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CHAPTER I
MEDICINE AND SURGERY IN THE COLONIES
Medicine and surgery in the Colonies at the time of the American Revolution reflected the state of those sciences in Europe, more particularly in Great Britain. No marked advances were being made or had been made recently. The great discovery of the circulation of the blood in the beginning of the century had not led to important results. Surgery had advanced little beyond the time of Ambrose Pare,1 medicine was still in the hands of the givers of strong drugs. The chief and only capital operations were amputations and trephining. The great cavities of the body were beyond reach. Anaesthesia was not to come for seventy years; even so simple a thing as the haemostatic forceps was yet far in the future. Suppuration was expected in all cases, and it was a matter of course that worse infections occurred in hospitals than in private practice. Medical men had great faith in medicines in healing and in heroic doses. Cathartics, emetics, blisters, bloodletting, opium, the bark, were the standbys. Even in surgical cases there was more reliance on internal medication that on surgery itself. As Waldo said, “We give them a capital medicine, to start the disease from its foundation at once.” Those were the days of faith.
At the close of the Colonial government there were two American medical colleges: one in Philadelphia, founded 1765;2 the other in New York, founded in 1768. The operations of both were suspended by the war. Up to that time they had conferred less than fifty medical degrees. Boston, although a medical center, had as yet no school of medicine. The great majority of the physicians of the colonies had obtained their medical education by a system of apprenticeship lasting from three to seven years. A favored few, like Rush, Morgan, Shippen and Church, had been able to resort to the celebrated schools of Europe: Edinburg, London, Leyden, Paris,—even Italy.
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Some medical graduates had emigrated to the colonies: as Dr. Hugh Mercer, Dr. Arthur St. Clair, Dr. Matthew Thorton and James Craik of Scotland; Dr. Edward Hand and Dr. James McHenry from the north of Ireland. Many of these gentlemen had been surgeons in the British Army and had left it to settle in America. When the conflict came they felt the call of the service, but as a rule they chose the Line of the army, and many of them achieved distinction there.
Major General Arthur St. Clair
In 1775 there was but one State medical society, that of New Jersey, organized in 1766. The Massachusetts society was founded before the war closed. There was no American medical publication during the period of the war. The first quarterly, the Medical Repository of New York, appeared in 1797. The great medical discovery of the time, vaccination, was not given to the world until 1798. Many of the conveniences and even necessities of modern practitioners were unknown. The stethoscope was not invented until 1814, aspiration not until 1850, and the clinical thermometer not until still later. The alkaloids and other elegant drug preparations were entirely unknown, and of course the hypodermic syringe. Medicine was far from being an exact science. The practitioner must needs be a courageous man, bold, and unmoved by suffering and death. His facilities were so few, particularly in the field, that the utmost use must be made of all those available. When in the Canadian wilderness Surgeon Isaac Senter was reduced to extremities he threw away everything except his lancet for blood-letting. In this act he reflected general opinions as to bleeding.
There were also but few hospitals. A hospital3 had been founded in Philadelphia as early as 1755, largely due to the efforts of Benjamin Franklin. This was used both by Americans and British. The second permanent hospital in America was that of New York. Erected in 1771 it had been destroyed by fire in 1774 and was but partly rebuilt when the war began, and it was used more as a barracks than as a hospital. If we may believe Dr. John Jones,4 Professor of Surgery in King`s College at that time, this was one of the most commodious hospitals of that or any other age. He states that the dimensions of a ward designed for eight patients were twenty-four by thirty-six feet and had a height of eighteen feet. A little calculation shows that these dimensions allowed each patient one hundred and eight square feet
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of floor space, and almost two thousand cubic feet of air space. This was the more notable in that hospitals at that time were as a rule literally packed with patients. Jones says of the Hotel Dieu of Paris, “The beds are placed in triple rows, with four and six patients in each bed. Often in the morning the dead were found with the living.” Quite often, no doubt, for of every five who entered this hospital but four left it alive.
While the mortality bill of the Hotel Dieu was excessive, it was still typical of hospitals of the time, which were often etapes on the soldier`s last march. Of the patients in St. Thomas` and St. Bartholomew`s of London, one in every thirteen died annually; while in the less crowded infirmaries of Manchester but one in twenty-two died, and in private practice still less. These were civil hospitals. Military hospitals were worse, for they were, as a rule, in unsuitable buildings, where the sick and wounded were crowded indiscriminately, without proper food, clothing, nursing, or sufficient medical attendants. Worst of all, each patient was subject to,—could not escape,—the infections of all the others. As Tilton said,—”Many a fine fellow have I brought into the hospital for slight syphilitic affections, and carried out dead of a hospital fever.” A vastly greater number of the wounded died of infections contracted in hospitals, dysentery and typhus, than of the effects of their wounds.
