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By: Dr. E.H. Conner
I had an urgent call from my secretary while I was in the operating room a while back, so off the top of my head I gave the title of "General Clark's Medical Attendants" and now I'll have to change that little to “General George Rogers Clark: His Health and His Medical Attendants", because I had to include that in order for it to make sense. General George Rogers Clark was the founder of Louisville, the Conqueror of the Old Northwest Territory and a member of several prominent families by birth. He was related to others of equal stature and importance, by marriage of his close relatives. Perhaps it is not surprising that he was related to 3 of the 6 physicians who attended him in some manner during a life-threatening illness at age 57. There's been no medical historical review of the General’s health problem nor of the severe accidental burn of his right leg, which was complicated by infection, and this finally necessitated its amputation. A critical review of the method of management of this type of injury and its complications together with biographical identification of his medical attendants may provide some interesting insights concerning the quality of medical practice, of the frontier at the beginning of the 19th century. The sundry disorders of mind and body that afflicted this particular leader and which may have influenced the course of his illness and alternate recovery were also being done. Now we are most fortunate that during the late 18th and into the 19th century the physician was paid for his services annually, and I might say even longer. Now this practice certainly worked a hardship on the medical practitioner, and perhaps forced him to pursue other trades in order to provide for the needs of his own family. The physician however was required to keep records of his visits to families, which included the person cared for, and fortunately, in most instances, medication provided. Now one such bill rendered to General George Rogers Clark by his surgeon Richard Barrington Ferguson, has survived. Bil1s and receipts from the other medical attendants have also been saved and transcribed here too, to circulate, but they're not as detailed and therefore don't tell us as many stories. An examination of the bil1 tells us a number of important facts and allows us to pass some judgment on the method of treatment and to extract some information relevant to the time and nature of complications as they developed. In February 1809, the time of the accidental burn, General George Rogers Clark, a bachelor, was living alone in his cabin home in Clarksville, Clark County, Indiana Territory. Now the home was of squared logs built on the rise of the riverbank called Clark's Point. It was an unprecocious building in a beautiful location. It was described by visitor Josiah Espee in 1805 as “the point is situated opposite the lower rapids, commanding a full and delightful view of the falls. The General has not taken much pains to improve this commanding and beautiful location having raised only a small cottage.” I don't think the General was too accustomed to luxury, and he didn't bother with it too much. Mr. Espee made another observation and comment that's of interest here. He said, “General Clark has now become frail and rather helpless, but there are the remains of great dignity and manliness in his countenance, person, and deportment.” Here we have an early observation of the physical failure of the General, who was then only 53. It appears that General Clark continued in failing health for four more years, but persisted in his bachelor's existence in his cabin at the falls. On several occasions prior to his accident he was persuaded to spend some time in company of his sister, Lucy, at Locust Grove or his nephew Samuel Earl Graffney, in Louisville. One such so journey at Locust Grove in June of 1807 was precipitated by an eye disorder, most likely, I believe, glaucoma. The General's nephew, John Crogan, described the traumatic loss of his younger brother, Nicholas's eye, continues in a letter, “Nicholas is deprived of his sight. Uncle George (George Rogers Clark) who is here at present appears to be very near the same predicament. Indeed, sore eyes predominate almost throughout the whole neighborhood. Uncle has been here some time.” Now how long he remained at his sister's home or what treatment he received for his eye disorder has not come down to us. Desultory efforts at improving his living quarters were made by the General, apparently with the financial assistance of his brother-in-law in Louisville, Dennis Fitxhugh. In August, 1808, he'd just built a brick chimney cabin, and he was asking for materials to paint the windows in preparation for the winter of 1809. His family was apprehensive of his living alone, and his nephew, Irwin Brockne, in writing the General in September of 1808 compliments him on his efforts to finish his home. He says, "But I should feel better satisfied if you would come and spend this winter with us." There's no doubt that General Clark, by the turn of the 19th century, was no longer the vigorous military commander he once was. He even admitted it himself, saying that he had noted a physical decline. For he says in a letter to the Federal Congress asking for some