First Do No Harm

The History of Medicine
The Revolutionary War

During the American Revolution, more soldiers died from illness than from combat. This was the reality of the state of the art of medicine and would be so right up to World War I. By WWI, it wasn’t so much that medical science had advanced to such a degree as to reverse this situation as it was that military science had advanced even further.

Clouds of gas could wipe out thousands in minutes, not to mention the machine guns and advances in explosive technologies. Humans were suddenly more capable of killing fellow humans than the scourges, plagues, and various bugs pursuing us, although the bugs were a very close second: it was WWI that introduced the world to the Spanish Flu killing an estimated 40 million around the world (the bulk of whom died after the war ended).

The Colonial physician was a pillar of his society. His status was nearly that of the local minister. He was a scholar and a gentleman. The best physicians of the time were often judged by their oratory eloquence rather than their successes as most of the time, an attending physician seemed to help the ill hurry toward their maker, especially if blood letting and mercury were involved.

In our first essay on the History of Medicine in America we touched on the Four Humor Theory of Medicine. At about this time, some competing theories were blossoming in both Europe and in the colonies. They too were ludicrous, by our standards today, and utterly without scientific merit. It seems that science, at this time, was considered an art. If a physician studied anatomy (some did not), that was considered science. Trial and error was looked down upon, while today our science is based upon trial and error. This is called empiricism: taking a theory to the laboratory and testing it. Empiricism was frowned upon by most physicians. One stuck to the rigors of his education and never questioned or tested. However, since there were no organizations or affiliations to enforce any particular form of medicine at the time, Colonial physicians were free to choose therapies from herbalism and what they called Indian Medicine, as well as from their formal or informal medical education.

One new theory to enter the mainstream at this time came from the Dutch physician and professor Hermann Boerhaave. Boerhaave explained disease in terms of acidity and alkalinity, or tensions and relaxation. At this same time, William Cullen, a Scottish physician from the University of Edinburgh, theorized that either an excess or insufficiency of nervous tension was the cause of all disease.

What we had during this period was an attempt to distill the causes of disease down to a singular source. Diagnosis of any particular disease was to become totally unnecessary. Whether the patient had a sore throat, an appendicitis attack, or whooping cough did not matter to these theorists; what mattered was balancing the nervous tension or acidity. As Mary Gillet writes in her online book entitled THE ARMY MEDICAL DEPARTMENT 1775-1818 , ". . . fact took second place to theory…."

Hindsight, they say, is always 20/20. Looking back, their acid/alkalinity theory was quite close to that of the Medical Outlaws of the 19th century: i.e., Bernard and Enderlein. Had medicine focused on the human terrain (acidity/alkalinity), it would have evolved entirely into a very different species from what we have today. (See also, The Lost History of Medicine.)

The Colonial physician’s job was mainly providing support and comfort. He would set a broken bone on occasion. If there were multiple fractures, he could perform an amputation. He gave some herbal preparations to his patients, opting oftentimes for a bark from the Cinchona trees introduced into Europe from Peru since it seemed to help malaria patients. One historian tells us, "It was not until 1820 (200 years after the bark was introduced into Europe for the treatment of malaria) that quinine was isolated from the bark of the Cinchona tree." It was quinine that led to a cure for malaria. []

Each physician had his own favorite medications, calomel and jalap being the favorites. The dose was heroic, meaning the patient oftentimes was overdosed. Calomel is a form of mercury. Today we know this heavy metal to be a neurotoxin and a general, all around, poison to our system. Sadly, if you are over the age of 30, you got a dose of mercury in your vaccinations. Mercury was used as a preservative in vaccinations right up till recently. It was still being injected into our children after it had been outlawed from veterinary medicine.  

Benjamin Rush was a brilliant man (mentioned already in our previous essay). It’s quite funny how lightly some historians treat him, considering the probability that his medicine killed more people than it ever saved. Rush graduated from the college we now know as Princeton at the youthful age of 15. He then studied medicine as an apprentice under a Dr Redman in Philadelphia and attended the first course in anatomy to be taught in this country. In 1766 he went to Edinburgh, Scotland and received his medical degree in 1768. He took Cullen’s theories back to the colonies where he, according to Mary Gillet, "eventually modified Cullen's doctrines, which he had originally so much admired, and discouraged the study of separate disease entities by blaming all disease on excessive tension which caused disturbance in the blood vessels. By 1793, he was openly contending that there was but one single disease in existence." She goes on to say:

The method of treatment upon which Rush insisted with increasing inflexibility called for a low diet, vigorous purges with calomel and jalap, and bleeding until the patient fainted. Rush apparently did not hesitate to remove a quart of blood at a time, or, should unfavorable symptoms continue, to repeat such a bleeding two or three times within a two- to three-day period, it being permissible in his opinion to drain as much as four-fifths of the body's total blood supply. In time, Rush's system and treatment became, in the words of a noted medical historian and physician, "the most popular and also the most dangerous 'system' in America.