There is little doubt that the great hospitals of that day increased the death rate of the time. Sir John Pringle expected his readers to be surprised that he should rank hospitals, intended for health and preservation, among the chief causes of sickness and death in an army. Yet such was the case, due chiefly to crowding. He describes a melancholy scene of infection, whose pestilential influence nothing could suppress, until, by general orders, the hospitals at Ghent and Bruges were broken up and the sick distributed in small parcels, under the care of the regimental surgeons. This was done from motives of frugality but it had the happy effect of preventing further infection.
Such was the mortality of the hospitals that Tilton in 1781 said,—perhaps with too much pessimism:- “The French make greater hospital provisions than the English, and the English than the Germans; yet the French lose more men from camp disease than the English, and the English more than the Germans; and I may add, the Americans have outdone all their pred-
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ecessors in the pomp and extravagance of their hospital arrangements, and have surpassed all other nations in the destruction and havoc thereby committed on their fellow citizens.”
The state of military surgery at this time may be learned from a little volume by John Jones, M.D., Professor of Surgery in King`s College, New York. The book was printed at Philadelphia in 1776 and was designed chiefly for the use of young military and naval surgeons. It was one of the very few such books available to them. Of the treatment of wounds, he says:
King`s College, New York
“Mr. Sharp, in his excellent introduction to the Operations of Surgery, recommends nothing but dry, soft lint to recent wounds; which is generally the best application through the whole course of the cure. At first it restrain the hemorrhage with less injury than any styptic medicines; and afterwards, by absorbing the matter, which is at first thin and acrimonious, it becomes, in effect, the best digestive. During incarnation (granulation) it is the softest medicine than can be applied between the roller and tender granulations; and at the same time an easy compress on the sprouting fungus.
For these reasons I shall not recommend to you any ointments for recent wounds, unless some mild, soft one, to arm a pledget of tow, to cover the lint.
When a wound degenerates into so bad a state as to resist this simple method of treatment, and loses that healthy, florid appearance, which characterizes a recent wound; it is then denominated an ulcer, which is distinguished by various names.”
Inflammation, caused by irritation and pain, are to be combatted by sudorific anodynes, bleeding, gentle laxatives, warm baths, and soft cataplasms of the affected parts. Opium is always necessary. Abscesses are to be opened, and the first appearance of gangrene obviated by a more nourishing diet, spirituous fomentations, and a liberal use of the bark.
Incised wounds are to be brought together with sticking plaster and bandages. The use of a suture is unnecessary in longitudinal wounds. Transverse wounds require the suture. The interrupted suture is used and the needle dipped in oil. A plaster is applied over the sutures, which may usually he removed in two or three days.
Punctured wounds require no special treatment, unless deep and winding, when they must be enlarged.
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In lacerated wounds preserve as much as possible of the lips.
In severe contused wounds suppuration must ensue; and the wound must be opened. Meanwhile, use warm embrocations; with gentle purging and bleeding.
Cut tendons are not sutured but held by plaster and bandages, the limb being properly flexed.
Wounds of the chest and abdomen are serious. Those of the heart, aorta, cerebellum, medulla and receptaculum chyli are mortal; those of the lungs, liver, intestines, kidneys and other organs and vessels are hazardous; to which may be added errors of the patient or his physician.
It is always necessary to dilate the external opening; the patient should then be bled all he will bear, bleeding to be repeated at intervals.” The remaining treatment seems to consist of remedies whose names have a pleasing and hopeful sound to the ear, but could have been of but little use in these dangerous wounds: “emollient glysters, cooling nitrous drinks, anodynes, most rigid diet consisting solely of thin, diluting drinks, perfect quiet, and a proper posture.”
“Should any portion of the intestines or omentum be forced out, they ought as early as possible to be reduced, by placing the patient on his back, with his hips a little elevated,” the opening to be enlarged if necessary. “The external wound may be united by means of the interrupted suture, assisted with a compress bandage, and a suitable posture.”
