 1200 people. East of the Missouri, where there were some of the richest gold strikes in Montana, the important settlement was Diamond City in Confederate GuUh. For the 5,000 miners there and those in neighboring gulches during the 1860s there were as many as six physicians. The gold rush physicians came from diverse locations: the southern, northeastern, and middle states of the United States, Europe and Asia. Their reasons for coming to the Northwest were equally diverse. Very few came for purely professional reasons. Most were seeking their fortune. Some were in search of their health. The West tempted many who had a spirit of adventure. Financial, domestic and other troubles induced others to leave the more settled areas. In the southern and border states the Civil War had created conditions making it impossible for some physicians to remain. Foreign physicians came to the area primarily because of personal troubles, hardships and poor pay in their native lands. Some were remittance men, paid by their families to stay across the Atlantic. In Montana there were many miners of foreign origin who offered a field for professional service and help in mining that made the gold rush attractive to many foreign physicians. The gold camp physicians told nothing of themselves or their training, and ordinarily no one would inquire. All that was expected was for a man to 14 say he was a doctor and to show a medical kit. Even this wasn't always necessary: when word spread that a miner was a physician, he would be called upon to treat the sick and injured. His success with his first patients determined his reputation. If he failed his practice was done, and he was encouraged to occupy himself full time panning and sluicing. This tended to eliminate or at least to minimize the effects of the grossly incompetent and/or fraudulent healer. There was usually something for the physician to do in the mining camps, although he was never certain of payment. Violence was routine in the gold fields. Between 1849 and 1856 miners extracted 600 million dollars in gold from the California Mother Lode, and during that time they spent 6 million dollars on Bowie knives and pistols. And they used them. During the first five years of the Gold Rush there were 4200 murders and 1400 suicides in the California mining camps alone. A mining-camp physician lived elbow to elbow with trouble, and his practice tended to be somewhat special ized. Much of his concern was with injuries sustained at the mining sites, gunshot and knife wounds sustained almost anywhere, and venereal disease sustained in the social setting of the hurdy-gurdy girls. The gold rush physician often had to function under trying circumstances Consider an incident involving Drs. Jerome Glick and Ira Maupin of Helena, One day they galloped to Oro Fino to find three badly wounded men lying in the snow. The mine's manager and a rival had simultaneously shot each other near the heart, and the manager's son had been hit in the wrist, In below-zero weather they staunched the bleeding and probed for the bullet in the manager's chest and amputated his son's arm. They weren't able to save the rival, but they did keep a family unit intact. 15 Outside the mining camps the environment was even more lawless. Bandits roamed at will, and they had distinctive ways of dealing with physicians. Once the sheriff shot Montana's most famous bandit, Henry Plummer, in the trigger arm. Dr. Glick, then in Bannack, was taken to the bandit's hideaway, where he saw that the bullet had passed down the arm from the elbow, shattering the ulna and radius and making the wrist useless. The physician recommended amputation. Plummer was opposed to this action: he could ill afford to lose his shooting arm. Two pistols at his head made Glick elect a more delicate operative procedure. He painstakingly pieced together the fractured bones, only to have the bandits hold him hostage until Plummer's recovery was assured. Two months postoperatively, Plummer's arm was functional, and he could go gunning for the sheriff, who, it may be assumed, was not overwhelmed by Glick's surgical achievement. Some physicians were rousing drinkers themselves. In Red Mountain City, Seymour Day practiced medicine and surgery, in which he had an excellent reputation, worked a mining claim, and indulged his favorite hobby, hard liquor. When faced with a patient. Day would dose himself with three tablespoons of black pepper mixed with whiskey, presumably achieving instant sobriety. At any rate, he said it was good for his blood. In Helena, the equally Falstaffian Dr. Joseph Claridge was made of weaker stuff. One night he made a bet that he could drink an unreported number of glasses of whiskey without getting drunk. He put down four large tumblers of raw whiskey, walked out of the saloon, and fell face down in the dirt. He died the next day, truly in good spirits and in no need of embalming. The gold mining camps were the stimulus for development of organized government. Missoula County, which included the gold camps in Clark Fork Valley, was organized as part of Washington Territory in 1860. The 16 territory east of the mountains, however, remained part of Dakota and without government. Troubles in these camps led to formation of Idaho Territory in 1863, leaving only the immense Bighorn country without government. Finally, disorders incidental to the lack of government led to creation of a separate Montana Territory in 1864. The new Territory had a population of 12,000, which increased within five years to 20,600 individuals, 9S% of whom were males. The gold rush was essentially over by 1870. It had been a turbulent period, but the basis of community had been established. The