Rush later became the middle army’s first Surgeon General. However, the story of the Director General and Chief Physician of the Hospital of the Army, from July of 1775 through Oct of 1775, is much more interesting.

Dr Benjamin Church was the son of a merchant and deacon. He had attended the Boston Latin School and was a graduate of Harvard in 1734. Like Rush, he apprenticed in medicine at first and then finished his studies abroad, opting instead for London. He returned and built himself a reputation as a talented and skillful physician and surgeon. He supported the Whigs and vilified the Tories, at least in writing, though like many, he was once or twice accused of being a secret Tory sympathizer. He treated many of the wounded in the Boston Massacre (May 5, 1770) and in an attempt to alleviate all doubts as to his loyalty, he delivered a rousing speech on the fifth anniversary to that massacre entitled, "To Commemorate the Bloody Tragedy of the Fifth of May 1770." However, when information from a secret meeting of the Whigs that he had attended made its way to the Tories, Church was again accused of being the "rat."

Since no one could prove these allegations, Dr Church was appointed to more and more committees as preparation for war continued. After the battle of Lexington, again he came under fire for a little trip to Boston to confer with the British officer General Gage, but this seems to have been dismissed, and later he went to Philadelphia to meet with the Continental Congress concerning matters of the security of the Massachusetts colony. On the 27th of July, the Continental Congress authorized the establishment of a Medical Department of the Army, and when Washington arrived at Cambridge to take command of the forces there, he appointed Dr Church as the Director General and Chief Physician of the Hospital of the Army.

Dr Church was a fine physician, surgeon, politician and orator; a true renaissance man. He had but one failing: he was a lousy leader. Within a few weeks of his appointment, because of a spate of complaints, Washington was compelled to order a full investigation. Church’s defense was that petty jealousies among his peers were afoot here, and asked to be excused from the army.

Not so fast. He was hauled up before a court-martial in October of 1775 and asked to explain a cipher letter addressed to Major Cane, another British officer. Strangely enough, when the letter was decoded, it did not contain any really useful information (for the British) though it did contain a declaration of his devotion to the crown and a request for further instructions.

On October 17, 1775, Dr John Morgan took over Dr Church’s job, and three weeks later the Continental Congress, having not yet determined in any resolution or statute exactly what to do with traitors, passed the following resolution:

That Doctor Church be close confined in some secure jail in the Colony of Connecticut, without use of pen, ink and paper, and that no person be allowed to converse with him except in the presence and hearing of a magistrate of the town or the sheriff of the county where he is confined, and in the English language, until further orders from this or a future Congress.

Long story short, Dr Church was allowed to hop a slow boat to China that never made it there and thus ended Church’s life and career in both the military and in medicine. There is still some controversy among historians as to whether Church was a traitor or not, though it appears that his family was pensioned by the British government after his passing, which would seem to seal his lot in history.

* * *

"MOST diseases are infectious," begins Dr Buchan’s book on medicine first written in 1769. "Every person ought therefore, as far as he can, to avoid all communication with the diseased. The common practice of visiting the sick, though often well meant, has many ill consequences. Far be it from us to discourage any act of charity or benevolence, especially towards those in distress; but we cannot help blaming such as endanger their own or their neighbours lives by a mistaken friendship, or an impertinent curiosity."

Malaria comes from Italian meaning "bad air." Much of medical thought during this time blamed a lot of illness on bad air. Early writings from the Military on where to camp and how to camp focus on clean conditions, lots of fresh air, avoiding swamps, etc. One preventive measure caught my attention; the burning of frankincense. Frankincense supports immune function.

Dr Buchan teaches us all something we’ve never heard previously:

INFECTIOUS diseases are often communicated by clothes. It is extremely dangerous to wear apparel which has been worn by the deceased, unless it has been well washed and fumigated, as infection may lodge a long time in it, and afterwards produce very tragical effects. This shews the danger of buying at random the clothes which have been used by other people.

Dr Rush and his colleagues wrote up pages upon pages of how to keep the soldiers’ areas clean and how to keep the hospitals clean. Little did they know that sanitation would do more to combat disease, in the long run, than any drug they possessed in their apothecary. I recall one day when my brother, who had been studying medicine at the time, opined that the person who invented underwear probably did more to increase the longevity of humankind than Alexander Fleming who discovered penicillin.

