We're trying something new today. We have a guest speaker to chat with me about the American Revolution.
Dr. Ronald S. Gibbs is a physician by trade and a medical researcher. He teaches at Stanford University in California, but he is a Philly native, went to Drexel University and to the University of Pennsylvania medical school where he also did his residency. During medical school, he received a traveling fellowship to study 18th century military medicine in London.
|Dr. Ronald Gibbs|
He's also an avid collector of 18th century maps, and serves as President of the California Map Society. But we're most interested in today is his understanding of 18th century medicine and how it applied to the American Revolution.
Dr. Gibbs is also the author of several books. The one you may find most interesting is a novel of historical fiction, called The Long Shot, The Secret History of 1776. We'll be talking more about that at the end of our discussion. It is available on Amazon. Dr. Gibbs also has his own website at RonaldSGibbs.com.
Dr. Gibbs, thanks so much for joining us today. And I look forward to our discussion.
Pleasure to be here, Mike.
So we're here today to talk about 18th century medicine and the way medicine was practiced during the American Revolution. One of the statistics that shocks so many people is that many more soldiers died from disease during the war than were killed by the enemy. That seems to be pretty common in earlier wars. Until I guess the last century or so. Why is that?
That ratio was about eight or nine deaths from disease for every death from battle. And to begin, we have to look at what life was like in the American colonies in 1775. The population was only two and a half to three million. Nearly everyone lived on a farm or a small village. The largest city was Philadelphia with a population of 30,000. New York had only 20,000. And hardly anyone traveled more than 30 miles from home.
The war changed all that. The war changed it by crowding and by lack of hygiene, and by mass movements of troops of 20 or 30,000, at some times, and travel of soldiers to new areas and exposure to new diseases. Then if we look at the tactics of the time, there were usually only a couple or three major battles per year. The weapons were relatively slow firing and had relatively short range. And so that explains why there was this high ratio of death from disease compared to deaths from wounds in battle.
Yeah, I suppose that makes sense. I've actually read some things about soldiers who were kind of almost eager to get into battle. And then it almost makes sense because a battle might be decisive and might bring the war closer to an end, and your chances of surviving a battle, I guess, were better than surviving months and months in a camp.
Well, right, the chance of dying on the battlefield was, by and large, a couple of percent. If you got admitted to a hospital, your chance of survival might only be 75%. So you're better off on the battlefield that you were in the hospital.
Standing in front of an enemy's gun is the way to improve your odds of survival?
Yeah, I mean diseases were real killers. What diseases were really the greatest threats to a soldier?
Well, of course, there was smallpox. And I know you covered that in one of your previous episodes. And that occurred in epidemics. There was a particularly bad outbreak in Boston, when the British occupied Boston 1775-1776.
But day in and day out, there were other diseases that were bigger killers. And one of the biggest was called typhus. Well, it's called typhus today, and then it had really very graphic names like putrid fever or ship fever or camp fever, or hospital fever or jail fever. This implied that the disease was recognized in crowded conditions.
Then there was malaria. Malaria was called intermitting or remitting fever. Back in the time of the war, in the warm months, malaria would get into the middle colonies and even into the northern colonies as well. Dysentery was a common disease. This was a conglomeration of a variety of gastrointestinal disorders, including typhoid.
Then day in and day out, there were problems with venereal diseases, now called sexually transmitted infections, and in winter bronchitis and pneumonia, and because of problems with cleanliness, all sorts of skin diseases called the itch, If you'd like I could say a little bit more about each of these because they were such big killers.
So typhus, as the 18th century name implies, occurred in crowded conditions, and it was spread by body lice. Symptoms were very dramatic: high fever, chills, terrible muscle and leg aches, headaches, and then late in the course of disease, skin or mucous membrane bleeding spots called petechiae. This was recognized by 18th century physicians as a clear disease, and the mortality rate was high.
Today typhus is rare. Diagnosis can be made with modern techniques. And if treated early with a common antibiotic called doxycycline, the cure is very rapid. Well, malaria now is mainly in tropical areas. But in North America, that was a common problem in the summer and fall. And there actually was a treatment that worked pretty well from South America called Jesuit’s bark or Peruvian bark. This was a preparation from which later quinine was derived.
Did the Americans have access to that treatment?