reimbursement in 1805: “Thus at the end of the war, I had the pleasure of seeing my country secure. But with the loss of my mutual activity and the prospect of future indigence,…” and he goes on to tell of some of his other problems. There is a question about this loss of mutual activity, as is alluded to by Dr. Ferguson in a certificate that he wrote in 1809. Dr. Ferguson states that he'd been attending the General occasionally since 1802, and he comments, “A violent rheumatic affection on the left hip and knee joints which the General states to be of many years standing. I have heard him frequently complain of it. It is attending with such general weakness of the extremity that in walking the body was rendered tottering and unsteady. It is the belief of the General, nor do I hesitate to subscribe to the opinion, that fatigue and exposure to weather, which he underwent while engaged in the service of his country was the cause. Symptoms of rheumatism troubling General George Clark had been spoken of before. In February of 1797 by his younger brother William, when he says, “My brother George is much inflicted with the rheumatism.” Now the General may have found it rather difficult to move about on account of his rheumatism, or his locomotion may have been further impaired by an injury to his ankle. Which one is not mentioned. Which was sustained prior to August, 1796. His brother William records the incident in a family 1etter. “Our brother George who had unfortunately his ankle sprained some time ago has not and I fear will never recover perfectly. He hops with the assistance of a stick.” Lameness, for whatever cause, was noticeable in the General, and was recalled many years later by a man who as a youngster had seen him in Jeffersonville, Indiana Territory. He gave this description of the General from memory. “He was a tall man, heavy set, and lame.” Thus far, we have this venerable commander, lame in his left hip and knee, perhaps by rheumatism, and his locomotion further compromised by a sprained, possibly fractured ankle. By his surgeon’s statement, he was tottering and unsteady in walking. Now we must address ourselves to the accusations that the General was often intoxicated and fond of Irish spirits. The earliest documentation of such an accusation was in 1782. In a letter from Colonel Arthur Campbell, a Virginian, slightly known to the General, says, “General Clark is in this country, but he has lost the confidence of the people, and it is said, has become a sot, perhaps something worse.” Another report of this intemperance was instigated in December of l786 by General James Wilkson, who had an unfavorable report sent to Governor William Randolph of Virginia, concerning the campaigning practices and intemperance of General Clark. Whether the reports of intemperance were true or not, this was a plot of the sinister General Wilkinson, to destroy the only strong military leader in the West, who stood in the way of his own schemes of riches. A more despicable man in the western country was never born. Again, in 1787, George Rogers Clark is reported drinking heavily at Fort Finney, near the present Jeffersonville. In the act of military exploits as a French citizen and commander of French forces in the West, and escape from U.S. authorities and eventually a return to Louisville, General Clark is again reported frequently intoxicated during the summer of 1799. That the General may have become too familiar with strong drink from time to time cannot be refuted at this date. However, the report of his falling into the fireplace as a direct result of being drunk cannot be verified, and it is quite likely from his medical history that since he was normally unsteady-of gait, that his fall could have been truly an accident. Another explanation for his mishap could be a cerebrovascular accident, which seems possible from contemporary correspondence. It is documented, though, only in the fall of 1810, some eight or nine months after his accidental burn. From what we know now of cerebrovascularascemia, symptoms, little strokes and ascemia, associated with changing possession and aclusion of an already compromised carotid blood flow. He may well have sustained transient episode of cerebral ascemia and maybe have had a seizure and as a result, had fallen in the fire. Now we can determine from three extent letters that the General did have a right hemi-parasis, in the early fall of 1810. First, William Cardman Senior, his sister Lucy's husband, who had built Locust Grove, in addressing a reply to Governor James Barber of Virginia in December of 1812 begins, “General George Rogers Clark, by power of a stroke he received about three years ago, (which would put it somewhere in December of 1809) being deprived of the use of his right side and unable to write,…” We find the other two letters written closer to the event. John Crogan, the General's nephew, then a medical student in Philadelphia, addressed a letter or reply to his father, dated October, 1810, and he said, “I am sorry to be informed that his (George Clark's) late paralytic stroke disabled him, so as to render it impossible for him to use the pen. This being the case, let him impart all the information he has.” And I think this is important because somehow John didn't know that he couldn't speak, or else nobody had said he