desire for an orderly, stable society had long been there, sometimes resulting in vigilante action. The depth of this desire is well illustrated by the citizens of Bannack who, on one day in 1864, hanged twenty-three outlaws for a total of one hundred two murders—and started a school. The gold rush population was in constant motion. The early physicians, too, moved frequently. Many had as many as four locations during the gold rush. Some never became identified with a specific corranunity and practiced in many. Many who came left without a trace of their presence. The transience of the majority of them notwithstanding, the gold rush physicians were distinctive personalities, each with special problems and functions in the gold camps, and each made his contribution to his community or communities. The physician often played a prominent role in bringing order to the frontier. Thus in one of the first miners court trials the judge was a physician and he was assisted by two other physicians as associate judges. Of the gold rush physicians, five served as judges in miners courts, five became probate judges, eight coroners, two sheriffs, two county treasurers, and two superintendent of schools. This pattern remained. Among the later physicians some served as county commissioners, justices of the peace and mayors, A large number were, naturally, county physicians and county health officers. One became secretary of state, another was candidate for Congress and Chairman of the Democratic state central committee. Eight physicians were members of the legislature, and three served in the constitutional conven tions of 1884 and 1889. * * I have used the term "physician" to designate those individuals on the frontier who called themselves doctor and practiced some form of medicine. This is somewhat misleading, for the Northwest frontier was heavily populated by varieties of healers that represented a smaller proportion of the medical profession in the more settled East. Unorthodox and irregular practitioners, quacks and curealls were a significant part of the medical manpower of the frontier until the end of the nineteenth century and the development of registration laws and licensure requirements. It should be remembered that the frontier "doctor" was not necessarily trained in any formal sense, and if he did have training, it was not necessarily for the practice of orthodox, or allopathic, medicine. During the nineteenth century, medicine in its allopathic form was less than triumphant anywhere in the world, and around mid-century it entered into a period of therapeutic nihilism. Polypharmacy resulted from the conjunction of this attitude and the availability for the first time of drugs of kiown quality and quantity. The resultant indiscriminate use of drugs prompted Oliver Wendell Holmes' remark that "if all the medicines were thrown into the sea it would be so much the better for mankind and so much the worse for the fishes." In the United States polypharmacy became part of "heroic" medicine, which relied upon bleeding, sweating and the use 17 18 of drugs to induce vomiting and diarrhea. It presumed symptoms must be treated, and when the symptoms were no longer apparent the disease was cured. The patlnet was subjected to an array of emetics, cathartics, cupping, bleeding, calomel, and other drugs In large dosages. The reaction against heroic medicine gave rise to many unorthodox medical sects and their acceptance by a large segment of the American public. The largest unorthodox medical sect on the Northwest frontier was homeopathy. The homeopaths operated on the general theory that a medicine which causes the symptoms of a disease Is effective In treatment of that disease. Their primary therapeutic regimen was the administration of drugs In Infinitesimal dosages. The eclectics were also well represented. They claimed to use the good part of all medical systems. Including Indian medicine. They opposed the use of calomel and abuse of the lancet, The eclectics advocated specific medication, the prescribing of certain drugs for certain symptoms, replacing many regular drugs with others with the same physiological effects. There were also Thomsonlans, who rejected blood letting and cupping and swore by herbal treatments and steam baths. In the course of treatment a Thomsonlan might employ lobel1a--a favorlte-- tea, sage, castor oil, and rhubarb. Hydropathy was also represented on the frontier. This system relied upon the curative effects of copious quantities of water. Internally and externally. There were also galvanotheraplsts, physlomedlcal therapists, mental therapists, sanitarians, and yet others who didn't subscribe to any particular medical doctrine. Unorthodox and Irregular practitioners, quacks, and curealls notwith standing, the allopath was the dominant medical man on the Northwest frontier. The bag of the allopathic physician contained medicines arranged according 19 to their functional capacities. It held emetics, diaphoretics, cathartics, diuretics, alteratives, tonics and stimulants. It might also include narcotics and sedatives, such as "opium, camphor, ether, musk, castor, henbane, ratsbane, dogbane, and diverse other banes." Generally the physicians prescribed cathartic for inflammations of the bowels, including cancer, appendicitix and colitic, emetics for stomach ailments, and calomel for biliousness and liver complaints. For diarrheas and dysenteries a common treatment was opium in large dosages and a bland diet. Chronic dysentery might be attached with Elliotson's pills of copper and opium aided by enemas of zinc and alum. With the aforementioned medicines and a surgical kit the frontier physician attempted to cope with a host of unknown