Yes. In the war, there was a bit of a short supply. We'll talk about that a little bit later. But this was available from South America. And then today, one of the treatments is hydroxychloroquine. And that's made the press lately because of a purported and shown to be an ineffective treatment for COVID-19. Dysentery was a variety of gastrointestinal illnesses. Some of these were self-limited, but some could be fatal, like typhoid with gastrointestinal hemorrhage. Today, the diagnosis of typhoid can be made and again, rapidly cured with common antibiotics like ciprofloxacin, azithromycin, or ceftriaxone.
Venereal diseases, as in all armies, was pretty common, but back in the 18th century, doctors really couldn't distinguish syphilis, from gonorrhea, from others, but they had pretty graphic treatments, and one of them that I read in my early research back in London was to inject oil up into the urethra, into the penis. I think that would be a great way to prevent future sexually transmitted diseases. Now, there was one disease that more simply did not occur during the American Revolution. And that was yellow fever. But after the war in 1793-1794, there was a huge epidemic of yellow fever, particularly in Philadelphia.
Yeah, I remember reading about that. Robert Morris was in debtors prison in Philadelphia at that time and was slipping through the entire epidemic and couldn't get out of town.
That was right, if you could, and you lived in Philadelphia in 1793-1794. You got out of town.
I mean, particularly military diseases. And it sounds like the fact that they had, you know, some People gathered together and unsanitary conditions was a big part of that. How much of a problem was disease for civilians in peacetime during this era?
Disease was huge and devastating. In the 18th century, the average lifespan of males was late 40s to early 50s. And much as a result of death from disease. And for women who now live longer than men on average in the United States, mortality could be even higher because of complications of childbirth and infection. And among infants, up to 25% died in the first year of life. So death was a common place story in really all developed countries and in North America as well as Europe. North America was actually a little bit safer than Europe because it was less crowded. Jeanne Abrams, whose book you cited in one of the other episodes, says that disease was a constant fear on the American psyche. It was just everyday present. And war made it worse with crowding, lack of hygiene travel, and using up the supplies, the precious hoard of supplies that physicians might have.
Do you think people deliberately stayed away from cities or avoided traveling just for the purpose of concerns about disease?
Well, I think the major reason that they stayed away from cities was economic. It was pretty much an agrarian economy. Not much industry, cities where people went for commerce, maybe on a market day. But considering when there would be outbreaks, and the underlying problem with endemic disease, it was a benefit not to live in the city.
What steps could people take to prevent disease at this time, I know we talked about a lot of modern medicines that can cure these things in a couple of days. Obviously, most of those didn't exist at that time. What could people do either to prevent themselves from getting sick or getting healthier after they had gotten a disease?
Well, among the civilians, it was hygiene and really isolation. Among the military, there were preventative strategies that were known and that may be coming up a little later. But leading physicians at the time appreciated the need for cleanliness and hygiene, using latrines properly, covering the latrines periodically as well.
So even though they didn't understand about germs per se, they understood the benefits of cleanliness?
Right, so the germ theory of modern microbiology didn't find its way into medical practice for another 75 to 100 years, largely coming from European physicians, but senior military physicians like Sir John Pringle, the leading military physician in England, and Benjamin Rush, the great American physician, had written about the importance of cleanliness, fresh air, and the problem of being closed to rotting garbage and noxious air from swamps, for example, and stagnant water. There were orders that were written one Pennsylvania regiment said that if a soldier "eased himself" outside the latrine, he would be subject to five lashes - pretty severe punishment for hastening to your bodily needs. Benjamin Rush's pamphlets came out, I think, in 1777. This was called Directions for Preserving the Health of Soldiers. Unfortunately though, while these were understood principles, they were not grounded in modern science and often not followed up, particularly at the regimental level.
I did speak a little bit in one of my earlier episodes about the smallpox problem, and that there was an inoculation debate. Could you tell us a little bit about how effective or dangerous inoculation was?
Inoculation was introduced early in the 18th century, both in North America and in Europe. So the process was that the skin was prepared by making a small wound or scratch, and then a small amount of pus from a smallpox pustule from an infected person would be introduced into the small wound. This was called inoculation, or variolation. So, this was an important public health measure and usually caused a mild version of the disease. Every once in a while though, it would run a muck, and there was a mortality rate of about 1% from inoculation, but I compare very favorably to the mortality from the natural disease which was 15% to 25% or greater.