Morris Bealle gives us a perfect example of the healing power of sanitation in his book, The Drug Story: "The death rate of children under five years of age was 750 per 1000. By 1800 better knowledge of sanitation reduced this to 41 and by 1914 to 14."

Sadly, during the Revolutionary War, because of the routing of the American forces, it was very difficult to maintain sanitary conditions at the hospitals, let alone the soldiers' quarters. This is one of the reasons so many of our soldiers died.

Overall, medicine of this era was ineffective and dangerous. Sanitation was poor. Rush, in his autobiography, gives us some of the best statistics of this time: Out of 100 persons born, only 64 made it to age 6. By age 16, there were 46 still living and by 26, only 26 still alive. Only 16 made it to the ripe old age of 36, and just 10 made it to 46 with only 6 of those making it to 56. Ten years later, we find only half of those alive, and just one of those will see his 76th birthday.

In Rush’s family of 13 children born, 4 died within five months of birth; and a fifth died at the age of 31. [Drug Story]

When I hear people claim that modern (medical) science is responsible for today’s longer life spans, I listen with just half an ear. Yes, no doubt medicine, especially trauma medicine, has saved many, many lives. But to be absolutely honest, as you will see again shortly, medicine was far too often the reason for many shortened lives.

Smallpox – Epidemic or Germ Warfare?

During this time, smallpox was deadlier than combat; it could lay an army lower than anything the enemy had in their arsenal. Some historians, it seems, believe that the British knew this and began infecting various tribes of Indians as well as the civilian population in an effort to put a halt to the revolution.

Let us first take a look at the history of smallpox.

Smallpox has been around for centuries. It is at least three thousand years old and quite possibly four times that. It is thought that the Pharaoh Ramses the Fifth died from smallpox in 1157 BC. Anthropologists have uncovered evidence of smallpox running through India during the start of the first century and from there it quickly spread to China. [] Smallpox was brought to Africa by slave traders and reached Europe in 710. From there it was spread to the rest of the world by our famous explorers, Columbus, Drake, and especially Cortez who killed some three and a half million Aztecs in under two years with the virus.

Communicable diseases are most deadly to a civilization upon their initial contact with the disease. It seems that some portions of our immunity can be passed on to our children. This is an amazing benefit given us by nature or our Creator, whichever you prefer. For those with no history of the disease, smallpox was deadlier than any previously known plague. An estimated 90% of the American (both south and north) natives perished from smallpox.

The History of Inoculation

In ancient China, a young emperor had smallpox scabs blown into his nostrils in an attempt to protect him from the disease. The science of inoculation as we know it begins in Europe with the story of Lady Mary Wortlley Montagu. 

Lady Montagu was a famed beauty, that is till a case of smallpox robbed her of that beauty, leaving her scarred with patches of hair missing. Some even note that her eyelashes had vanished never to return. Her husband was appointed as the ambassador to Turkey and Lady Montagu accompanied him there. The year was 1717.

One account we discovered [] states that Lady Montagu learned of inoculation by Turkish physicians. However, the PBS web site [NOW with Bill Moyers] has posted a portion from one of Lady Montgau’s letters that gives the story another angle:

There is a set of old women, who make it their business to perform the operation, every autumn, in the month of September, when the great heat is abated. People send to one another to know if any of their family has a mind to have the small-pox; they make parties for this purpose, and when they are met (commonly fifteen or sixteen together) the old woman comes with a nut-shell full of the matter of the best sort of small-pox, and asks what vein you please to have opened. She immediately rips open that you offer to her, with a large needle (which gives you no more pain than a common scratch) and puts into the vein as much matter as can lie upon the head of her needle, and after that, binds up the little wound with a hollow bit of shell, and in this manner opens four or five veins.

Smallpox is caused by the variola virus. Quite possibly this virus is a mutated version of one that affected cattle. It mutated and suddenly it was capable of infecting humans. At least, this is how the theory goes.

The act of inoculating individuals in the manner described above was named, aptly, variolation. Lady Montagu had her son inoculated that year while in Turkey, and upon returning to England in 1721, she had her daughter inoculated. This caught the attention of the king and that same year six condemned prisoners volunteered to be "variolated" using the pus from a smallpox of an infected individual. Some historians claim that this was the first use of humans in experimental trials.

These human guinea pigs survived the test and were granted full pardons. Since the king, in addition to owning the lives, body, mind, and soul of prisoners, also owned the children in the orphanage, some of them were "variolated" upon his command. Convinced of the safety of variolation, following this last successful experiment in the orphanage, the Royal Family had their two princesses, Caroline and Amelia inoculated, and they too survived the procedure.