couldn't speak. Although none of the family made mention of his impaired speech with his right hemi-parasis it had been affected. Joseph Davies, who had wished to write a history of the western country, using General Clark's papers and picking General Clark's brains, I might add, addressed the General a letter in November of 1810 and confirms the speech difficulty. He says, “The recovery of your power of speech has determined me to visit you again.” So there was something to pick. The recovery of speech was only apparent to the family, or else he sustained another stroke in the interval, for he spent the summer of 1811 in a spa near Jeffersonvi11e, and the son of the hotel owner there remembered that he was partially paralyzed and could speak with difficulty. Thus we can imagine the possibility of a stroke preceding the tragic episode which reveals what we may assume as medical practice at its best in February of 1809. Now we find an infirm General George Rogers Clark, aged beyond his years, living alone in a rather crude cabin, in the sparse settlement of Clarksville near the falls in Indiana Territory. He falls in or near the fireplace and is severely burned on the right leg. The events that followed were recorded by his medical attendants, his friends and his relatives. The date of the tragedy is unknown. The first medical man to visit him was a fellow by the name of Elisha Lee Hall. Little is known of Dr. Hall, who is said not to have regularly studied his profession, and his fame extended only to the cure of fever and ague. He had been in Louisville at least in 1791, and was county tax assessor and tax collector in 1797. His practice apparently provided insufficient funds for his needs, being a doctor and having to go a year without collecting, and in 1799 he accepted the appointment to take care of the stray pound for the city. Now the stray pound was where they hauled the animals who were strays and had broken lose from their lines, and kept them there till they sold them. But anyway the doctor took care of the pound. It doesn’t say how much he was paid. By 1801 his practice was improving, and he announced in the Fowler's Library in the Ohio Intelligencer, our only newspaper at the time, a new location for his shop, and an additional supply of medicines. Perhaps he was summoned to the General's cabin across the river because he was available, for he appears not to have cared for the General after he obtained a consu1tation from Richard B, Ferguson, on February 23, 1809. Now it should be pointed out that in the early 19th century a physician's services were not immediately sought, until the family and friends had rendered care to the best of their knowledge and skill, except in obviously serious injury or sudden illness. Now the General was most likely alone, and whoever did discover him sent for the physician who was available. This was apparently Dr. Hall. We do not know if the General was acquainted with Dr. Hall before this meeting, nor do we know how long Dr. Hall may have treated the General, before seeking medical consultation. It’s interesting that we don’t have a receipted bill from Dr. Hall. Next we should meet Dr. Ferguson, for he appears to be the primary physician caring for the General, and it is he who finally amputated the General's right leg. Dr. Richard Ferguson, originally of Londerry Island, arrived in Louisville in 1802. He presented himself in our community as a surgeon. He had training and experience, and he was in search of a suitable situation in which to practice. He announced his beginning practice in the local press, and I read from the October, 1802, up-to-date; Ohio Intelligencer: “Dr. Ferguson respectfully informs the public that he has opened a store in the town of Louisville, where he may supply physicians and others who may apply on the most moderate terms. He also proposes putting up small medicine chests for the use of the families, with a book of printed instructions (no doubt with numbers on the bottles). Gentlemen wishing to purchase applying by letter or otherwise should all be immediately supplied.” And there is a little “M.D.” at the bottom of the advertisement which is interesting. It says, "One or two young gentlemen wishing to engage in the study of medicine will hear of a situation by applying as above.” Dr. Ferguson continued to practice medicine, and during his first decade in Louisville, he established himself as a useful citizen and a reliable practitioner. We notice in the above advertisement that he was interested in medical education, and offered the earliest medical apprenticeships in our community. It was this surgeon, then, who took charge of the burns of General George Roger Clark, on February 23, 1809. By the bill rendered by Dr. Ferguson and paid on the 30th of May, 1810, over a year later, we learn that he dresses the burn on the 23rd of February, the 24th, the 26th, and the 27th, and on the first of March. His patient was still at his cabin in Clarksville. We do not know how he cared for the burn, except that he dressed it, and maybe that some of the family dressed it, because there is later comment that Dr. Lymon Draper began use of the bark, The Peruvian bark. The burn was now two weeks old. I have a book called An Essay on Burns, by Edward Kintish, Surgeon, published in London, 1797, and this man really