Bayonet or sabre wounds of the chest are to be enlarged, w give free discharge of the blood lodged in the cavity. Perfect rest is necessary, “even speaking should be forbidden.” Nitre & c. are to be given; even in surgical cases medicines are greatly relied on.
In general, all serious compound fractures, especially those involving joints, call for amputation. Amputation at the hip joint was not, however, done at this time. They might be treated otherwise in the country, but not in hospitals, where serious infection is certain. The amputation must be done at once, before inflammation begins. In the cases where amputation is not done, large openings must be made. Dry, soft lint is to be applied, bleeding used, and the usual embrocations, antiphlogistics, etc., & c. Compound fractures require dressing at least once a day, and in hot weather, with large discharges, oftener. The
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eighteen-tailed bandage is absolutely necessary. A piece of fine oilcloth should be placed between the bandage and the skin. The discharges are removed with soft sponge; and the bandages may be moistened with camphor or plain spirit. Small abscesses must be opened, and left open. Relaxing cataplasms and fomentations should be used through the whole period of inflammation and swelling, but not later. If, however, all means fail, and gangrene appears, in a large and crowded hospital, amputation should be done at once; but in private practice an attempt may still be made to save the limb. In case of serious gangrene with emphysema, the bark is to be pushed and numerous deep incisions made, with dressings wrung out of spirits, renewed several times daily.
In gunshot wounds the first object is to remove the ball; next, restrain hemorrhage, if proper, using a ligature, as no styptic is to be relied on. The first dressing should be light, easy and superficial, with a retentive bandage of soft flannel. It is well to first dip the lint in oil. At the second dressing some mild digestive may be used, with a bread and milk poultice over all. General treatment is given as in other wounds. If amputation is necessary, it is of the utmost importance that it be done at once.
The wounds of those days were chiefly made by musket balls. The British troops used the long barrelled, smooth bore musket, carrying a round ball, about three-fourths of an inch in diameter. It only had an effective range of one hundred yards or a little more, but within that range it did considerable damage; though it frequently lodged. The bayonet was actually used though rarely. There were few wounds from artillery missiles. The guns were small, with a short range. Solid shot and grape were alone used; explosive shell and shrapnel had not been invented. There was also a considerable number of wounds made by knives, clubs and hatchets; due to the Indian contingent of the British forces. As there was no regular system of collecting the wounded, those seriously wounded often lay unattended for days. And when cared for, the means in the hands of the surgeon were so limited, the surroundings so very unfavorable, that one is led to wonder what he could have done in the case of grave wounds.
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Of the diseases affecting the armies, space allows only a brief mention of the three principal affections; dysentery, camp fever or putrid fever, and small pox.
The widespread and malignant dysenteries which attended armies of those days, and for a hundred years later, are difficult to understand today. We know that they did exist in camps, and also in hospitals; that they killed many and disabled still more. They were doubtless bacillary diseases of a malignant type, rarely seen today; though a similar dysentery was met in the Philippine Islands in 1899-1901. This dysentery was common in both armies during the American Revolution. British surgeons mention it in Burgoyne`s troops, also in the southern armies. It was very common on the continent of Europe. All American medical writers speak of it as one of the most serious. diseases of the army. Schoepf, the Chief Surgeon of the Hessian Force at New York, wrote: “Our troops arrived here in July (1776). From that time to October most of our men were, one after another, in the hospitals on Staten Island or at Harlem. There were very few who escaped without an attack of dysentery or fever.”
Tilton, who saw plenty of dysentery in the wretched hospitals of Pennsylvania and New Jersey, has described it briefly:
“The putrid diarrhoea was generally the result of dregs of other camp and hospital diseases; and was the most intractable disorder of any we had to deal with. The patient would often be able to move about, while little or no fever, his skin remarkably dry and dusky, and constant drain from bowels. Various attempts have been made to force the skin by warm bathing, Ipecac mixed with opium, & c., and by that means to divert the current of humours from the bowels; but all to no purpose. The only astringent I recollect to have been of any use was recommended us by Doctor Craik, one of our physicians general, noted for his great range in the materia medica. It consisted of Tinct. Huxham, and Tinct. Japon.; equal parts, of this mixture one or two teaspoonfuls were given every morning before breakfast, and again before dinner.
