GO WEST, M.D.

Byline: CRAIG SMITH

It's the early 19th century. You're setting out to explore vast and unknown regions, from rivers and plains to mountains and marshes. Your job is to evaluate, analyze, and note what you find so that those in power can decide the next best steps for exploration and colonization. You need to make it back alive with your information in order and your faculties intact. Who and what do you take along?

First off would be plenty of tough people able to stay the course, get along with one another, live off the land, and handle weaponry. You would want guides familiar with the areas you were to traverse,

if possible, and goods with which to placate or barter with the locals. You would need the best navigation tools available, from previous travelers' accounts to telescopes and compasses. And given the trials and terrors of dangerous overland travel, you would want the best in medical supplies and implements and the knowledge to use them wisely.

For the 1803-1806 Lewis and Clark expedition, that meant a chest filled with drugs and supplies that came to $90.60. There were a mortar and pestle for blending dry or paste substances, a beaker for measuring liquid drugs, a tourniquet to use in amputations, and lancets for that beloved medical treatment, bleeding. There was also a penile syringe for the treatment of gonorrhea.

The drugs included 15 pounds of Peruvian bark (containing quinine) to treat fevers, half-pounds of jalap and rhubarb as laxatives, and four ounces of ipecacuan to induce vomiting; cleansing the digestive tract from top to bottom was another cherished technique of the day. The inventory also included powdered cream of tartar, gum camphor, poppy gum for producing opium, benzoin, saltpeter, sugar of lead, 600 "bilious pills," peppermint, and laudanum.

Because the men in the Corps of Discovery had Army training and discipline, because the expedition moved carefully, because Meriwether Lewis was a good herbalist and observer of symptoms, and because of luck, there were few fatalities during the amazing journey, though there were regular bouts of injuries and sickness. But as David Dary makes clear in his fascinating book Frontier Medicine, not every pioneer group could boast such good results, and neither could inhabitants living on America's rougher edges -- even into the middle of the 20th century. Thus the book's subtitle, From the Atlantic

to the Pacific 1492-1941.

A specialist in Western history and exploration, Dary is the author of more than a dozen books, including The Santa Fe Trail: Its History, Legends, and Lore; The Oregon Trail: An American Saga; and Seeking Pleasure in the Old West. Born in Manhattan, Kansas, he worked for CBS and NBC News in Texas and Washington, D.C., and taught journalism at the University of Kansas in Lawrence and the University of Oklahoma in Norman. He holds a Cowboy Hall of Fame Wrangler Award, two Western Writers of America Spur Awards, and the Westerners International Best Nonfiction Book Award. We spoke to him by phone at his home in Oklahoma City.

Pasatiempo: Were most of the sources you used

in English?

David Dary: Yes, they were. I have one story in

there [New Mexico historian] Marc Simmons told me about, and then he located the story he had

written about it -- I think that was originally in Spanish. It was about a doctor who was going to be arrested and went into a church. In those days, you could seek refuge in a church.

Pasa: As in sanctuary?

Dary: That's it. And the folks in the community said, let's keep him as a doctor. They needed a doctor. It was a delightful example of one doctor and what he did in the Southwest.

Pasa: How long did it take you to write Frontier Medicine, and why did you start it?

Dary: Five years. As for why I did it, well, it's one of those things. I'm essentially a journalist. I had written about seeking pleasure in the West, journalism in the West, about the Santa Fe Trail and the Oregon Trail. I knew my grandfather had been a physician in Kansas. I had some material on him. Being curious, I said, I'm going to find out more. As I researched, I realized that I couldn't do it properly about medicine in the West unless I went back and talked about medicine in the East and how it evolved when it got out West.

Pasa: It was interesting to read about how some long-range expeditions were well-planned from a medical viewpoint -- like Lewis and Clark's -- and some were just perambulating disasters.

Dary: Oh, yes. It depended, obviously, on individuals. On planning and whether they had a doctor with them. You have to remember that a lot of the doctors had limited knowledge. They had studied with other doctors, but they had not gone to medical school. It was the teacher who determined the level that each student reached in medicine, unless they were curious and did a lot of reading on their own.

A friend said, "What did you learn from this book?" I said, "I have to say, like back then, doctors today are still practicing."

Pasa: Practicing on their patients. You make that point, too, in terms of the various forms of medicine on the frontier -- heroic, with lots of bleeding and purging; or homeopathy; or botanics-based treatments; or just letting nature take its course.

Dary: I was born in the '30s, and as I think back on it, knowing what I now know, the good doctors were the ones who were able to look at the symptoms and look at the person and deduce what might be wrong, and then they would try to treat the symptoms. Often while doing that, the body got well. When I was young, I think about the only tests were blood tests and X-rays. Those were kind of expensive. There were not many done. Today you go in and see a doctor and maybe they don't want to think too much about your symptoms and so forth. They want all these tests first, and then maybe you go have them again in six months.