reviewed the literature. According to Kintish, “The bark was likewise employed with much success to combat this symptom, (fever) and above all, where the wound carried any symptoms of the appearance of gangrene.” This is from Kintish's book, published some three years before. We may assume by this that Dr. Ferguson was not only an astute physician, but acquainted with the published current practices of his day and he lived in a community of about 1300 people. The condition of the patient must have continued to worsen, for we observe that on either the 12th or the 13th of March, the General was taken from Clarksville across the river to Louisville where he could be cared for by family and friends and would be more accessible to his physician. To whose home he was removed and its location is not certainly known. Next we observe for the first time, that pain has become a symptom, necessitating treatment. The entry on the 14th of March is, “Pills of opium, 15… $.75”. And we may observe, too, that the fee for the visit and the dressing is now only $2.00 instead of $4.50, since Dr. Ferguson does not have to take his skiff and go across the river. Within 2 days after prescribing the opium pills, the patient needed cathartic. Now in an ear of purgings, extreme conservatism for the early 19th century or that the patient is gravely ill, and no stimulation of the patient was to be hazarded. Again, we can find in Kintish, that stimulants (within the current systems of medicine then subscribed to in 1809) cathartics were considered stimulants. Kintish stated that stimulants were not indicated in cases of severe burns, because any excitation of the system was considered to be dangerous.” Now on the 25th day of the burn, Dr. Ferguson obtained the consult from two of his medical colleagues, William Cragg Gault, and Dr. John Collins. I have a picture of William Gault, the only known picture of any of Clark's attendants, and it was done when Dr. Gault was in Philadelphia, or in Annapolis, or in Williamsburg. His family was from Williamsburg. Dr. Gault had come to Louisville in the latter half of 1802 from Williamsburg, Virginia, with his wife, Matilda Beale. He came here to settle and practice. He most likely received his medical education from his father, John Winston Gault, of Williamsburg. Prior to February 1809, Dr. Gault had established himself as a physician of good reputation, and had trained at least one apprentice, John L. Murray, prior to that date. Dr. John Collins was a well-established practitioner of medicine and surgery, reputed to have attended classes at Harvard; however, there is no record of this. He was apparently incapacitated by consumption. We find him leaving our community in 1803, but he recovered his health to marry the widow Eliza Johnston in January, 1801. Although chronically ill, he continued to practice here, and according to Samuel David Gross he was one who practiced surgery with uncommon success. At the time of his consultation, he had an apprentice named Charles Sebastian, who signed one of the receipts for Dr. Collins. The summoning of two consultants most likely indicates the development of some further threat to the life of the General. Indeed use of another preparation to the burn was indicated on the 20th of March, which was now the 25th day of the burn. It is entered on the bill as bassil flava. I take this to be the yellow vasolin ointment. This ointment was generally known as a locally stimulating ointment. It consisted of yellow wax, that's bees' wax, and pitch, and turpentine in varying amounts. How would you like that on your burn? The turpentine was added to alter the consistency. It is not known which of the three men suggested the bassil ointment, that it be used in an effect to treat the complication that had arisen. One can understand the rationale of using such a painful therapeutic agent as turpentine, on a burn, if we're reminded that at the turn of the 19th century, heat to a tissue damaged by heat would increase the action of the exhalent vessels. It sounds like I know what I'm talking about, but in other words, they wanted to produce secretion of the damaged parts. They wanted it to flow with serum, and so they irritated it, and they knew then that it was getting better. Our predecessors were not without theories in their methods of treatment, and their selection of methods were quite rational. In Kintish there is a suggestion that if a restoration of a balance of absorption and secretion is not achieved, then healing will not take place by the 10th day, and then arisipolis inflammation will begin. Now in reconstructing the methods used in treatment of this burn, Dr. Ferguson had made the rational additions to his treatment, but the arisipolis must have begun near the 25th day of the burn, then to enhance the secretion of the burn, they dressed it with the solution of turpentine containing ointment. This they did in order to stop the progress of this severe form of infection, arisipolis. On the 23rd of March, now the 28th day of the burn, Dr. Gault and Collins were again consulted. They must have concurred that the general's leg would have to be amputated, to save his life. The amputation was most likely an above the knee amputation. The best evidence comes however from a non-medical observer of questionable veracity sometimes, Ruben