Previously, in our first essay on the History of Medicine, we told the story of how surgery raised its status by the successful removal of an anal fissure on the King of France’s bottom. What we failed to mention was that afterwards, many of the aristocracy and sycophants to the king suddenly wanted the same and everywhere near the castle you would find the King’s most loyal subjects trouncing about with bandages on their bottoms. Well, once the Royal Family had openly inoculated its own, the aristocracy began a flood of copy cat inoculations, though not as successfully, for as it turned out, one in one thousand died from this procedure.

There was a risk of death. Following the variolation, you got sick. You came down with a fever and could be sick for up to two weeks, though at times even longer. Additionally, you were contagious for two or three weeks, whereas an individual with smallpox was only contagious when he was very sick, usually too sick to be in public. Again, once variolated, you could be sick for around two weeks, though some lucky few merely had a slight fever for a few days and then were back on their feet – highly contagious. For at least two weeks, possibly more, you were contagious. (Remember this.) 

Edward Jenner is credited as being the "Father of Inoculation." He didn’t set out to be. He certainly wasn’t the first person in the colonies to inoculate anyone, since the practice had come to America via the slave ships. Slaves too had practiced variolation, scratching each other with sharp quills and then introducing pus from a smallpox pustule. The Reverend Cotton Mather is credited for carrying out early experiments with variolation when he learned of this practice from his slaves.

It is an interesting historical fact that many resisted variolation not because it could be dangerous, but because it had been practiced by slaves, and many of our forefathers and foremothers were racists. 

Jenner wasn’t really interested in variolation, though he had certainly heard of it. He was much more interested in the possibility that animal diseases might very well spread to humans. His ideas were frowned upon by the medical community, the general public, and of course, the church. In fact, variolation was outlawed by the church. Surgery was outlawed by the church. The human body was not to be violated in such a manner.

Jenner was not a physician. Thus, he was looked down upon by those in the medical community.

He believed that cowpox was derived from horses. This idea led him to believe that smallpox was derived from cowpox. At some point, he theorized that inoculation against cowpox might build resistance to smallpox. This wasn’t an original theory, since many living in rural America believed that infection with cowpox led to immunity against smallpox, hence the fables of Jenner and the Milkmaids.

The actual story is this: Jenner collected pus from cowpox sores on the hands of a woman, a milkmaid, by the name of Sarah Nelmes, and inoculated James Phipps who was eight years old at the time. Phipps came down with a slight fever, but it quickly went away. When Phipps was given a variolation using smallpox, he did not get the normal reaction of a fever. Jenner knew he was onto something. He went on conducting similar experiments, but no one would publish his work until he paid to have it published himself. Like nearly every innovation in medical history, Jenner and his work were derided, scoffed, and laughed at. His detractors were quick to publish (not at their own expense) attacks in local papers and professional publications, suggesting that those inoculated with Jenners cowpox serum might grow horns, give milk, or start to moo. Luckily, broad-minded physicians copied Jenners experiments, came to the same conclusions, and "vaccination" was born. The word vaccination is from the Latin word for cow: vacca.

The benefits of vaccination over variolation were clear. With variolation there was a risk of death. Vaccination did not present that risk. A vaccinated individual was not contagious to others. Within fifty years, most European countries were not only vaccinating everyone, they had passed laws making vaccination compulsory.

Back to the Revolutionary War

Variolation wasn’t compulsory, but it was highly recommended. The Continual Congress wanted each and every soldier variolated. They were to be vaccinated because of two reasons. The first was that soldiers could easily contract smallpox from each other and from the civilian population. The other reason was that a few people in the Continual Congress were well aware that the British had used smallpox as a weapon previously during the French and Indian War, in 1763. At the PBS web site we discovered a letter from the British Commander-in Chief, Sir Jeffery Amherst: "Could it not be contrived to send smallpox among these disaffected tribes of Indians? We must use every stratagem in our power to reduce them."

In her book, Pox Americana: The Great Smallpox Epidemic of 1775-82, Elizabeth Anne Fenn points out that 130,000 North Americans lost their lives to smallpox. Washington, aware of what the British had done in 1763, decreed that letters from Boston were to be dipped in vinegar to kill the germs. When it became evident that the British were attempting to spread smallpox by invariolating civilians and sending them out among his troops (remember, an invariolated individual was contagious for at least two weeks), he asked the Continental Congress for funds to invariolate his troops.

Appealing to the international public, the Pennsylvania Gazette published, "Lord Cornwallis' attempts to spread the smallpox among the inhabitants in the vicinity of York . . . must render him contemptible in the eyes of every civilized nation."

Some put the death rate to small pox at 25%, while some virulent strains were approaching a 40% rate. Fenn puts the overall rate of death at this time at 30%. Just recently we’ve learned that there was a childhood form of smallpox, like chicken pox, that wasn’t as deadly, but it did produce an immunity to smallpox later in life. However, this childhood smallpox was endemic of Europe and not of the early colonies.

