We all have an idea of what life was like for our 18th century ancestors: no electricity, no running water or indoor plumbing, no central heat, no telephone or computers, no rapid transportation. But try to imagine what medicine was like under these conditions. Most things that we take for granted as a routine part of our medical care did not yet exist. There were no X-rays, no lab tests, no EKGs, no antibiotics and no concept of sterile procedure or anesthesia. Surgery was a painful and often fatal process.
In many ways, medicine was more of a trade than a profession. There were only two medical schools in 18th century America. The Philadelphia Medical College was founded in 1765 and Kings College Medical College in New York two years later. Most physician and surgeons (chirurgiens as it was spelled at the time) who had formal training received it in Europe. By far, most physicians received their training by a one-to-three-year apprenticeship in the office of an established physician. Others, particularly on the frontier, simply declared themselves physicians and set up practice. In some remote areas, surgery was performed by the local barber or butcher because they had the tools.
The first medical society was formed in Boston in 1735. By the mid-1700s most colonies required a medical license of some form. In many colonies the medical license was little more than a business tax with few, if any, enforceable professional standards. The first hospital in the colonies was founded in Philadelphia in 1751 by a group that included Benjamin Franklin.
In 1775 there were an estimated 3000 physicians practicing in the colonies. Fewer than 300 had a medical degree or a certificate from a formal apprenticeship. Early attempts at licensing were resisted as an attempt to place a monopoly on medicine. Massachusetts was the first colony to attempt regulation by issuing a certificate of proficiency for completion of an approved apprenticeship. But even in Massachusetts, as notable a physician as Benjamin Rush reported that the only prerequisite for “…. a doctor’s boy (apprentice) is the ability to stand the sight of blood”.
While modern concepts of disease and sanitation were beginning to evolve in the late 18th century, many practitioners still ascribed to the almost 1000-year-old ideas of the Greek physician Galan. He believed that the body had four humors: blood, phlegm, yellow bile, and black bile. Good health required a balance of the humors and illness resulted from their imbalance. Attempts to restore balance included bleeding, purging, diuretics and laxatives, and placing heated cups on the back to form blisters and draw out the humors. It was this belief that led to the bleeding that hastened George Washington’s death. Quite literally, the cure was worse than the disease.
The physicians of the time had few effective medicines and often acted as their own apothecary, compounding medications of spices, herbs, flowers, bark, mercury, alcohol, or tar. Opium elixir was marketed to help babies sleep through the night. Mercury was used to treat everything from syphilis to scabies. Voltaire summed up the state of pharmacology when he said “…. a physician is one who pours drugs of which he knows little into a body of which he knows less.”
Disease and hardship were a fact of life in the colonies. One in eight women died in childbirth or from complications of pregnancy. One in ten children died before the age of five. Diseases such as malaria, yellow fever, typhus and measles ravaged many communities. They were especially deadly for American Indians.
Smallpox was perhaps the deadliest disease of the colonial period. Entire American Indian tribes were annihilated. Epidemics repeatedly swept through the colonies in the 1700s killing thousands. George III became King of England in part because of smallpox. The last Stewart claimant to the throne died of the disease and England looked to the House of Hanover for the German born King George I.
Inoculations against smallpox had been widespread in Africa and in Arab countries for many years. In the American colonies inoculation was denounced as barbarian and some clergy preached that it was thwarting God’s will. Despite the support of such notables as Cotton Mather and Benjamin Franklin, inoculation against the disease was not widespread until George Washington, seeing the debilitating effect of smallpox on the Continental Army, ordered massive inoculation of all troops.
Disease and poor hygiene were the greatest foes faced by the army. John Adams reported that for every soldier killed in battle, ten died from disease. On July 25, 1775, the Continental Army Medical Corps was formed. Initially, each regiment was required to provide its own surgeon and there were no established qualifications. Only Massachusetts required examination of regimental surgeons and many colonies did not provide the surgeons with a military rank. To make matters worse, the first director general of the army medical corps, Dr. Benjamin Church, was a British spy.
Modern ideas of sanitation were unknown to most colonists. Few people bathed because they believed it removed the body’s protective coating. Most soldiers had only a single set of clothes in which they also slept and almost never washed. Army camps were hot beds of flux (dysentery) and camp fever (typhoid and typhus, the distinction between them was unknown). Camp fever took a huge toll on the army because it left the survivors so debilitated that they required almost constant care and seldom returned to duty.
Sanitation consumed a large part of General Washington’s time at Valley Forge. Latrines, garbage disposal and animal manure were constant problems. Attempts to prevent and treat the itch (scabies) were relentless. At times, several hundred soldiers would be unfit for duty due to infestation. What little clothing and blankets they did have often had to be burned to prevent the spread of the parasite.
Conditions in army hospitals were not much better and could be far worse. Camp fever spread rapidly through the close confines, often killing entire wards, including the staff. Death rates could run as high as 25% in hospitals and many soldiers preferred to remain in camp where they felt they had a better chance of survival. Dr Benjamin Rush stated “Hospitals are the sinks of human life. They robbed the United States of more citizens than the sword.”
The French, as with many things during the revolution, aided the patriots with their health problems. Dr. Jean Francois Coste, chief medical officer of the French Expeditionary Force, was one of the first to introduce strict regulations concerning sanitation and hygiene in army camps. The Americans, noting the significantly better health of their allies, were quick to follow suit.
