MEDICAL PRACTITIONERS OF THE REVOLUTION
FACED EXTRAORDINARY CHALLENGES
By the time of the American Revolution, the state of medical knowledge was entering a period of transition that would result in major advances in health care more than a hundred years later. The physicians of the Revolutionary era, however, had to go about their work in the face of handicaps that are almost unimaginable today.
The Continental Army’s medical department was established in 1775. The regimental surgeons with the army and the physicians in the hospitals were given an almost impossible task. An underpaid staff that was often unfamiliar with military medicine and handicapped by serious shortages of drugs and instruments was expected to provide competent care for an army that faced problems caused by poor hygiene and inadequate supplies of food and clothing. During the course of the war, nearly 90 percent of the deaths in the Continental Army resulted from disease, not battle wounds.
The usual pattern in the army was outbreaks of respiratory illness, including pneumonia and pleurisy, in the winter and dysentery in the summer. “Fevers,” probably malaria, yellow fever, typhus and typhoid, were always a threat, and scabies, or “the itch,” was a constant problem.
Most treatment involved bleeding, purging and the use of drugs, including mercury, opium and wine, when they were available. The only disease physicians knew how to prevent was smallpox. Immunization through inoculation was effective but involved some risk. General Washington bravely ordered his entire army to be inoculated several times during the Revolution.
Surgical treatment consisted primarily of dealing with bayonet and musket ball wounds. Little could be done for chest or abdomen wounds. Fractured limb bones often resulted in amputation. Although this was a routine procedure, the mortality rate for major amputations was often as high as 50 percent because of subsequent infections.
Despite all of the problems encountered by the physicians in the army, they struggled to ease the suffering of sick and wounded American soldiers. The Marquis de Chastellux wrote in 1781, “The Americans … are well pleased with their doctors, whom they hold in the highest consideration.”