diseases. In Montana he was faced with many fevers. So-called "mountain fever" was prevalent until 1880. Typhoid was common. Smallpox often accompanied boats coming up the Missouri en route to Fort Benton. Fevers were generally poorly understood and they were classified according to prevailing medical nosology as intermittent, remittent and continuous. Typhoid was often called ardent fever, typhus applied to a fever with a punctate rash, and was also known as nervous fever and camp fever. The term "congestive" fever signified fever with associated presumed congestion of the internal organs, and it was used to describe any severe case of fever of whatever type. There were other specific febrile diseases designated according to the specific clinical picture: measles, influenza, smallpox, spotted fever, and puerperal fever, to name a few. The cause of fevers, whatever their clinical manifestations, was generally thought to be miasmatic in origin, and their treatment varied only slightly according to the specific manifestation. The sovereign remedy 20 for fevers was quinine, available either as powdered Peruvian bark, usually dissolved in wine, or as isolated quinine sulphate. Calomel, second only to quinine, was the most commonly used drug, and it was given in dosages of 20 to 30 grains a day. Purgation with calomel and the exhibition of quinine was the most popular regimen for treatment of fevers. Other measures were used. The lancet was employed, especially if the physician perceived "an excess of arterial action." Tincture of opium in doses of 30 or 40 drops was given beginning four hours prior to expected chills followed by quinine for a day or two. Emetics such as ipecac were commonly employed. Diuretics and diaphoretics such as potassium nitrate also entered into treatment, A popular therapeutic combination was 8 or 10 grains of potassium nitrate, 1/8 grain of tartar emetic, and 1/4 to 1/2 grain of calomel administered every two or three hours. The supply of drugs was limited and shipments were uncertain on the frontier, so the physician tried to keep a large supply on hand. Frequently he owned a drugstore or had an interest in one, exercising considerable control over purchases for the establishment. He also usually had proprietary remedies, sold under trade names. The drugstore, regardless of ownership, played an important part in frontier settlements. Each large mining camp, for example, had at least one drug store, always stocked with many patent medicines popular during this time of self-treatment. There, according to the demands of his self-diagnosed complaint, the customer could select among the serried bottles such proprietary remedies as Hotstetter's Celebrated Stomach Bitters, Parr English Pad, Certain Cure for All Malarial or Contagious Diseases, Hamlin's Wizard Oil, for Liver Complaint, Constipation, and All Disorders of the Stomach and Digestive Organs, Gray's Rheumatic Cure, and Dr. Goodman's American Anti-Gonorrhoea PilIs. 21 Interestingly, frontier physicians seem to have had little faith in anesthetics, and, even during the second half of the nineteenth century, they tended to rely upon large quantities of whiskey instead of ether and chloroform. They seem also to have practiced little preventive medicine, except for smallpox vaccination. They had little encouragement in this regard from the community. The frontier population generally accepted epidemics of measles, scarlet fever, and diphtheria without making any significant effort to ward them off, and there was no application of the concept of quarantine. This was not so great a problem during the early years, when the population was relatively small and predominantly adult males. But conditions began to change after 1870. * * * Montana had settled down by 1870, after the turbulence and rapid changes of the gold rush. Population had shifted in the mining areas from transient gold diggers' camps to established towns and cities. Mining had changed its character, and the wandering individual prospector was replaced by large mining companies, engineers, managers and laborers, who settled into the towns where they worked. The newcomers often brought their families with them or established families soon after their arrival. They settled into one place and they stayed there. Montana was, however, still very much frontier territory. Settlement in the great plains region east of the mountains was delayed during the 1870s by the Indian Wars, culminating in the Battle of the Little Bighorn in 1876 and Sitting Bull's surrender in 1881. Another disturbing factor was the march of Chief Joseph and the Nez Perce across Montana. This did have one positive effect. During the Battle of the Big Hole in 1877 almost 40% of 22 the American troops were killed or wounded. Physicians from Virginia City, Deer Lodge, Butte, Philipsburg and Helena came to their aid, and their devotion to service did much to raise them to a position of respect they had not previously known. The rapid growth of population soon after 1880 was accelerated by the coming of railways. The railroads expanded the population of towns along their routes and developed new towns of importance. Aconsiderable population of farmers and ranchers flov/ed into the region east of the mountains. The railroads and the development of farming and ranching gave new importance to or resulted in the establishment of such communities as Missoula, Bozeman, Billings, Miles City, and Great Falls. These were new areas for physicians to serve, and their growth brought physicians into the Territory, The population of Montana more than trebled from 1870 to the close of the territorial period in 1889. The population grew most rapidly in the cities which