Editor’s Note: Prior to our invasion of Iraq, newspapers, spin doctors, and politicians unabashedly claimed that we could experience a 30 to 40% rate of death were terrorists to release smallpox in our country. At the same time, many physicians and even the CDC and WHO countered these remarks with much lower numbers. Our own research assured us that these loosely tossed around figures were extremely inflated; that a figure less than 10% was more realistic, 7% being our guess, though we had found a few who speculated it would be as low as 4%.

Personally, I don’t know for sure. I do know that other things complicate the situation when one contracts smallpox, such as poor nutrition and the general state of health of the individual at the time smallpox is contracted.

The reasons that the death rate was so high among the soldiers of the revolutionary war are many. On retreat, the sick and wounded fought alongside healthy soldiers. Conditions were so unsanitary that in one hospital (actually a barn that had been turned into a hospital) one patient wrote home that inch long maggots crawled out of two patients’ ears one morning. Many were already suffering from dysentery. Soldiers with venereal disease kept their mouths shut as they could be punished and fined. And finally, there was medicine itself. If you got smallpox, the last thing you needed was the first thing you got: heroic medicine. You were bled and poisoned. People in rural communities, unaware of modern medicine and far from a physician, seemed to fair better with their chance of dying from smallpox around 20%. [Pox Americana: The Great Smallpox Epidemic of 1775-82]

The Attack On Canada

The army medical department could pretty well predict the number of patients, hospitals, physicians, and amount of medicine needed in the course of battle because of a Frenchman, Hugues Ravaton who, in 1768, had written, "…one could assume that three of every 100 soldiers would be ill at the beginning of a European campaign. Halfway through the campaign, a probable five or six of 100 would be out of combat because of disease, and by the end of a campaign, if the victims of venereal disease and nonbattle injuries were counted, ten to twelve of 100 would be unable to fight because of illness. A day's battle would produce, he estimated, ten wounded per 100 combatants, but this percentage would drop as the number involved approached 100,000." [Gillet].

There was one thing wrong, however, with the above formula, one factor that was missing: smallpox.

The attack on Canada is a remarkable story of two very different enemies: one in uniform and the other, small, virulent, insidious, and invisible; something no human being would see for at least one hundred years.

Early fall of 1775, the Continental army prepares for an attack on Canada. Major General Philip Schuyler leads the push. He has no department physicians and some of his units have no surgeons. As of August, he has no hospital supplies and already 100 of his 500 men are ill. He gives his own supply of wine to the sick, purchases medical supplies and hires a surgeon, Dr Samuel Stringer, with his own money. On September 14th the General learns that Stringer has been officially approved and his expenses are being reimbursed, but he’s out of the push for now, having come down with smallpox. He is replaced by Brigadier General Richard Montgomery.

The unit bulks up to 2000 men strong, and although Dr Stringer accompanies Montgomery to Fort George, he remains behind to run the hospital when Montgomery continues north to take Montreal.

On the 12th of November, Montgomery holds Montreal, but his army, due to disease, desertions and expiring enlistments, is down to 500 men. He marches on to Quebec in December with only 300 men, having lost 200 more to illness. These 300 contain the seeds of an epidemic.

In Quebec, Montgomery joins forces with Colonel Benedict Arnold who had arrived with approximately 11,000 men after a grueling march through the thick New England swamps and forests. Arnold brings along a 22-year-old regimental surgeon, Isaac Senter, and one of Senter’s assistants. As a result of an extended incubation period, when smallpox does strike, it leaves a trail of casualties from Quebec to Fort George. Dr Senter is ill in Canada; Dr Stringer and his Hospital Department are ill on the banks of Lake George.

Montgomery is soon reinforced but falls in battle that January. Brigadier General David Wooster takes command in the spring of 1776, but half of his 1,900 men are sick with smallpox. The outbreak spreads as officers and enlisted men secretly inoculate themselves and pass on the contagion to those who are not inoculated.

The British, recently reinforced, attack the Continental Army, forcing them to evacuate. Smallpox victims fight along side the others as they retreat to Montreal. They finally arrive outside of Montreal to regroup with the forces there, but 1,200 of the 3,200 are unfit for duty, sick with smallpox. In late May, Stringer complains that he’s out of medicine and supplies. He receives permission to hire more staff.

In early May, the Continental Army in Canada numbers 8,000, but by the 6th of June, a promoted Brigadier General Arnold reports that he’s got only 5,000 fit for duty. Two weeks later he evacuates Montreal with just 4,000 fit. Half of his army is down with smallpox.