So the militaries appreciated this. And the British Army introduced inoculation beginning about 1750. But it was not universally applied to the troops in North America at the time of the beginning of the Revolution. And when the smallpox outbreak occurred in Boston in late 1775, winter 1776,there were a lot of cases among the British troops. The American army was a little later in getting inoculation going. Finally, in early 1777, both the Commander in Chief George Washington and Congress ordered general inoculation. And inoculation, though it had about a 1% death rate, was highly effective. But you were sick after this for several days, and this would impact the fighting ability of the troops. Well, the answer to smallpox came after the war in the 1790s when an English physician and scientist Edward Jenner came up with the first modern sort of vaccination. This was using a cow pox variant, which induced immunity and was much safer than inoculation.
Right, because if the inoculation gave the cow pox disease that wouldn't be fatal. So even a 1% risk of getting cow pox wasn't a big deal. Yeah, that was a great innovation and certainly saved a lot of lives, unfortunately, came a little too late for our generation, the generation we're talking about here at the American Revolution. Yeah, I know, smallpox was really devastating to the Quebec campaign. A lot of people lay the blame solely on smallpox for essentially wiping out the northern army at that time. I guess that played a big role in encouraging Washington and others to develop the risk of using inoculation. So that didn't happen again.
Right in from the research that I did way back as a medical student, there are several examples where disease really did have a major impact upon the field operations.
One thing I've never really understood about the inoculation. I mean, it seems like if you're infecting a person with an active smallpox disease directly into their bloodstream, why wouldn't they just get a full blown version of smallpox?
Well, that was a great experiment. And fortunately, it's the way that it did. It was because what we'd say in medical terms, the inoculum was a very small dose. And the normal way of catching it would be by close contact with pustules or by inhaling it. So this was a very, very small dose introduced through a small scarified area in the skin. And fortunately, it was enough to induce really lifelong immunity with a much lower complication rate than the natural disease.
Interesting. I'm almost afraid to ask how they figured that out, but I guess they did. They must have had the person who first came up with the idea “Hey, let's inject someone with the disease. See what happens to them” sounds like a really scary experiment.
There was no human research committee back in the early 18th century and the physician who introduced this in Boston was Zabdiel Boylston. And there's a famous street in Boston, I think named after him. So if you do it, right, you get a street named after you.
There you go. So, physicians did a lot of this work with inoculation, and obviously with the treatment of the soldiers. What kind of training did physicians receive in the 18th century? What kind of training would a typical physician have?
Well, at the time of the American Revolution, it’s estimated that there were 3500 physicians, but only 200 or 300 had degrees from a medical school, either in Europe or from the two medical schools that existed in North America. The first medical school was called the College of Philadelphia. This later became University of Pennsylvania, my medical alma mater. So that opened 1765 and then the next year or two, a medical school opened in New York City, and this was affiliated with King's College, later Columbia University. But when the British in invaded New York, that medical school closed.
Most physicians, over 90% of the physicians in North America, had trained by apprenticeships. Now these were informal bedside training at the side of a practicing physician. But there was no standard. There was no regulation and no licensing, and unfortunately, quacks and incompetents practiced medicine, and during the American Revolution, lots of examples of an incompetent regimental surgeon providing that “care” for the troops.
So, pretty much any person could just say, "I'm a doctor now" and, you know, why don't you hire me and that was it.
It was just that, it was just about that loose.
I know we call people doctors today because they have an MD, a doctoral degree from a university. Did physicians in the 18th century that did not go to medical school call themselves doctors?
Well, particularly the regimental surgeons, who largely did not have a medical degree, they were called either mister or doctor. You know, in the English system today, surgeons often pride themselves in being called mister. So mister or doctor were the titles. And they, the physicians both in the American army and the British army, were outside the normal command structure. They were like ministers, no real line responsibilities.
Much of what I read about 18th century medicine sounds dangerous and sometimes I'll say almost comical if it wasn't so deadly. You know, physicians bleeding, patients are talking about balancing humors and stuff like that. Even for people who went to medical school and got a good professional training, could you talk about the state of medical care that existed at that time?