But while the patients remained about the hospital, nothing appeared to have more than a palliative effect. Multitudes melted away, as it were, of this miserable complaint, and died. The only expedient I ever found effective for their relief was to billet them in the country, where they could enjoy pure air and a milk diet; or to furlough them to their own homes, if within reach.”
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Of all the diseases of that day putrid fever was the most feared. This was a term synonymous with jail fever, camp fever and hospital fever; and included typhoid as well as typhus. While the descriptions always mention the purple spots, Tilton afterwards could not remember them, probably having seen more typhoid than typhus. Yet there was enough of typhus; in the terrible camps of the Northern Army; in the barracks on Manhattan Island; in the crowded hospitals of New Jersey and Pennsylvania, even in the small pox hospitals of Virginia; and, above all, in the horrible prisons and prison ships of New York, where imprisonment was all but equivalent to a death sentence.
Tilton again is an excellent witness. He not only saw this disease in all its malignancy, but himself suffered from it in the hospital at Princeton. His description corresponds fairly well with the symptoms of typhoid.
“The jail fever generally gives some days notice of its approach, by a languor and listlessness of the whole body, and a peculiar sensation of the head, as if it were tightened or compressed by a hook. The febrile attack is very much in the style of the Synochus, as described by Cullen. It is not very uncommon for the symptoms to run very high in the beginning, so as to warrant blood letting and an antiphlogistic course. But after some days, more or less, in different patients, the pulse begins to sink, a dry tongue, delirium, and the whole train of nervous and putrid symptoms supervene. If I ever saw the petechiae, so much dwelt upon by Pringle and Munro, I have forgotten all about them. This I am sure of, they were not regarded as essential to the disease.
Although often compelled to let blood in the commencement of this fever, we were cautious of repeating the operation; and were disposed to avoid it altogether, when not demanded by a
full pulse and other pressing circumstances * * * * *.
When the fever is formed, mercury is of the greatest importance, so long as any signs of an inflammatory diathesis remain. This Sampsonian remedy has the power of subduing all manner of contagion and infection that we are yet acquainted with.
********
As soon as the pulse sinks, and a dry tongue, delirium and other typhous symptoms predominate, we must have recourse to bark (Peruvian bark), wine, volatile salts, blisters, etc. A dry tongue generally warranted the use of the bark * * *
Wine was deemed a capital remedy in every stage of typhus. In my own case, besides an obstinate delirium, I had a crust on
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my tongue as thick as the blade of a knife, and black as soot. The skin was worn off my hips and dorsal vertebrae so as to make it necessary to patch those parts with common plaster. At the acme of my disorder, eleven surgeons and mates all gave me over, and only disputed how many hours I should live. Providence ordered otherwise. My friend, Dr. Rush, paid kind attention to me; and a benevolent lady of the neighborhood sent me several gallons of excellent wine. I drank freely of the liquid, and took, at the same time, liberally of Huxham`s tincture. My tongue soon after began to moisten on the edges; and in the course of some days the whole crust fell off and left it so raw and irritable that I was obliged to hold skinned almonds in my mouth to abate the irritation.
* * * * * * * All the cuticle scaled off from my skin; and all my hair gradually combed off from my head; so that instead of my former straight hair I had an entire new suit, that curled beautifully.
Being reduced to skin and bones I had a voracious appetite, and in a moderate space of time recovered a more than ordinary plump habit; but it was not less than nine months before I gained the usual elasticity of my muscles.”
Small pox was the one infectious disease which the medical men of that period understood, and could combat with a measure of success. Their weapon was a heroic one,—inoculation. Vaccination was not given to the world until twenty years later; consequently they were forced to adopt the prophylactic procedure of the Turks (originally of the Hindoos) ; which was introduced into Europe at the beginning of the century. They fought fire with fire; prevented small pox by inoculation with its own virus. At first thought this appears an insane idea, as that of the man who commits suicide to avoid death. But it was by no means so. Our forefathers of that period were a hard headed set. They had few facts, but with such facts as they had they reasoned with a rigid logic. The natural small pox destroyed one-sixth of its victims. The disease produced by inoculation caused but one death in two, three, four or even five hundred; one in three hundred is a safe average. Even the opponents of inoculation admitted the decreased fatality and were forced to the argument that by inoculation smallpox was spread to vastly more people, and although the percentage of mortality was less, the total of deaths was greater than before. The bills of mortality for London tend to support this contention; yet there can be no doubt
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that inoculation was a valuable procedure in the army,—if properly done. When recruits were inoculated at isolated points, before joining the main army, when they were prepared and cared for, when the proper procedure was carried out, and the vaccination was done in the Spring or Fall, not more than one in three or four hundred died. The army was thenceforth immune to the dread disease and was vastly benefitted by inoculation. When, however, the inoculation was done in a winter camp in the wilderness, and in the face of the enemy, as was the case in Canada, it was an ill advised measure, detrimental, if not ruinous to the army. Dr. Morgan appears to have opposed inoculation, and the army at Boston suffered little from small pox. But it was generally applied during the summer of 1776, and Washington himself is said to have been inoculated. Ship-pen favored it, and during the latter part of the war all recruits appear to have been required to undergo inoculation. Thatcher records that his regiment of five hundred men was inoculated in the Spring of 1776 at Boston, with the loss of but one man,—a Negro. Other similar records have been left. Inoculation hospitals were established at Alexandria, Dumfries, Colchester, and other places, and inoculation became a proved and established procedure.
