Minutemen, Militia and Medicine

Hippocrates, the Father of Medicine, once said: “If you want to study medicine, go to war”.

In 1776 there were only 3,500 physicians in the colonies. These men clearly played a disproportionate role during the Revolutionary War, with around 1,300 of them serving as military surgeons at this time.

During the war, anyone with medical knowledge of any kind was drafted into service, and although all regiments had their own physicians, less than 300 of them actually had a medical degree. The minority had been trained in Philadelphia, at The Pennsylvania Hospital – the first medical school in the Americas, which opened in 1768. Since there were no laws or professional organizations to regulate medicine, however, this left anyone free to practice.

Inevitably therefore, more soldiers died due to health issues than combat during the Revolutionary War.

Anesthesia was not discovered until the mid 1800s, so alcohol and opium were typical agents used for surgical preparation of patients.  Medical equipment and drugs were in very short supply during the war, and physicians were frequently forced to work with what little equipment they had in their pocket kit. Additionally, they typically performed the only surgery that they knew to be useful – amputation. Surgeons had to work fast, since their patients were not anesthetized, and some reports describe things being stuffed into soldiers’ ears so they could not hear themselves screaming! And there was always the method of “biting the bullet”.

Wounded soldiers awaiting surgery were also first bled. Bloodletting was used to treat just about every type of medical illness, based on ancient beliefs that withdrawing large quantities of blood would purge the sick patient of “bad humors”. To add insult to injury, postsurgical procedures also often involved even more bloodletting! Unsurprisingly, surgical success rates were low at this time, with wartime surgeons having no idea that such blood loss could lead to death.

Overall though, despite the fact that professionally trained physicians were rare in the colonial military organization, Revolutionary Wartime surgeons did extremely well at treating the sick, and attempting to save lives. And although no major medical or surgical advances came from the war, one step forward did come in the form of smallpox control.

Smallpox was not a problem in America until introduced here by European settlers. The American Revolutionary War brought about numerous smallpox outbreaks. Patients who actually survive the disease develop lifelong immunity to it, so the British were at a distinct advantage since many of them had previously suffered the disease.

At that time, there were only two ways to deal with smallpox:

• Isolation: Where susceptible soldiers were quarantined away from potentially diseased people.
• Inoculation: Where material from smallpox lesions was extracted and injected under the skin of unexposed individuals.

By 1777, the ever increasing smallpox epidemics had led George Washington to order mandatory inoculation of all troops who had not had the disease. Medical historians actually credit this decision as a pivotal one – smallpox threatened to kill more soldiers than the British would, so it was this decision by Washington that allowed the Continental Army to turn the situation around and continue to fight at full strength.

Thankfully huge advances have been made in medicine since the era of the American Revolution. But one thing that remains unchanged is the fact that physicians continue to serve in the US military, helping not only fellow servicemembers, but foreign citizens too. “Service beyond self” clearly remains the mission of both the caring physician and proud military servicemember.

Happy July 4^th everyone!