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  Hypochondria and Malaria

Did Meriwether Lewis suffer from debilitating effects of malaria during the last weeks of his life? Did these symptoms lead to his committing suicide? Did the "hypochondria" that Jefferson believed Lewis suffered, refer to abdominal pain caused by malaria? Or was the "hypochondria" a result of a nervous system disorder, contributing to Lewis being depressed and a possible suicide?

Some of the evidence that is used by those who support the abdominal pain theory, is that the term "hypochondriasis" meant something completely different that what it means today. They have stated that the modern meaning of this term has only become popular during the past century. (The term today means "a morbid concern about one's health especially when accompanied by delusions of physical disease" - MedlinePlus ( Supporters of this theory believe that Lewis's malarial infection lead to enlargement of his liver/spleen, which resulted in pain in his abdomen, or what they call "hypochondriasis".

In my research of both medical historical texts as well as the historical information available about Lewis in his final days, there is very little support for this type of twisting of the historical record.

If you ask, "What is your evidence Dr. Peck?" , I would answer as follows.

The "hypochondrium" is an anatomical region of the abdomen found just inferior to (below) the lower ribs. The Greek prefix "hypo," means "under" or "below". Thus a "hypodermic" needle is a needle that goes underneath the skin. "Hypothermia" is a condition in which the body's temperature is below what is normal. Therefore, "hypochondria", in a strict anatomical sense, refers to an abdominal region below the lower margin of the ribcage.

The modern medical disease of mental depression and hypochondriasis referred to the belief in times past, that these conditions were caused by an excess of black bile, whose source was in the "hypochondrium" area of the abdomen. In ancient times, medicine believed there were various types of bile. Bile was held responsible for various illnesses, various types of personalities and other interesting effects. Therefore, bile from the hypochondrium, might influence people's behaviors, mental stability, etc. "Hypochondriasis" related primarily to a mental illness, caused by an excess of black bile in the hypochondrium.

In a letter written by Thomas Jefferson in 1810, he referred to Captain Lewis, from his personal contact with him during the years Lewis spend as his personal secretary in the White House. What did Thomas Jefferson mean when he wrote that Lewis "was much afflicted & habitually so with hypocondria"? It is clear that Jefferson associated hypochondriasis with a mental disorder. In his letter to John Adams in 1816, Jefferson describes people with "gloomy and hypocondriac minds", always feaful of the future and "always counting that the worst will happen, because it may happen". It is very clear that Jefferson meant what we mean by the term in the 21st century. So rather than the term taking on its modern meaning within the past century, we clearly see that Jefferson's meaning 200 years ago was the same as the meaning today. For excellent coverage of this topic, I refer the reader to the Lewis and Clark Trail Heritage Foundation's journal, We Proceeded On, February, 2010, "Hypocondriac Affections": Letters Help Define Jefferson's Phrase, by Ann Rogers.

What would Dr. Benjamin Rush (1746-1813), the medical advisor to the Lewis and Clark Expedition mean if he had used the term "hypochondriasis" during the era of the Lewis and Clark Expedition? Well we are in luck, because Rush used the term in his copious writings about various medical issues.

In written lectures published in 1815, Rush wrote about the "Phenomena of Fever." In this lecture he addresses various causes of fever, with "convulsions of the nervous system" being a chief among various causes, which he believed to incite fever. Rush wrote, "Are there certain grades in the convulsions of the nervous system, as appears in the hydrophobia, tetanus, epilepsy, hysteria, and hypocondriasis?" (Medicine & Society In America, Arno Press & The New York Times, New York, 1972, p. 12.) It would seem obvious from his thinking, that "hypocondriasis" (sic) is included in a list of what he believed to be nervous system disorders/convulsions. Note that "hysteria" directly preceeds hypochondriasis in a list of his nervous system disorders. Rush is not referring to abdominal pain, but to a nervous system disorder. (Hysteria was then, as it is now, a term referring to a disorder or the mind evidenced by emotional instability/excitability, or overwhelming or unmanageable fear or emotional excess. ( For further insight into this fascinating topic of medical history, do a web-search of "female hysteria".

I believe those who support the idea that hypochondriasis referred to abdominal pain resulting from malaria, which led Lewis to kill himself have twisted the historical record in an effort to create a novel theory of Lewis's death. I do not believe that Jefferson's diagnosis of "hypocondriac affections" had any reference to malaria.

It is documented in Lewis's writings, that he had a case of self diagnosed malaria during his final months. For treatment, Lewis took opium pills! In addition, he was drinking heavily. There are much more compelling reasons for his death which I cover in detail in my book, OR PERISH IN THE ATTEMPT, and more briefly in another article on this page of my website.

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Produced by Oregon Public Broadcasting and Lewis and Clark College, Unfinished Journey, The Lewis and Clark Expedition is a 13 part series, narrated by Peter Coyote.  This landmark series was carried nationally on over 80 NPR stations and covered a diverse number of topics relating to the Lewis and Clark Expedition.  Dr. Peck was a featured participant in two of the episodes.  These episodes are featured here in their entirety for your pleasure, courtesy of Oregon Public Broadcasting, Portland Oregon.
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