Not-So-Revolutionary Medicine

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Not-So-Revolutionary Medicine

An Unprecedented Problem. In the last two centuries times of war have often seen great advances in medicine. This was decidedly not the case in the Revolutionary War. The eight-year conflict was America’s first experience with large-scale treatment of sick and wounded over a protracted period. The colonies were woefully unprepared for a long war in this as in so many other areas. The Continental Congress learned about providing medical care for its troops “on the job,” giving much of its effort an inefficient quality. Lack of funds, problems of supply, and the limitations of eighteenth-century medicine made medical delivery to the needy soldier problematic. At any one time throughout the war an average of 18 percent of the Continental Army—almost one fifth—was ill, and of course this number rose dramatically when epidemic diseases swept the army.

Medical Staff. Each regiment had a surgeon to attend to its soldiers. Ideally surgeons were trained doctors, but with these often in short supply, the army was glad to get anyone with some medical experience. The surgeon was supported by several surgeon’s mates. James Thacher of Plymouth, Massachusetts, was probably a fairly typical surgeon’s mate. He had apprenticed for some time under an established doctor, and when the war began, he wanted to serve as a medical officer. He and fifteen other candidates were examined by the Massachusetts medical board: “This business occupied about four hours; the subjects were anatomy, physiology, surgery, and medicine. . . . The examination was in a considerable degree close and severe.” When it was over, ten out of the sixteen passed, including young Thacher, and received appointments as surgeon’s mates.

TO “BITE THE BULLET”

The term “to bite the bullet,” meaning to bear hardship stoically, is commonly thought to have derived from eighteenth-century military surgery practices. The patient, about to undergo an agonizing operation with no anesthetic, was supposedly given a soft lead musket bullet to bite upon, to stifle his screams and prevent severing his own tongue with his teeth. This does not seem to have been the case; patients instead bit a stick of wood or a leather pad, these being both easier on the teeth and incapable of being swallowed while reclining on an operating table. The term more likely originates in military punishment; soldiers about to be flogged for some infraction were expected to take their punishment “like men” and not cry out. A bullet held in the back teeth enabled the victim to “bite back” the pain of the whip’s impact without the visible aid of a wooden or leather gag. One further use of bitten or chewed bullets in this period does not relate directly to “biting the bullet” as defined here. Some soldiers deliberately chewed their musket balls in the knowledge that irregular or cut bullets would create more ragged wounds in their enemies. Several such bullets have been discovered at Revolutionary War battle sites.

Source: Roger R.P. Dechame, “To ‘Bite the Bullet,’” The Bulletin of the Fort Ticonderoga Museum, 15 (1993): 403-406.

Seeing the Doctor. When a soldier felt sick enough to seek medical attention, his first stop was his regimental

hospital. If his regiment was in a town or city, the hospital might be located in a private home (often that of an absent Loyalist); during long winter encampments such as those at Valley Forge and Morristown the hospital might be in three-hut complexes built to house twenty-five patients. In either case the sick soldier met with the regimental surgeon or one of his mates. The surgeon knew that any soldier out of action due to wounds or sickness was worse than useless; he was a drain on meager supplies, personnel, and payroll. Depending on the ailment, the surgeon or his mates would either treat the sufferer and send him back to duty or confine him to the regimental hospital. If the case proved serious or epidemic, the surgeon would send the soldier on to the general hospital for more-specialized care or for discharge from the army. The general hospitals were usually commandeered private homes and barns or public buildings such as churches or colleges. The only advantages to these structures was their size; they were generally too cramped, cold, or dirty for the purpose of restoring sick men to health. Many soldiers who technically should have gone to a general hospital remained with their regiment, however, due to lack of transportation.

Dubious Drugs. Assuming the regimental surgeon considered the soldier’s problem treatable with drugs, he turned to the contents of the regiment’s medicine chest. More than likely it was seriously short of the eighty-one different medicines it was supposed to contain, for before the war most medical supplies had come from England, and, of course, that source was no longer available. Medicines trickled in from ships braving the Royal Navy’s blockade, but the supply in America soon ran low; private doctors and apothecaries were increasingly unwilling to take wildly inflated Continental money for their precious stores of drugs. Only after the French alliance in 1778 did medical supplies arrive at the hospitals in decent quantities. American doctors and surgeons tended to rely on relatively few “standby” drugs, anyway. “Peruvian bark” was a favorite and may actually have done some good; it was from this source that quinine, the answer to malaria, was later developed. Other choices were less effective and almost universally unpleasant. Great store was put in purgatives, either tartar emetic to induce vomiting or concoctions of ipecac, rhubarb, and other agents swallowed to “cleanse” the body by defecation. Venereal diseases might be treated with a drink made of spring water, sumac roots, and gunpowder. If that did not work (and it is difficult to imagine that it did) the patient took a stronger dose of mineral salts and turpentine. For snakebites the surgeon sometimes applied a mercury-based ointment accompanied by doses of olive oil. Kidney problems sometimes required an elixir of horseradish roots, mustard seeds, and gin. Narcotics in the form of gum opium or laudanum (a tincture of opium) deadened the pain of toothaches and especially of surgery, for there were no effective anesthetics.

Battlefield Surgery. When on campaign, American armies included “flying,” or mobile, hospitals housed in tents or huts. These contained operating tables for the gruesome work of treating bayonet or gunshot wounds. Musket bullets, three-quarters of an inch in diameter, often created shocking wounds. If the bullet was lodged in the body, long probes located it while retractors held the skin and muscle apart, and extractors drew the bullet and bits of clothing from the wound. The skin was then stitched back together. If the ball had struck bone, the

bone was often shattered beyond saving, and amputation was the only alternative. For this grisly job the surgeon’s kit contained tourniquets, forceps, surgical knives, bone saws, and usually a few opiates. The patient was strapped or held down and the operation carried out as quickly as possible. Shock was the primary danger in any amputation, so speed was essential. In this American doctors could learn much from the enemy, as Thacher discovered when he observed the great “skill and dexterity” of British surgeons operating on their own wounded after the Battle of Bemis Heights in 1777. If the patient survived the operation, however, the greatest concern was infection. In an age before tools and bandages were sterilized, when doctors had little idea how infection worked, even flesh wounds could be as life-threatening as highly intrusive operations such as amputations.

Sanitation. Hygienic conditions in American camps were often deplorable, even by the standards of the time. European soldiers understood that it was important to keep latrines far away from tents and drinking water. Americans had little experience with army camps before the Revolution; during the French and Indian War, British officers were scandalized by the filth and disorder of American camps, and when Washington took command of the Continental Army in 1775, he had much the same reaction. These conditions were perfect for contracting and spreading disease among a closely packed population of soldiers. Some American doctors strove to improve camp conditions. One, Hugh Willamson, conducted an “experiment” with American soldiers encamped in the Great Dismal Swamp of North Carolina and Virginia after the battle of Camden in 1780. Williamson wondered if strict attention to cleanliness in dress and lodging, a wholesome diet, and good camp drainage would reduce the incidence of sickness. His findings were encouraging: out of a force ranging from five hundred to twelve hundred men, only two died in six months, an incredible survival rate for the time. Sadly, Williamson’s experiment was not tried elsewhere, and disease continued to be the great killer of American soldiers. Statistically a Revolutionary soldier had a 98 percent chance of survival on the battlefield; that chance dropped to 75 percent the moment he entered a hospital—small wonder that soldiers often preferred to suffer in silence rather than face dubious remedies, bloodletting, and hospitalization.