While inoculation was generally being done, at that time it had not been required by Congress. However, it was being considered, and on February 12, 1777 the Congress ordered, that the Medical Committee write to General Washington and consult on the propriety and expediency of causing such troops in his army, as have not had the smallpox, to be inoculated, and recommends that measure to him, if it can be done with the public safety, and good to the service.
What came of this action is unknown, but a few months later the Congress seems to have arrived at a decision. On April 23rd there was a resolution:-
Resolved, That Dr. James Tilton be authorized to repair to Dumfries in Virginia, there to take charge of all Continental soldiers that are or shall be inoculated, and that he be furnished with the necessary medicines. * * *.
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And a few days later :-
Resolved, That Major General Schuyler be directed to send a proper officer to hasten the march of Carolina continental troops, supposed to be now on their way to headquarters: that they halt at Dumfries, Colchester and Alexandria in Virginia, there to pass through inoculation; which the hospital surgeons lately despatched from this city to Dumfries, are directed to see effected, with the greatest despatch.
In December of that year news had reached the Congress that the inoculation at Alexandria and been attended by ill results, and the medical committee was directed to enquire and report. Inoculations, however, were continued throughout the war.
Why the inoculated smallpox was so much less fatal than the natural disease is a question not entirely answered. Some reasons may be given. The inoculation was commonly done in the summer, a more favorable season than winter. In the army it was done in isolated hospitals, for recruits; not in large camps.
The virus was taken from young and healthy subjects, on the twelfth or thirteenth day, presumably from the milder cases. It was also done with dried scabs, which may have lost some of their virulence. Lastly, there was certainly less malignancy in the disease inoculated through the skin into the superficial capillaries than when inhaled into the auxiliary sinuses and lungs. Whether the course of medical preparation given to the subjects was of much avail may be doubted. An idea of this course of cathartics may be had from the drugs supplied.
When the Congress was in session at Baltimore in the winter of 1776-7 it was voted that all the troops there be inoculated.
Feb. 20, 1777. ORDERED, That the Assembly of the State of Maryland be requested to deliver to Dr. McKenzie so much Medicines of the following Denominations as he shall want and they can spare, to enable him to inoculate the Continental Troops in this Town, in the following Proportions, for (each) one hundred men:
Six ounces Calomel. Two pounds Jallap. Three pounds Nitre Elixir Vitriol. One Pound Peruvian Bark. One Pound Virginian Snakeroot.
When the war began there were many men in the camps who had served with the British armies in the field. The Virginians had witnessed with dismay the massacre of Braddock`s
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men at the Monongahela; seven thousand colonists watched Abercrombie`s fatal assault at Ticonderoga; they had also participated on happied occasions, as Louisburg, Frontenac and Quebec. A considerable number had served as surgeons or assistant surgeons of regiments. These men proceeded to place the crude medical service of the new army on a footing approximating, at last in form, that of their enemy. To understand what these early medical officers of the Continental Army were attempting it is necessary to take a hasty survey of the medical service of the British Army at that time; for the Continental Army, in all its parts, was modeled after that army.