Well, in the 18th century, medical care really had not advanced much beyond what the Greeks and the Romans had applied, and the prevailing theory was called the humoural theory, having nothing, nothing to do with things being funny or humorous. It was pretty devastating as you have already noted, but humors were referred to as body fluids. And the internal concept of disease going back to ancient times, was that disease was caused by an imbalance of the body fluids or imbalance of the humors. So it followed in a internally logical way that you cured disease by restoring the balance. And one way that you could restore the balance was by bleeding and sometimes the bleeding was done in a rigorous way.
So George Washington died in 1799. On the 200th anniversary of his death, the prestigious New England Journal of Medicine recorded his treatment. Over a period of 12 hours, George Washington's physicians subjected him to four separate bleedings. And the total amount of blood taken from George Washington by bleeding was almost two and a half quarts - nearly 40% of his total blood volume, but of course, that didn't help him at all. It is said that the doctors bled to death. That's not quite true. He actually died of a very severe bacterial throat infection. But it sure didn't help.
And if bleeding was part of the therapy, so too were treatments to cause a vomit, and emetics were used. And if you wanted to restore the fluids, it would be a good idea to cause fluid to leak out from the other end by purges. And there were some chemical purges, and some botanical purges. And then using blistering was often used. And mercifully, sometimes they were soothing poultices that were used, and wine was used for just about everything: for pain relief, for calming, and as the sedative
So in addition to things that would make you throw up or otherwise expel waste, did physicians or doctors have some understanding of medications and what was the state of medications at this time?
There were a couple of medications that from a modern perspective, were helpful. So there was an effective painkiller called “gum opium” from which narcotics were later derived. And then as I mentioned from Central and South America, there was the bark, sometimes called the Jesuits bark or Peruvian bark. Quinine was later derived from that as well as hydroxychloroquine, but that was about it. Others, the purges, could cause dehydration and weakness, and fluid imbalance and so on, or electrolyte imbalance.
So, some of these treatments stick around for today. So, maybe when you were ill, your mother wanted you to vomit, and she gave you ipecac as a botanical. That was used. And for purges, calomel was used. Well that was a mercury salt, and that was downright poisonous. And then rhubarb was used and jalap was used and epsom salts. These were all used with the purpose of cleansing the body - restoring the balance.
Obviously, wartime a big problem was gunshot wounds, and we hear a lot about amputations taking place. Can you tell us a little bit about amputation at the time? Was there a decent survival rate from it? And was it really necessary to save a patient from a bullet wound in an arm or leg?
Well, surgery was pretty limited, and one of the most common surgical procedures was amputations. So indications were actually pretty well thought out, and common indications for an amputation from a wound would be a shattered bone, a wound involving the joint, or gangrene was recognized, or repeated abscess.
|18th Century Medical Chest|
A good surgeon could amputate a leg in three minutes. There was no understanding of germ control. So just about every amputation became infected. And pus was seen to come out. Surgeons and physicians thought that pus was actually a part of the healing process. It occurred all the time before you got the healing. And they use the term “laudable pus” because they thought it was a sign of healing. So there was no antiseptic. There was also no anesthetic. And for pain control for a several minute amputation, the poor soldiers would get maybe some gum opium, they might get wine, they would surely be restrained, and you would get a wooden rod to clench between your teeth. Sometimes you would pass out, and that would be your saving grace.
So in the book that you kindly mentioned, there is a medical theme in which the hero, the surgeon, does go through some amputations. So if you're up to vivid descriptions - that's in there for you. So what was the mortality? Well, if you had your leg amputated, the mortality from either blood loss or infection might be as high as 50%. And if the amputation was because of an infection like gangrene, it was even higher.
By the way, Mike, we were talking about drug availability. You might want to add a note about supply of medication also. So particularly on the American side, it was pretty dicey, particularly early in the war. There weren't huge stocks of medications in North America. Many of the apothecaries were loyalists. Those apothecaries, who sided with the patriots ,were often really not happy about accepting pretty worthless currency. And so the solution early in the war was scrounging whatever they could, and the commissary officers for the hospitals and regimental surgeons had to do that. Privateers did play a part in raiding British ships. Then, after the alliance with France, that's when the problem of medication supply ameliorated.
So for what minimal medications there where I take it, pretty much all had to be imported? There was no local manufacturer of anything or very little?
Right, very little. And in the British Army, everything came from England.