The revolution was always close to failure. It was made even closer by widespread disease. But as with everything, our patriot ancestors persisted and triumphed.
This post was adapted from my article published in The SAR Magazine, Fall 2020, Sons of the American Revolution.
Sources:
Colonial Society of Massachusetts. Medicine In Colonial Massachusetts 1620-1820. Boston, MA, 1980
Miller, Christine. A Guide to 18th Century Military Medicine in Colonial America, Self-Published,Lexington, KY, 2016.
Reiss, Oscar, MD. Medicine and the American Revolution; How Diseases and their Treatments Affected the Colonial Army. McFarland & Co, Jefferson, NC, 1998.
Shryock, Richard. Medicine and Society in America 1660 – 1860. Cornell University Press, Ithaca, NY, 1960.
Terkel, Susan. Colonial American Medicine. Franklin Watts, NY, 1993.
Wilber, C. Keith, MD. Revolutionary Medicine 1700 -1800. The Globe Pequot Press, Guilford CN, 1980.
The Man Who Saw The Future
By John Turley
On June 18, 2022
In Commentary, History
One of the true joys of studying history is coming to understand that no matter how bad we think things are, past generations have faced the same or worse problems. In fact, apart from science, there is very little that hasn’t been seen before.
We are constantly being told that we live in an era of unprecedented polarization and partisanship. This is probably due to the human tendency to give undue importance to our personal experiences.
Recently, I was reading George Washington’s Farewell Address to the People of the United States. It was distributed across the country at the end of his second presidential term. Truly there is nothing new under the sun. His address is very long, and I have reproduced only a portion of it below.
It is written in the style of the 18th century and specifically references the problems of that time. It takes some effort to read, given his tendency toward long and complex sentences. It is worth the effort because its application to the United States today is clear. It requires no comment from me.
“ …….a solicitude for your welfare, which cannot end but with my life, and the apprehension of danger natural to that solicitude, urge me on an occasion like the present to offer to your solemn contemplation, and to recommend to your frequent review, some sentiments which are the result of much reflection, of no inconsiderable observation, and which appear to me all important to the permanency of your felicity as a people….
“…. The unity of government which constitutes you one people is also now dear to you. It is justly so; for it is a main pillar in the edifice of your real independence, the support of your tranquility at home, your peace abroad, of your safety, of your prosperity, of that very liberty which you so highly prize. But as it is easy to foresee that, from different causes and from different quarters, much pains will be taken, many artifices employed, to weaken in your minds the conviction of this truth; as this is the point in your political fortress against which the batteries of internal and external enemies will be most constantly and actively (though often covertly and insidiously) directed, it is of infinite moment that you should properly estimate the immense value of your national Union to your collective and individual happiness;…. discountenancing whatever may suggest even a suspicion that it can in any event be abandoned; and indignantly frowning upon the first dawning of every attempt to alienate any portion of our country from the rest, or to enfeeble the sacred ties which now link together the various parts….
“…. Citizens by birth or choice of a common country, that country has a right to concentrate your affections. The name of American, which belongs to you in your national capacity, must always exalt the just pride of patriotism more than any appellation derived from local discriminations. With slight shades of difference, you have the same religion, manners, habits, and political principles….
“…. These considerations speak a persuasive language to every reflecting and virtuous mind and exhibit the continuance of the Union as a primary object of patriotic desire….
“…. In contemplating the causes which may disturb our Union, it occurs as matter of serious concern that any ground should have been furnished for characterizing parties by geographical discriminations—northern and southern—Atlantic and western; whence designing men may endeavor to excite a belief that there is a real difference of local interests and views. One of the expedients of party to acquire influence within particular districts is to misrepresent the opinions and aims of other districts. You cannot shield yourselves too much against the jealousies and heart burnings which spring from these misrepresentations. They tend to render alien to each other those who ought to be bound together by fraternal affection….
“…. The basis of our political systems is the right of the people to make and to alter their constitutions of government. But the Constitution which at any time exists, until changed by an explicit and authentic act of the whole people, is sacredly obligatory upon all. The very idea of the power and the right of the people to establish government presupposes the duty of every individual to obey the established government….
“…. All obstructions to the execution of the laws, all combinations and associations under whatever plausible character with the real design to direct, control, counteract, or awe the regular deliberation and action of the constituted authorities, are destructive of this fundamental principle and of fatal tendency…. to put in the place of the delegated will of the nation the will of a party, often a small but artful and enterprising minority of the community…. However combinations or associations of the above description may now and then answer popular ends, they are likely, in the course of time and things, to become potent engines by which cunning, ambitious, and unprincipled men will be enabled to subvert the power of the people and to usurp for themselves the reins of government, destroying afterwards the very engines which have lifted them to unjust dominion…
“…. But this leads at length to a more formal and permanent despotism. The disorders and miseries which result, gradually incline the minds of men to seek security and repose in the absolute power of an individual; and sooner or later the chief of some prevailing faction, more able or more fortunate than his competitors, turns this disposition to the purposes of his own elevation on the ruins of public liberty….
:…. It serves always to distract the public councils and enfeeble the public administration. It agitates the community with ill founded jealousies and false alarms, kindles the animosity of one part against another, foments occasionally riot and insurrections. It opens the door to foreign influence and corruption….”
George Washington
1796