Dr Jonathan Potts writes, "Large barns [being] filled with men at the very heighth [sic] of smallpox and not the least things, to make them comfortable and medicines being needed at both Fort George and Ticonderoga." John Adams writes, "The smallpox is ten times more terrible than Britons, Canadians and Indians, together."

By mid-July, three thousand are sick, three thousand are well, and five thousand are unaccounted for. Dr Stringer and his staff at the Fort George hospital are desperate. Soldiers are dying from smallpox at a rate of sixty per week. There are not enough healthy individuals to bury the dead. Dr Stringer asks Gates, "In the name of God, what shall we do with them all, my dear General?"

The war in the north would not be over until the battle of Saratoga in October of 1777, but for well over half the northern army in the summer of 1776, the battlefield war was over and a new war begun; their battles fought in filthy, understaffed, overcrowded, makeshift hospitals.

Rumors eventually reach headquarters that the plague is receding. Fewer soldiers are dying. Fewer new cases are showing up. The end, they pray, is in sight.

In the late summer of 1776, because Dr Potts went forward with mandatory inoculation as ordered by Stringer, Gates writes to Washington that "the Smallpox is now perfectly removed from the Army."

Chemical Warfare

That’s right, the British also employed chemical warfare during the revolution. Washington, as you will recall, was hesitant to enter Boston after the siege. He sent only those who had survived a bout with smallpox into the city, and one of those was Dr Church’s replacement, Dr John Morgan. Morgan was assigned the task of locating drugs and supplies the British left behind in their evacuation. He enlisted the aid of Dr John Waren in this quest, but as Warren testified in March of 1776, after entering a hospital used by the British he found the medicines were contaminated with small amounts of arsenic. At first, they attempted to "clean" the drugs, but Warren finally put a stop to that as Morgan discovered two Tory physicians who had stayed behind. One of them, according to Mary Gillet, "was reputed to have the largest pharmaceutical business in the city." On orders from General Washington, Morgan confiscated everything he could, putting the physicians and the drug company out of business.

This is the last time in American History that a large pharmaceutical interest was ever hassled rigorously by the American Government. From this point onward, only small companies and individuals producing or selling vitamins and supplements will be attacked, ramshackled, and closed down. (Stick around, we have a long list of storm trooper-like busts.)

Surgery – The State of the Art

"If you want to study medicine," Hippocrates once said, "go to war."

Ask any present day surgeon and s/he will tell you that the "meatball" surgery on the battlefield is the best training a young surgeon can ever receive.

A physician’s education at this time included the French language. Some very good surgical techniques had come from France. At the time of the Revolutionary War, though, England was becoming the center of this medical art. After our Revolutionary War, France’s war for independence began and education in medicine came to a standstill till, near the end of their revolution, when a surfeit in cadavers (headless, of course) was found with which to teach anatomy and surgery.

To study surgery, you need cadavers. "For every surgical procedure developed," writes Mary Roach in her book Stiff: The Curious Lives of Human Cadavers, "from heart transplants to gender reassignment surgery, cadavers have been there alongside the surgeons, making history in their own quiet, sundered way."

Wars make lots of cadavers. However, when a war is finished, where do we get bodies? Grave robbing was an offense punishable by death in some places. People tend to frown upon grave robbing, even if the purpose is to teach a new batch of eager physicians.

Now, we are in no way implying that early instruction in anatomy involved grave robbing, though there were rumors bruited busily about all the time that this was how doctors got their cadavers. Mary Roach reports on a few actual cases, but for the most part, bodies were obtained from morgues then, as they are now. However, ordinary citizens simply associated dissection with body snatching and, like the church, regarded it as a desecration of the human body. To the common person, this was way too distasteful, and as Mary Gilette writes: "Even postmortem examinations were infrequent and their purpose was limited to determining cause of death when murder was suspected. Nevertheless, in 1762, Shippen began a series of anatomy classes involving both a human body and a series of anatomical plates and casts donated by a prominent London physician. His first class held only ten students and triggered a minor riot, Shippen being accused, despite his denials, of grave robbing. The popular assumption that dissection of the human body implied body snatching lasted at least until the 1788 Doctors' Mob riot in New York City when three days of violence, put down only by military force, inspired the first practical laws regulating such matters." 

My brother, who is a surgeon and has an interest in the history of medicine, discovered one physician, a Dr Howard Kelley, who had wanted to perform a postmortem on a particularly interesting case, but the family refused on the grounds that he would desecrate the body. Kelly approached the family carefully and asked them if they would allow him to conduct a post mortem if he could find a way to do so without harming the outside of the body. They could not fathom how this could be done. Still the good doctor assured them that the outward appearance of the body would not be harmed in the least, and they finally agreed. How did he do it? Well, my brother’s particular specialty is colorectal surgery. He is a proctologist. And, yes, you guessed it. This physician performed not only the first, but many succeeding autopsies by going in through the rectum. My brother has recently (2004) published a paper on this physician, and when our discussion of the latter half of the 1800s, we'll take a look at it. 