The medical service of the British Army at that time was rather loosely organized and was none too efficient. Such success as it had was due rather to the individual loyalty, energy and devotion of its officers than to any excellence of general plans and management. The head of the service was not one officer but a Council, consisting of a physician general, a surgeon general and an inspector general. This Council was, strange to say, not made up of experienced medical officers of the army, but of eminent (or favored) local practitioners of London. The practice of medicine was sharply differentiated from that of surgery. It was supposed or assumed (contrary to real facts) that army physicians treated the sick in the hospitals, while the regimental surgeons treated the wounded in the regimental hospitals. Only a graduate of one of the great universities or of the College of Physicians of London could become an army physician. The requirements for a surgeon were not so high, and a commission as regimental surgeon was purchased for cash, as were all other commissions. McGregor purchased his commission, as surgeon of the 88th Regiment, for one hundred and fifty pounds. Brocklesby thought these positions worth from five to six hundred pounds. The system was bad, and doubly bad in that their regimental surgeon could look forward to no promotion. When John Hunter reached a place of authority in 1790 restrictions on physicians and surgeons were removed, regimental surgeons were promoted to higher places, and the highest places could be filled only by men of previous service. The medical service was improved, but went back to its former status on his death in 1793.
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For an army in the field (20,000 to 30,000) there was an inspector general (medical) and an inspector for each division of about four or five thousand men. For the principal hospital there was a physician, with several assistants. There were also two surgeons for the hospital and two for the field. Each regiment or battalion had a surgeon and an assistant; two in time of war. These were known as surgeons` mates and were of warrant rank. The regimental surgeon held a commission and was called “Mister” or “Doctor” but had no real rank. On the regimental list he was named, if at all, after the last ensign. He ranked somewhat with the chaplain and quartermaster and was overlooked on ceremonial occasions.
For an army in the field a fixed general hospital was established, in existing buildings. Each regiment had a small hospital, in a dwelling or other convenient building. Tents were used only when no other shelter was to be had. Jackson states that a hospital of 400 beds would have about six medical officers and 48 hired assistants, cooks, nurses, &c. &c., as follows:
Officers A physician and two assistants
A surgeon and one assistant
An apothecary.
Others: 1 Steward 1 Sempstress
3 Wardmasters 5 Laundresses
2 Dispensers 3 Barbers
1 Surgery man 3 Cooks
Attendants as needed Laborers as needed
1 Keeper of packs 7 Servants.
2 Bathers
1 man for Itch ward.
There was, however, no fixed quota and the hospital had much liberty in hiring help. There was no enlisted corps of hospital men of any kind.
In 1801 the total expenses of a hospital did not amount to more than ten pence per man per day, including the pay of attendants, cooks, servants and the like. It is worthy of notice that wine was a part of the fixed ration of a patient, and that so much liquor was dispensed that the total cost was as much as that of the bread consumed in the hospital. Possibly some of it was used for prophylactic purposes.
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The great British army surgeons of the 18th century almost without exception favored small regimental hospitals rather than large general hospitals. McGrigor and Guthrie came dangerously near to disobeying the orders of the Duke of Wellington on this subject. In this attitude they were undoubtedly supported by experience. To collect a large number of weakened men in an ill suited building was to subject every one of them to all the wound infections and malignant diseases brought in by all, and with which the building was saturated. By keeping the sick scattered in small lots some of these infections were avoided. Pringle, Brocklesby, Guthrie, Jackson and McGrigor all favored regimental hospitals. They claimed that the great general hospitals did not reduce disease mortality, but, on the contrary, increased it; and this was true. Thousands of young men entering a hospital with but slight injury or perhaps venereal disease, perished from typhus or other deadly disease therein contracted. Hospitals earned, and with reason, the fear of all intelligent men; a fear that has descended, among the ignorant, to the present day. Military hospitals, even in the 18th century, were much more dangerous than battles. A soldier entering a great battle had on an average ninety-eight chances out of a hundred of escaping with his life; entering a hospital he had no more than ninety, in many cases but eighty or even seventy-five five chances. Tilton said it was a fact “that more surgeons died in the American Service in proportion to their numbers than officers of the line. A strong evidence that infection is more dangerous in military life than the weapons of war.” The reputation and character of military hospitals made officers fear and even refuse to send their men to them. And, with many ignorant or empiric physicians, with little or no sanitation, and the most fatal infections constantly present, both officers and men followed the strongest of all instincts in shunning these hospitals. No well-to-do person ever thought in those days of entering a hospital. These institutions were for the poor and helpless; not a cure house but a host house, a tent where takes his one day`s rest a Sultan to the realm of death add rest.