became the centers of mining, industry and trade. During this period physicians moved to the cities and forsook other activities, such as mining, to practice their profession on a fulltime basis. Moreover, beginning with the surgeons, specialization began to occur in the urban centers. Most of the population and most medical practitioners concentrated in the in the cities. The rural population, particularly in the range area, was scattered over thousands of miles of range lands. A pattern was established that has remained problematical to the present time: great areas remained without adequate medical care. The development of large cities and associated demographic changes gave rise to new medical concerns. It's not that there weren't enough of the old ones. Many of the diseases of the gold rush persisted and continued to 23 defy understanding. "Mountain fever," which had not yet been dissected into malaria, typhoid and various other infections, was still most often treated with a strong decoction of sage tea, an old Indian remedy, and whiskey, an old mountain man remedy. The causes of spotted fever remained unknown until well after the territorial period. Tuberculosis was misunderstood and common, accounting for approximately 6% of all deaths in 1880. Typhoid fever was prevalent. Smallpox occurred in serious epidemic form. Cancer, rheumatism and colds were common and resisted effective treatment. Urbanization and the changed nature of the population made epidemic diseases and the diseases of childhood more common. Scarlet fever, diphtheria, whooping cough, and measles became prevalent during the 1870s, as the proportion of children in the population increased. These diseases were not managed well by either physicians or communities. Quarantine laws were nonexistent, and schools stayed open even during epidemics. Those physicians who tried were generally unable to persuade parents to keep their children at home. Not surprisingly, severe epidemics swept the entire Territory in 1873-74 and 1877-78, resulting in the deaths of many children. * * When communities reach a certain size they recognize the need for social services and hospitals. These were somewhat slow to develop on the frontier, but, beginning with St. Joseph Hospital, opened by the Sisters of Charity of Providence in Vancouver in 1858, hospitals were established throughout the Northwest during the second half of the nineteenth century. In Montana the military had hospitals associated with their forts since the 1860s, but, with the exception of Fort Missoula, their location was such that they were not too useful to the civilian population. The first hospital for Indians was established by the ubiquitous Sisters 24 of Providence at St. Ignatius Mission in 1864. Two years later the first hospital for general use was established by the citizens of Helena, then Last Chance Gulch, to provide aid and hospital service for "sick and helpless miners." Miners Hospital was soon replaced by a tax-supported hospital which cared for the county's sick and insane until St. John's Hospital opened in 1873. That same year the first general hospitals opened in two other communities: St. Patrick's in Missoula and St. Joseph's in Deer Lodge. It was in the latter that wounded soldiers were treated after the Battle of Big Hole. Hospitals opened throughout the Montana Territory during the 1870s and, especially, the 1880s. Even the railroads built some. The hospitals made it possible for physicians to treat patients more effectively than before. It was not simply the existence of these institutions that accounts for this. Medicine itself underwent revolutionary changes during these decades. The cell theory and the concept of cellular pathology were firmly established, anesthetics replaced whiskey even on the frontier, the Lister system of antisepsis was adopted by many surgeons and hospitals, the germ theory of disease and the concept of immunity were in the process of formulation, and the X-ray would soon supplement already improved diagnostic, analytic and surgical techniques. In the hospitals, then, the physician and surgeon of the late territorial period was able to apply the advances in medicine to the improvement of patient care. * * * In 1890, the new State of Montana had a population of 142,950, dispersed over 146,000 square miles. Much of the population was concentrated in the cities of western Montana, and so were the physicians. Vast areas were thinly populated, and people there went without medical care or depended 25 upon a general practitioner in a distant community to enter their farming, ranching or lumbering area on horseback. From the 1890s onwards, rural medical care tended to suffer comparison with that of urban areas. But the rural and urban sick alike could be somewhat more certain of the person appearing before them in the role of physician than could the fur trapper and gold miner earlier. Medicine, like the society in which it occurred, was becoming organized and attempting to ensure professional quality. For decades the Northwest's medical world had been one of laissez-faire, laissez-passer, and only caution protected the patient from the fraudulent or dangerous healer. The medical profession was not held in high esteem, and physicians and laymen alike recognized the need for improvement. The territorial physicians were anxious to separate the competent medical men from the incompetent. Medical diplomas didn't guarantee quality: standards of American medical education were variable, but invariably low. At the best medical schools the curriculum was anemic, instruction erratic, and the criteria for graduation undemanding. In the Northwest there were also many foreign-trained physicians