Durret. He was present at the identification of the General's grave when his remains were removed from Locust Grove in 1869. Mr. Durret says they identified the General's remains by finding a skeleton “with the left leg amputated above the knee.” Well, it was not the left leg, but I think we could excuse this error and agree that even a layman might recognize the surgically abbreviated femur. The operation was performed on March 25, 1809, by Dr. Ferguson, according to the General's brother, Jonathan, who had entered this in his diary, under March, 1809, “Clear, Louisville. Brother George has leg taken off by Doc. Ferguson.” And that's all he says. Jonathan was a man of few words anyway, and when William took off for the Lewis and Clark expedition he made about a three-word observation on the weather and about a four-word observation on where they were going. Anyway, neither Dr. Ferguson nor his assistant Dr. Collier nor Dr. Gault nor the medical apprentices Mr. Thomas Booth or Charles Sebastian have made any records of the operation that have survived. The General's namesake, General George Rogers Clark Sullivan, wrote a letter on the 24th of April 1809, to John O’Calla, the General's nephew, and he made the best contemporary comment on the operation. He said, “Your Uncle George is with us and in high spirits and the wound healed up. I have stayed with him every night since he has been in town, and that is about five weeks. (This is about the time when they brought him over from Clarksvil1e to Louisville) I never knew a man in my life to stand it so well as he did the day it was taken off. He sent for the drummer and the fifer to come and play. Floyd then took the hint and had all the men pace around the house with two drums and two fifes and played for about two hours, and his leg was taken off in the meantime. In the evening they returned and played for about an hour, and then about 10:00 at night, four elegant violins, two drums, and two fifes marched around the house for about an hour playing elegant marches. The operation was performed by Dr. Ferguson, presumably with Dr. Collins assisting. Dr. Gault and the medical apprentices, Mr. Booth and Mr. Sebastian, were no doubt also in attendance.” There was no anesthesia, of course. Very interestingly enough, neither is there mention of the use of spirits. It's interesting to observe that the letter of George Rogers Clark Sullivan was written on the twenty-fourth of April. Dr. Ferguson in his bill dates the limit of his cure as the 23rd of April. Ferguson says in his bill, “For sundry medicines, attendants, dressings, etc. until a cure was accomplished, from the 26th of March until the 23rd of April." There is one more comment on Dr. Ferguson's bill. The entry on the 29th of May for sugar of lead, about 1 1/2 ounces. We have no way of knowing what this medication was for, nor do we know what form it was in, but I would suggest that perhaps the General had a small granulating area in his wound and that this sugar of lead was prescribed as a solution to be used locally as an astringent. The use of sugar of lead as an astringent for use in the care of burns has been recommended by John Belle of Edinborough and also is mentioned in Kintish’s book. The wound healed, but the old General was confined to a chair on wheels in which he was able to maneuver himself with the help of a stick. He apparently became nearly self-sufficient for a few months for he was taken back to Jeffersonville to the spa there, in the summer of 1811. On the forth of July, 1811, the General was able to be escorted from Major Crogan's at Locust Grove, where he was then residing, to a bottom near the mouth of the Bear Grass Creek, to a dinner that was held in his honor. His last attendant at a meeting or the last we know of his going away from Locust Grove was on the first of February, 1813 when he attended the Board of Commissioners of the Illinois Grant, which was on the map as "Clark's Grant". The General suffered other strokes, perhaps as he deteriorated to an almost vegetative existence. He was confined to a chair on wheels during his last nine years of life under the care of his sister Lucy and others at his last place of residence, Locust Grove. He died on the 13th of February, 1818. The disorders of mind and body of this illustrious commander and the methods of treatment utilized by his medical attendants have told us much about the medical practice near the edge of civilization in the early decades of the 19th century. It is fitting to close with the notice of the General's death, which appeared in the Kentucky Gazette Saturday 21, 1818. Died at Locust Grove in Jeffersonville County, Kentucky, on the 13th of February. General George Rogers Clark, A distinguished Revolutionary hero, and of remarkable ability and perseverance, displayed and for the hardships and sufferings he endured in the early wars of the Western Country. In military skill and daring and intrepidity, no man ever surpassed in. His zel and devotion to his country's welfare were pre-eminent. It was impossible for that country to discharge, by word or action, the debt of gratitude she owes for the invaluable and splendid services he rendered. The immense sacrifices he made in support of her life, liberty, and independence.
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