Back to the State of the Art of Surgery

The year 1316 saw the publication of the book Chiurgia Magna, or Great Surgery, by a French surgeon, Guy de Chauliac. It was a massive book describing how to treat fractures using weights and slings, how to repair hernias, remove growths, and described a variety of stitching techniques (today called suturing). This publication heralded a new epoch in medicine, and surgery began its rise to respectability. The split with the barbers began here, as the surgeons began wearing "long" robes. Barbers, who had little medical training, were known as the surgeons of the short robes. It was the surgeons of the long robes who first considered the practice known as phlebotomy, or bloodletting, to be primitive and dangerous. One example of how slowly innovation breaks into the bastions of orthodox medicine is the history of bloodletting. Some texts say that the practice ended right around the turn of the twentieth century, but we have found a book by Sir William Osler published in 1923 entitled, Principles and Practice of Medicine which still recommended it highly.

During the Revolutionary War, a wounded (bleeding) soldier about to undergo surgery, was first bled. This practice led to a much lower success rate for the poor surgeons of the time who did not realize that people could die from loss of blood. 

Ambroise Paré (another Frenchman) is considered the "Father of Modern Surgery." He developed ligation, or tying off arteries to control bleeding. Previously arteries were seared or cauterized. 

Most surgery up to the Revolutionary war and into the early 1800s was restricted to the appendages and less critical areas of the body and did not penetrate very deeply into the body. This practice was employed mainly to avoid infection, for at this time, no one knew a thing at all about the causes of infection. According to Mary Gillet, when one physician's surgical patients had a better survival rate than another's, the reason was assumed to be his greater prowess as a surgeon, rather than his more sanitary methods.

Anesthesia would not be discovered until 1846, so alcohol and opium were quite common in prepping a patient for surgery. One "period text" we found told us of stuffing things into the soldiers ears so he wouldn’t hear the screaming! And of course, there was also the practice of "biting the bullet."

During this period, lithotomies (cutting for bladder stones), setting fractures, reductions of dislocations, and amputations were the most common forms of surgery, according to Mary Gillet. John Jones, who advanced the idea that medicine and surgery should be combined, returned from his studies in England and gave a whole new meaning to surgery as he could perform a lithotomy in under three minutes and sometimes even half that. Although, as stated above, most surgeries avoided the abdominal area, there were a few reported operations at the time that gave hope that more and more could survive such an ordeal. By the time of the revolution, "Jones could write of the proper handling of penetrating wounds of the abdomen with enough confidence and in sufficient detail to make it obvious that he believed survival from such wounds to be possible." Gillet goes on to point out:

There were also rumors in the 1760's of a splenectomy so well executed that the soldier-patient was able to return to duty. A successful appendectomy was performed in 1759, although apparently little notice was taken of it. Furthermore, before the end of the century, the indomitable John Hunter was experimenting with organ transplants in chickens, moving the testicles and spurs of cocks from one bird to another. He also noted that "Teeth, after having been drawn and inserted into the sockets of another person, united to the new socket which is called transplanting."

Because the patient was awake, the surgeon had to work fast. The most common type of surgery was a gunshot wound. They’d already accepted that the bullet was not poisonous, and were urged not to probe deeply for it. "Let it remain, if it can’t be easily located," were their orders.

Gillet writes:

When battle injuries involved fractures, the question of amputation arose, many surgeons favoring immediate amputation in compound fractures. Such injuries, when treated in crowded hospitals, were all too frequently followed by infection, making amputation eventually necessary even though similar fractures, treated in a rural environment, might never require such drastic measures. Van Swieten and John Hunter preferred to postpone amputation until it was obvious in each instance that it would be required. Amputation did not necessarily save the patient's life, however. The mortality rate was often 45 to 65 percent where the leg was removed at mid-thigh, although some surgeons lost markedly fewer patients than this.

Postoperative treatment could consist of more bleeding, if the surgeon thought it was necessary to control inflammation, more opium, and perhaps wine. Cinchona bark (from which we get quinine) was also favored by most physicians. Wounds containing foreign matter were left open that the pus might bring the debris to surface. Some wounds were covered in dry lint, others with poultices, but for putrefaction, van Swieten recommended wine and alcohol. To stop minor bleeding, turpentine was used, and today it appears that it is somewhat antibacterial.