Getting back to surgeries and cutting off arms and legs. It seems like in many cases, getting a wound in the belly or torso was often considered almost always fatal. Is that true? Was there any treatment for wounds to the torso or to the head or things like that?
We should talk about head wounds. For any injury or wound of the head, there was a procedure called “trepanning
” or “trephining
.” And this meant that with a circular saw, a disc of skull bone was removed, again without any anesthetic. And the purpose of this was to relieve the pressure on the brain from either bleeding or from inflammation. And that actually was a smart thing to do. But if you had a serious head wound, you were a goner.
If you had a wound of the belly of bullet wound or a stab wound, that was just about always fatal also because of the onset of peritonitis and widespread bacterial infection. And if you had a wound of the thorax or the chest that was just about always fatal also, unless the wound was very superficial. And just as a reference to my book, it's a "what if" question, what if Washington got wounded? And he indeed does.
It sounds like there were numerous problems and with surgery not only the inability to stitch people up properly, but also a very great risk of disease if you're getting stuck with a bayonet that might have just stuck fifty other people and been stuck the dirt and god knows where else before they stuck into you.
Gunshot wounds were, of course, big problems. These would be, usually musket balls. The ball will often take a maddening course ricocheting off bone and bouncing around the body. So the principles were to remove the ball and remove any clothing or debris that was also drawn in. But many of these also became infected and resulted in either amputation or death. The clean wound through and through a muscle with an exit or one that could easily be removed--those would have a more favorable outcome.
Right. But again, risk of infection is always there and there was always that threat.
Always there. The Angel of Death wearing an infectious cloak.
The British obviously had a long military tradition going way back. They've obviously had a lot of experience with wounds and disease and things like that. How did they address preventative care for soldiers as well as treatment of the sick and wounded?
They were very organized. They had two levels of care. And there were the General Hospitals. The referral hospitals are the hospitals where the officers often went. And these hospitals were staffed by usually medical school trained physicians. In the hospital, there were surgeon's assistants called mates. Then there were apothecaries and cooks. commissary officers, and often women to help with other indispensable chores. So when the army was on the move in the field, the General Hospital might be set up in a substantial building like a church or in a private mansion.
The regimental medical structure was much looser. There would be a regimental surgeon, usually accompanied by one or two surgical assistants called mates. And even in the British Army, the regimental surgeons were very unlikely actually, to have a medical degree. So what could they do? It was prevention by trying to institute order and cleanliness, particularly around latrines and quarantining. But again, these often broke down, particularly when the army was on the move.
You mentioned regimental surgeons, was that the primary medical care or was there a separate Medical Corps within the British Army?
The regimental surgeons were attached to the regiment. And there was the Medical Department that largely had the General Hospital. The American army model followed this. And there were general hospitals, again, usually staffed by well-trained physicians and they took care of the referral cases or when the regimental hospitals would be overwhelmed like after a big battle, and the regimental medical establishment took care of their own regiments in the field. The regimental hospital was likely to be a barn or a building or maybe in a remote area in a tent.
This isn't so much a medical question, but I'm assuming that officers received much better medical care than enlisted men, and that prisoners of war were probably the lowest priority after a battle the wounded prisoners. Is that the case and we see a difference in survival rates among these groups, or have you seen that?
Officers were protected. They were not the ones who ordinarily marched pell-mell into a line of musket fire, but officers were often taken care of at a general hospital. Prisoners of war sometimes were just left on the battlefield. Sometimes, surgeons from the opposing army were called to pick up their own wounded. But after some battles, particularly those ending late in the day, the wounded were left on the field till the next morning. It was pretty ghastly.
Yeah, I've actually read some pretty gruesome stories about Leaving them on the battlefield and having wolves come down from the mountains and just start eating dead at night things like that pretty horrific.
Well that's pretty graphic and the battle not far from where you live, the Battle of Brandywine, you know that ended late in the day, yeah, wounded were often left on their own.
Right and even several days later after Brandywine. I know General Howe invited several Philadelphia physicians to come down to treat the American wounded Dr. Rush being among them. So obviously, the British doctors were not giving top priority to the American prisoners. And they were saying, well, you want treatment Come Come treat them. It was a pretty brutal time.
I don't think it was a matter of active purpose to try to destroy your enemy by not treating the wounded. There was a code of conduct among soldiers, but it was just being overwhelmed.
Right - limited resources,
Limited resources. It was.