Of the hospitals in America Jackson said:-
“The author served in America with the late 71st Regiment, a corps which took possession of Savannah in the latter end of 1778. It traversed in its various expeditions the greatest part
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of the provinces of Georgia, the Carolinas and Virginia. The sick list was sometimes numerous. Georgia and Carolina, at least particular districts in these provinces, are singularly unhealthful. * * * * * * * * * *
There was no adequate provision (to be) made in the general establishment of hospitals for the sick of corps, serving in particular districts, at particular seasons of the year, for, in many instances more than one-half were actually under medical treatment.”
And, again, of the disadvantages of general hospitals:-
“In the regiment in which the author served during the late war in America there was often a great, even sometimes a prodigious degree of sickness, for service led the corps to districts singularly unhealthful; yet it had seldom anything to do with general hospitals; and the miseries of sickness, measured with the miseries of general hospitals, were of small account. * * *
“In regimental hospitals well conducted, acute diseases rarely exceed a fortnight in duration; from general hospitals few are found to return in less than three months.”
Very many never returned at all. In ordinary times of peace there were annual death rates greater than those which shocked the world during the influenza-pneumonia epidemic of
1918.
Not infrequently regimental hospitals were bad also. Brocklesby said:-
“Most commonly the habitation hired for an infirmary has for some time been altogether unoccupied, with the walls all damp, the boarded floors half rotten, and the roof in several
parts open above. * * * * * * *
I have indeed seen such a cottage stuffed with 40, 50, 60, nay 70, or 80 sick soldiers, all lying heels to head, as closely confined together with their own stinking clothes, foul linen etc., that it was enough to suffocate the patients, as well as others who were obliged to approach them. In such receptacles for the sick I have frequently observed the simplest inflammatory fever, without the least alarming symptoms at the patient`s admission, to degenerate into the spotted and truly petechial fever (typhus), and thus be converted by bad hospital air, from only an increased circulation of the blood, into a most dangerous putrid or jail fever.”
The relation of body lice to typhus, was, of course, unguessed.
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He did not contend that this variety of regimental hospital was superior to a good general hospital.
It is necessary to set forth the common status of hospitals in the time before infectious diseases were understood in order that conditions in the hospitals of the Continental Army, when later described, may be comprehended. The hospitals of European armies were little less fatal. They were probably better supplied with clothing, food and medicines, but had no more protection against the malignant typhus. The handling of the wounded was by no well ordered system. There were no bearer companies then or for a hundred years afterwards. There were no ambulances in the British Army then or much later. Napier says of the wounded of the Peninsula War:-
“In the British Army the carrying off of the wounded depended upon the casual assistance of the weak wagon train, very badly disciplined, furnishing only three wagons to a division, and not originally appropriated to that service; partly upon the spare commissariat animals (pack mules); but principally upon the resources of the country, whether of bullock carts, mules or donkeys; and hence the most doleful scenes after a battle or when a hospital was to be evacuated.”
After the battle of Alburea, Guthrie had on his hands 3000 wounded, with but four wagons and only such stores as the surgeon carried in their panniers.
Such was the Medical Service of the British Army; that of the Continental Army was a fair imitation of it.
NOTES.
1 “The Academy” on the west side of Fourth Street, near the corner of Mulberry, was occupied by the first medical school in America. The Medical School of the College of Philadelphia opened in 1795 with the following faculty:
Dr. John Morgan—Professor of Theory and Practice of Physic.
Dr. William Shippen, Jr.—Professor of Anatomy and Surgery.
Dr. Adam Kuhn—Professor of Botany and Materia Medica.
Dr. Benjamin Rush—Professor of Chemistry.
In the year 1791 this medical school was merged with the University of Pennsylvania, and still exists in a most flourishing state.
2 Dr. Edward Hand was born in Ireland in 1744, and came to America as surgeon`s mate of the 18th (British) Regiment in 1764. At the beginning
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of the Revolution he took sides with the Colonists and was made lieutenant colonel of Thompson`s Pennsylvania Rifle Regiment, June 25, 1775, and lieutenant colonel of the 1st Continental infantry January 1776. He was a candidate for Medical Director of the Hospitals when Dr. Morgan was chosen. On March 7, 1776, he was promoted to the rank of colonel, and on January 1, 1777, was made colonel of the 1st Pennsylvania Regiment. On April 1, 1777, he was made a brigadier.