Pasa: There are many fascinating stories in

Frontier Medicine. The doctor who did the first open-

abdomen operation on a woman with a huge ovarian tumor, and she recovered. Or the mountain men who suffered horrific injuries from accidents and recovered, like the man who survived a bear attack after his party abandoned him.

Dary: When someone asks about the mountain men, I say, "These guys had common sense." There was the one who realized after the bear attack that there were maggots in wood and that if he rolled over on his back on a log the maggots would only eat the infected flesh and leave his wounds clean.

Pasa: And he survived.

Dary: Yes. In all the research I did, the thing that impressed me most was the presence of considerable common sense [about illness and medicine] in some people and the lack of common sense in others. I've talked to a few doctors, and privately they say, yes, I have some patients who just don't understand the body. Those who do are better, because I can talk to them and they understand what I'm saying.

I think this is critical. Medicine today is such that people think all you have to do is go to a doctor and he'll prescribe a pill. A lot of people do not take responsibility for their own health. That has bothered me a lot. But I think it's interesting that every human body is a little bit different. You have people who have smoked all their lives and are in their 80s and are still smoking and others in their 30s who come down with lung cancer. I guess you can go in today and have a DNA test, and they can tell you what you're likely to die from, but that kind of takes the surprise out of it!

Pasa: Where did you find your sources?

Dary: I found a great many stories I had not expected to find in state histories and in biographies. That's what took a lot of time -- going through. There was so much material. Looking for a vignette here, a vignette there. I'd find something and say, I've never read this. I'll bet this is fresh and new.

Pasa: You talk a lot about women in medicine in the frontier, both in midwifery and general medicine --

the woman who became the first certified dentist in the U.S. and the woman doctor who studied under another doctor in a mining town and walked around with two guns on her belt.

Dary: I knew that midwifery had been around a long, long time in this country. It was generally thought that birth is a natural thing, so another woman helping is only natural. Then I got into reading about men going to England for their medical education, where teachers said, "You ought to be the one to deliver a child. It's a medical thing." But it was a money thing, too. Doctors were saying, "Hey, we can make some money delivering babies." I thought it was interesting that many doctors would not see the woman at all until she was ready to deliver, and they would not look into her eyes -- Puritan values and things like that.

Pasa: You point out many cases where patient confidence in the doctor was a big factor in healing.

Dary: I remember as a young boy growing up in Kansas I would have a sore throat. My mother would try to treat it. It wouldn't go away, and she would call the doctor. He would come up to the door. He would be in his overcoat, in winter, with a hat, a bag, and leather gloves. He would walk in and, at that moment, I could sense my mother and father were relieved at this presence. It gave them a feeling of security they had not had about their child.

I think once I had the measles, and the doctor came, and he put the house in quarantine, with a sign outside put up by thumbtacks: "This is what's going on in here. If you haven't had measles, don't come in."

I contrast that idea with when you go to a doctor now. You go to a waiting room -- he doesn't make house calls -- and all these people are sick, some are coughing. And you think, what am I going to catch here? That's where the old doctor would say, "Keep people away and let this person recover naturally." It bothers me a little bit and goes into the fundamental things doctors should learn about sanitation. Why are they doing this?

Pasa: Was it difficult to synthesize all these different historical strands into chapters and themes?

Dary: One of my problems with the book was that I kept wanting to devote a page or two of analysis at the end of each chapter -- analyze what I'd talked about. Then I said, no, I guess I'll follow the old AP approach of reporting the facts on both sides and then hoping the reader has enough common sense to come to their own conclusion.

I have two boxes, file boxes, full of things I didn't use. Many of them would have been redundant or repetitive. I tried to use what I felt was the best. But there were things I could have devoted a lot of time to --

Civil War surgery, for example. I tried to compress, but when you compress, you sometimes have to leave certain things out. Periodically I would put detail in on one thing or another. If I had done that for everything, I probably would have had two books.

Pasa: Did you groan your way through many revisions?

Dary: I think the first chapter, on Indian medicine, was revised six or seven times. But that's the nice thing about a computer. You can cut and paste, and you can type something and insert it. I pay a lot of attention to the thought flow, and I wanted to make sure that my language was such that it would be clear.

I'm not a typical academic writing for another colleague. I'm writing for an old man sitting in a rocking chair on a porch somewhere. The old Hemingway idea, one thought per sentence, is still in my mind. I find a period is a marvelous invention!

The hardcover edition of "Frontier Medicine: From the Atlantic to the Pacific 1492-1941" by David Dary was published by Alfred A. Knopf in November 2008. The softcover edition is slated to be published on Tuesday, Oc