I just mentioned Dr. Benjamin Rush, who you know, is a signer of the Declaration of Independence. He was a leading physician in Philadelphia. Do you know much about Dr. Rush?
Well, just two years ago, there was a very extensive biography by Fried
that talked about Rush. It's a wonderful book. And I'd love to tell you a little bit about Benjamin Rush because he was such a remarkable person. He was one of the most respected physicians in North America. He was born just outside Philadelphia, in 1745. He went to Edinburgh, in Scotland for his medical degree, and graduated at the young age of 23.
After he graduated medical school, he spent some time in England, Scotland, and in France gaining more experience. While he was there, he met everybody. He met the prominent English physicians William Hunter and Sir John Pringle, who we mentioned. He met men of letters Dr. Samuel Johnson and Oliver Goldsmith, and the famous painters Benjamin West and Sir Joshua Reynolds. In 1769 or 1770, he returns to Philadelphia. And here is the now the four or five year old Medical College of Philadelphia. And at this young tender age, he gets appointed the first Professor of Chemistry.
Now he was an extraordinary person. Fried describes him as being tireless. He only got four or five hours of sleep, and he was also described as being “bindingly sure of himself” with an “outsized ego.” But he was tall, he was lean, and he was handsome. Well, then he comes back to Philadelphia. And he met everybody. He worked with Benjamin Franklin. And he worked with Thomas Paine when he was writing “Common Sense,” Benjamin Rush had lunch with George Washington. And he knew Thomas Jefferson. And he was a signer of the Declaration of Independence. He was the fourth youngest member of Congress.
He also goes down in history as being a very forward-thinking physician. He was the champion of health. As you mentioned, he had a pamphlet about preserving the health of soldiers. And he was the champion of humanitarian social reforms. He was in favor of humane care for the mentally ill. He goes down as the father of American psychiatry. He was in favor of abolition of slavery, and he was in favor of education of women. But being sort of locked into 18th century thinking, he was an advocate of bleeding.
In terms of his military record, he was at the Battle of Trenton. And he was at the Battle of Princeton. And, as we just mentioned, he was the Battle of Brandywine. And in 1777, he became the Surgeon General for the middle department. But like his forebears, there were a lot of political rivalries. He got caught up in political rivalries with John Morgan. And that led him to quit, but he was one of the most truly remarkable physicians and patriots of the revolutionary period.
Yeah, the historian may always appreciate the fact that he did this hot of critical locations and wrote down the stories very well. So I always appreciate him for that as well.
There were obviously many other doctors that were part of the military leadership and Benjamin Church was one of them. He was the first, I don't think he had the title Surgeon General, but he was the head of the surgical part of the Continental Army. He was very quickly found out to be a traitor, was passing notes to General Gage in Boston and was expelled from the colony eventually. And it seems like the Continental Army went through quite a bit of leadership over the next few years. You mentioned John Morgan, William Shippen, and Samuel Stringer, were all in charge of all part of the Military Medical Corps of the Continental Army at one point in time. Did they ever really get their act together? Did they have an organized strategy? Or was this just kind of jumping from one person to another hoping to find someone competent?
There were tremendous rivalries between the chief physicians and Congress. And is really a sad, sad story to say a little bit more about Benjamin Church. Just as you said, he colluded with General Gage, the British General in Boston. And Church had the title of chief physician for the troops in Cambridge, outside of Boston. But he colluded with Gage anyway, was convicted, and he was jailed in late 1775. For some reason, in 1777, he was let go, was put on a schooner to go to the West Indies, and the ship was lost and sea, and old Benjamin Church was never heard from again, good riddance!
So a big question is, why was he such a turncoat? He only served three months. Well, his wife was English. But the real reason probably was that Church had a very high lifestyle, and the British were able to supply him with money.
Well, then following Church was John Morgan. John Morgan was actually trained at the College of Philadelphia, later the University of Pennsylvania, and his title was Director General of Hospitals and Physician-in-Chief. So he was at once hard working. He was intelligent. He was outstanding, but he had squabbles with Congress. And Congress actually ousted him. There was an investigation a couple of years later, and he was exonerated. But again, there was turbulence.