He was taken prisoner at the fight at Three Rivers, Canada, in 1776, and not exchanged until 1778. In 1779 he commanded the 2nd Pennsylvania Brigade and was Adjutant General of the Army from January 8, 1781, to November 3, 1783. On the latter date he received the rank of brevet major general, and on July 19, 1783, was made a major general. He was honorably discharged June 15, 1800, and died September 3, 1802. He was one of the medical men whose career in the line of the army was entirely successful.
3 The Pennsylvania hospital, the first general hospital established in the Colonies, originated in the efforts of Dr. Thomas Bond, Sr., supplemented by the skillful promotion of Benjamin Franklin. The necessary funds were furnished by the people of Philadelphia and the House of Representatives of the Provinces. The hospital was chartered in May 1751; the first patient was received in a temporary hospital, February 10, 1752. The corner stone of a permanent building was laid May 28, 1755, and this was occupied on December 17, 1756. Franklin said, “Dr. Bond conceived the idea of establishing a hospital in Philadelphia (a very beneficent design, which has been ascribed to me, but was originally and truly his) for the reception and cure of poor sick persons.” Although Bond originated the idea, it was Franklin who influenced public sentiment and by legislative action secured the necessary funds. It should be noted that this hospital, like others of that time, was for the “poor”. No one who could avoid it then entered a hospital.
JOHN JONES.
4 Dr. John Jones was born in Jamaica, Long Island, in 1729, the son and grandson of physicians. He studied medicine under his father; then with Hunter and Pott in London, Monroe in Edinburgh, Petit in Paris: and took his degree at Rheims in 1751. Settling in New York he acquired prominence as a surgeon. During the French War he served as a military surgeon from 1755 to the end of the war. He was present at the battle of Lake George, and attended the wounded Baron Dieskau. After that war he became professor of surgery in the Medical College of New York. Although a chronic sufferer from asthma, he did good service during the war; as we see, writing a manual for military surgeons. He removed to Philadelphia and was made physician to the Pennsylvania Hospital in 1780. He attended Franklin in his last illness, and himself answered the last call in 1781. His book, “Plain, Concise, Practical Remarks on the Treatment of
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Wounds and Fractures,” 1775, was the first book on surgery produced in the United States, and was the principal reliance of surgeons of the Continental Army during the war.
DR. SAMUEL DANFORTH.
Samuel Danforth, 3rd, was born in Cambridge, Massachusetts, son of Samuel Danforth, a probate judge in the County of Middlesex and descendent of the Samuel Danforth who came from England to Roxbury, Massachusetts, in 1634. The last named Samuel`s name appeared second on the list of Fellows of Harvard College, 1650-54 and in the College catalogue from 1634 to 1658.
Young Samuel Danforth`s early life was spent in Cambridge. He graduated from Harvard College in 1758, after which he studied medicine with Dr. Rand, the elder, either in Charlestown or Boston. He began practice in Weston, Massachusetts, but soon removed to Newport, Rhode Island, returning a year or two later and settling in Boston. He was an original member of the Massachusetts Medical Society and its president from 1795 to 1798. In 1790 his alma mater conferred upon him the honorary degree Doctor of Medicine.
Dr. Danforth was an instructor in medicine, many of the practitioners of his day having studied in his office. As New England then had no medical college, the office of some successful physician afforded to the average student the only means for studying medicine then available. He died on November 16, 1827, at his home in Boston, aged 87 years. His portrait painted by Stuart hangs in the Boston Medical Library.
JAMES LLOYD.
Dr. James Lloyd was, born on Long Island in 1728. Was educated at Stratford in Connecticut, and at New Haven. At the age of seventeen he began the study of medicine with Dr. Clarke of Boston, and continued it for five years. He then studied for two years in London with the best medical men of the day. In 1752 he returned to America and practiced in Boston. Soon afterward he was appointed surgeon to the King`s troops in Castle William, but later returned to general practice. He formed the plan of general inoculation for smallpox in 1764, along with Dr. Rand and Jeffries. From 1758 to 1775 he not only had a most extensive practice, but also had so many students that his office became almost a medical school. Among those who studied with him and learned of him were Dr. Joseph Warren, Dr. Isaac Rand, Dr. John Jeffries, Dr. John Clarke and Dr. Theodore Parsons.
He remained in Boston during the siege and had the whole population inoculated. While taking no part in politics, he continued his practice in Boston and was on terms of friendship with the great American leaders. He died in 1810.