whose degrees were as worthless as the diplomas from the shabbiest American proprietary schools. People with credentials devoid of any meaning practiced throughout the Northwest during the second half of the nineteenth century. In Montana, it seems, most of the "quacks" practiced in Madison County, Helena, and Butte, but some appeared in Bozeman, Deer Lodge, Missoula, the Bitterroot and other small communities. Attempts to ensure competence were made on the local level early in the gold rush. Thus in 1865 Virginia City required a license to practice medicine, but this required no more than payment of ten dollars twice a year and accomplished little more than a mild erosion of the healer's profit margin. Later, in 1885, a grand jury convened in Butte was able to 26 conclude only that "additional legislation is required to protect the community against the imposition of empirics and charlatans." It was the unrestrained activity of the innumerable quacks practicing in the Territory that precipitated the "call for the organization of a Territorial Medical Association" by a group of respected physicians meeting in Helena in 1879 with the declared purpose of advancing "the best interests of our noble profession." The Association would play a prominent role in legislation regulating the profession, but its immediate impact both within and without the profession was less than earth-shaking, as witness the response of Dr. C. G. Brown in Helena to an inquiry regarding the medical laws of Montana in 1885. "I will say," Brown wrote, "that medical laws in Montana are like angels' visits, 'few and far between.' Each physician is required to pay a yearly license of $16, and there is a law which says only M.D.'s shall receive a license, but there is no one to enforce it. Anyone who applies to the county treasurer, says he has graduated, and 'produces' $16, gets his credentials, and enters into the 'free-for-all'. , . We need a territorial board to regulate things. . I believe there is not a medical society in Montana, and there seems to be very little desire for mutual improvement." The desire for improvement and a territorial board was very much alive in the Medical Association, the existence of which seems to have escaped Brown's notice. After some years of lobbying, the organization prepared a petition for a law to regulate medical practice and drew up a bill to submit to the Legislature. The bill called for the establishment of a Board of Medical Examiners, which would examine the diplomas and pass upon the 11 qualifications of men coming to Montana to practice medicine. It required all physicians to have a certificate from the board to practice. The public was now increasingly concerned with irregulars and quacks, and thus the Helena Herald commended the Association's action and concluded that "Without inter mingling in the rivalries of different schools of practice we hope some law may be agreed upon that will protect the public from these itinerant quacks that destroy, fattening themselves like birds of prey upon the dead and dying." Two months later, on the eve of Montana's statehood, the governor signed the Medical Practice Act, legislation that reduced the number of incompetents playing the role of physician and encouraged well-trained physicians to establish a practice in Montana. * * Many changes occurred between the time of the Association's first annual meeting a hundred years ago and the end of the century that witnessed Montana's transformation from an unexplored wilderness to one of the United States. The population increased dramatically: from approximately 40,000 to about 240,000, and the number of physicians increased proportionally. In 1880, approximately 79% of the physicians in the Territory were registered as regulars, or allopaths, 12% as homeopaths, and 9% as eclectics. Twenty years later the allopaths represented 90% of the state's profession, the homeo paths 8% and the eclectics 2%. The general change is apparent also at the level of specific communities. Thus, in Butte, bastion of the irregulars during the territorial period, 63% of the physicians were allopaths in 1880, 30% were homeopaths, and 7% eclectics. In 1900 the regulars comprised 87% of the profession, the homeopaths 11%, and the eclectics 2%. At the beginning of the twentieth century, medicine in Montana rested upon an 28 organized base, not only at the state, but at the county level. The conditions, existing institutions, and—importantly--the desires of the profession, favored the continued development of improved health care for the population. Those of us who live in the Pacific Northwest often forget how recently our region entered into the stage of history. This area was once so shrouded in mystery and secrecy that Jonathan Swift located Brobdingnag of Gulliver's Travels here, and Jules Verne had it accommodate Five Million of the Begums. We frequently forget the truly remarkable developments of the nineteenth century In less than a century, medicine in the Northwest developed from a fur trapper treating himself with Indian remedies and whiskey into a prominent, increasingly respected and effective profession and a network of institutions. Medicine in developing Montana, like medicine anywhere at any time, reflected the social milieu in which it occurred. It passed through stages appropriate to those of the emerging territory, and, like Montana itself, at the time of achieving statehood its modern character was established. The mountain men, the missionaries, the gold-hungry doctors, and the pioneering physicians of the territorial period were all part of medicine in developing Montana, and they all made their contribution--something else we all too often forget