Following Morgan was Willam Shippen. He served as the third, but his term was also marred by strife and rivalry. Particularly, Shippen had rivalry with Rush. Then there were chronic problems of funding, and the chief physicians were always in rivalry with Congress to get adequate supplies. So things never really got harmonious. And there was turnover and rivalry and pettiness and personalities, and that worked to the disadvantage of the poor soldiers.
Yeah, I can imagine, I read a lot about the commissary general and the clothier general and people like that, the quartermaster of the army, constantly complaining about lack of resources. And Congress basically would say, no, it's your fault. I imagine the same thing happened to a lot of the medical leaders, they just weren't getting the support. They needed the supplies they needed and Congress saying we'll just make it all work.
Both the military officers and the medical officers, particularly the high ranking ones, they were just frustrated as could be with the non responsiveness of Congress. Because Congress had their own problem trying to find the resources. I never saw a public opinion poll about the approval rating of Congress during the war, but it couldn't have been very high.
No, I guess not. They were they were slightly above King George. I guess, though.
As far as medical care when, what role did women play at this time? I mean, we talked about things like Florence Nightingale in the 19th century, making a big world For women in nursing and stuff, but what was the what was the situation like in the 18th century?
Women played an indispensable role, but it was not really very organized. So moving with the army, there were women called camp followers. Some of these might be widows of soldiers who had died. Some might be wives, or other women, maybe women seeking freedom from slavery. And the women followed the army in an informal way. They cooked, cleaned, sewed, they provided nursing care for the ill, and the wounded. So all in all, these were informal, but indispensable services that the women provided, both at the general hospitals, as well as in the regimental hospitals. And one of the characters I portray in my book is a woman follower who plays an important role in the general hospital.
And given the state of training for doctors, I've got to assume there was virtually no training for nurses or other caregivers at this time.
This was on the job training. Let me show you what you're going to be doing today and go to it.
It sounds like they probably did a lot of the same things they had to do as wives and mothers in the home taking care of sick family or whatever, just making people comfortable, caring as best they could for them.
For soldiers that needed long term care, or had disabilities, were there hospitals that were equipped to take care of these sorts of needs?
Well, in the American Army, there were outlying or general hospitals. And these were usually pretty far from the scene of battle, where care could be carried out in safety and by 1777 there were actually ten of these. One was in Princeton, and a lot were in Pennsylvania, in areas of Allentown and Reading and Bethlehem. There was even one in Baltimore. In 1778, during the encampment at Valley Forge, there was a general hospital at Yellow Springs, now called the Chester Springs. Well, these had pretty large capacity, and the largest could care for 200 to 250 men. And these were usually staffed by more competent physicians, but this was for the care of those requiring usually chronic care for wounds and recovery.
And I guess, for a lot of them, care probably had to continue after the war for people who are permanently disabled or things like that. There was no Department of Veterans Affairs or anything like that that started after the Civil War. Was there anything for people after the war?
Not immediately, but there was, I think, right around 1800, the first public health bill in the United States, and it was for the care of sailors and seamen. And these hospitals were set up. And this was a real advance in public health and the beginning of public health as part of the agenda of the government.
Well, Dr. Gibbs, this has been really fascinating. I was wondering Also, if you tell us a little bit more about your book?
Well, thanks for the opportunity. So the book was published in March on Amazon, and it's called The Long Shot, The Secret History of 1776. It comes from a lifetime of reading and fantasizing about what could have happened.
So my “what if
” is what if during the early critical years of the American Revolution, General George Washington takes a bullet wound and becomes incapacitated, or even on the deathbed. Would the American Revolution have succeeded? What would happen to Washington? So I've had this idea for four decades because George Washington was thrilled by battle, he often led from the front, and he was in mortal danger. But traditional history contains not a whisper of him ever being shot. But it could have happened.
My book takes off in September 1776 with Washington being wounded and his wound sets in motion, I hope readers will find a thrilling cascade of medical, military and political events. So everybody knows that George Washington didn't die. He led us to victory in the Revolution and became our first president. So having now put Washington's life on the line with this wound, it's my task to save him.
By a providential twist of fate, arriving in the American camp just a couple of days before Washington gets wounded is Dr. Alexander Grant, a fictitious surgeon from the College of Philadelphia. And Grant is imbued with techniques and skills that are incredibly advanced for the time. And with Washington's life hanging in the balance, it tells an alternative history about what happened in 1776. Readers have been very generous with giving consistent five star reviews.
That sounds very interesting. Although it's a work of fiction, I assume it takes advantage of your vast knowledge about the American Revolution about 18th century medicine and all the things we talked about today.
Well, I weave together facts and things from my imagination. And in some of the reviews people did, they had the fact check to find out what was fact and what was fiction. And in the back of the book, I have a postscript revealing who was real and who was imaginary.
Oh, that sounds really fascinating. Anything else you'd care to tell us about today?
Mike, I think this was a wonderful opportunity to describe the medical and surgical care. And I've enjoyed it immensely.
Ron, this has been a real pleasure for me too. I think this has been a fascinating discussion and I really appreciate you taking the time to answer our questions today.
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Works by today's guest, Ronald S. Gibbs:
“On the brink of disaster: George Washington and the American Revolution, 1775–1776” IMCS Journal, Winter 2016, No. 147, pp 12-22: https://www.imcos.org/wp-content/uploads/2016/12/IMCOS147_Winter2017_web.pdf
Book: The Long Shot: The Secret History of 1776 (2020)
About the author: www.ronaldsgibbs.com
Other Relevant Resources
Mütter Museum of the College of Physicians of Philadelphia http://muttermuseum.org
Morens, David M. Death of a President (George Washington) (registration required): https://www.nejm.org/doi/full/10.1056/NEJM199912093412413
Museum of the American Revolution “Fighting Infection” https://www.amrevmuseum.org/read-the-revolution/history/fighting-infection
A Deadly Scourge: Smallpox During the Revolutionary War: https://www.armyheritage.org/75-information/soldier-stories/209-smallpox
Becker, Ann M. “Smallpox in Washington's Army: Strategic Implications of the Disease during the American Revolutionary War.” The Journal of Military History, vol. 68, no. 2, 2004, pp. 381–430. http://www.sjsu.edu/people/ruma.chopra/courses/h174_MW_F11/s3/smallpox_GWarmy.pdf
Bayne-Jones, Stanhope The Evolution of Preventive Medicine in the United States Army, 1607-1939, Part III The American Revolutionary War and First Years of the Republic https://history.amedd.army.mil/booksdocs/misc/evprev/ch3.htm
Kantrow, Louise. “Life Expectancy of the Gentry in Eighteenth and Nineteenth-Century Philadelphia.” Proceedings of the American Philosophical Society, vol. 133, no. 2, 1989, pp. 312–327. JSTOR, www.jstor.org/stable/987057.
(from archive.org unless noted)
Rush, Benjamin, Directions for preserving the health of soldiers : addressed to the officers of the Army of the United States, Philadelphia : Printed for Thomas Dobson, Fry and Kammerer, printers, 1808 (original published 1777).
Swieten, Gerard, Freiherr van The Diseases Incident to Armies: With the method of cure, Philadelphia: R. Bell, 1776.
Gillett, Mary C. The Army Medical Department 1775-1818, Center of Military History, 1981 (army.mil)
Thacher, James The American Revolution: from the commencement to the disbanding of the American army; given in the form of a daily journal, with the exact dates of all the important events; also, a biographical sketch of all the most prominent generals, American Subscription Pub. House, 1860 (originally published 1823) (or buy a printed copy, see below).
Books Worth Buying
(links to Amazon.com unless otherwise noted)*
Abrams, Jeanne E. Revolutionary Medicine: The Founding Fathers and Mothers in Sickness and in Health, NYU Press, 2013.
Coss, Stephen The Fever of 1721: The Epidemic That Revolutionized Medicine and American Politics, Simon & Schuster, 2016.
Fenn, Elizabeth A. Pox Americana: The Great Smallpox Epidemic of 1775-82, Hill and Wang, 2001.
Fried, Stephen Rush: Revolution, Madness, and Benjamin Rush, the Visionary Doctor Who Became a Founding Father, Crown, 2018
Petriello, David Bacteria and Bayonets: The Impact of Disease in American Military History, Casemate, 2016.
Reiss, Oscar Medicine and the American Revolution: How Diseases and Their Treatments Affected the Colonial Army, McFarland & Company, 1998.
Thacher, James An Army Doctor's American Revolution Journal, 1775–1783, Dover Publications, 2019 (reprint of free ebook, see above).
* As an Amazon Associate I earn from qualifying purchases.