One of the best signs of healing to a Revolutionary War surgeon was called "laudable pus." Gillet tells us that, "Redness and heat around a wound were seen as inevitable, as was fever in serious wounds.54 It was expected that the various healing processes might bring on a condition called "the hectic," the result of the body's trying unsuccessfully to heal itself and characterized by "debility, a small, quick, and sharp pulse; the blood forsaking the skin; loss of appetite; often rejection of all aliment by the stomach; wasting; a great readiness to be thrown into sweats; sweating spontaneously when in bed; frequently a constitutional purging; the water clear."55 Once "digestion of the wound" had taken place, fever, inflammation, and pain could be expected to lessen.

1800 – The State of the Art of Medicine

There were no professional organizations and no laws regulating medicine. Anyone was free to practice. Physicians were free to practice the medicine they preferred with no interference from any governing body or organization. Doctors learned from their patients. They incorporated new therapies as they learned of them. If the Indian doctors had a particular herbal remedy that came to a physician’s attention, he was free to use it or not.

Doctors in the army were men. We came across many a diary of a young woman who yearned to study to be a physician, but few women ever got into a university and none were allowed into medical schools at the time. Nurses were men. The women folk did their nursing at home, their duties restricted to caring for sick relatives and delivering babies. The department of the army had little need for midwives, though many a midwife doubled as a civilian physician. University trained physicians felt that the common person was not smart enough to understand medical science. The feeling among trained, male physicians was that no woman could possibly even come close to understanding "science," and besides, why should she "worry her pretty little head." 

By 1800, specific therapies for specific diseases were unheard of. Most of the time, a physician used the same therapies for nearly every illness he came across. The closest thing we have to a specific therapy came from James Lind, who by 1770 had conducted enough experiments to realize that oranges, lemons, and limes cured scurvy. However, even he felt that there must be more factors to the disease than just diet. The use of fruit for scurvy was adopted by both physicians and generals during the Revolutionary War. This was as close as we would get to a specific therapy for a specific illness till the discovery of Iodine in 1811.

Theories on diet were as ludicrous as the theories of medicine bandied about by physicians, with the common person knowing instinctively more about diet than any physician. Physicians argued about "low diets" versus "high diets" (no one knows what these really were) but they all "knew" that you did not enter a hospital with an empty stomach or you’d be a sponge to the various contagions. It was the common person who used common sense, which stated that a variety of foods was best. General Washington felt that one reason for the amount of illness in his men was due to their eating too much meat and not enough vegetables, however, the military, in its infinite wisdom, decided to add sugar to vegetables to make them more appealing (yuck), though today we know that sugar is immunosuppressive.

George Washington, though, did give his troops something that has been around for thousands of years. Hippocrates gave it to his patients. Later, Napoleon would give it to his soldiers. It was apple cider vinegar and honey. Even today this is a very healthy drink (whether watered down or not) for besides giving us a quick boost of energy, it helps to alkalize our terrain. (See also, The Lost History of Medicine.)

There were two schools of thought concerning Nature and Medicine. Hippocrates, because of his superiority over the physicians of his time, is called the "Father of Medicine." He used foods as medicine. One of his favorite foods was garlic, which he prescribed for infections and tumors. He also praised the healing power of nature and preached against too much intervention. Thus, we get from him the first rule of medicine: "Do no harm."

Aesculapius founded a great medical school in Rome, and ridiculed the Hippocratic attitude of relying on the healing power of Nature. Allopathic medicine took this stance and thus began the tradition of Heroic Medicine. 

Orthodox physicians of the time felt that nature was against the recovery of the patient; the physician did all. The common person, the Eclectic School, and Indian doctors believed in the power of nature. Even Ben Franklin stated that nature cured while the doctor collected the fee. It was commonly thought that patients recovered in spite of the drugs, purging, bleeding, and blistering administered by physicians.

"God cures and the physician takes the fee." English expression.

Air has always been a factor in the thinking of medicine. Pure, fresh air was considered healthy. At some time, however, night air became unhealthy and in the early 1900s we locked our doors at night and covered the windows to keep the night air out.

Water was also a source of interest to physicians, since early microscopes found "animicules" [one early spelling for the minute organisms seen with the first microscopes] swimming briskly about in samples taken from various lakes and streams. Soldiers were told to collect water only from cold spring wells and the middle of rushing rivers.

Physicians of this period came from a long tradition of scholarliness and erudition. There were a few unwritten laws they followed carefully. One very important unspoken law was that all physicians were equal. No one physician was to raise himself above the others. No physician was to ever imply that another could possibly be substandard. This was their professional courtesy. In reality, some graduated at the top of their class and some at the bottom. Some cured more than they killed and some killed more than they cured. As a group, though, allopaths agreed that nature was against them and that heroic medicine was the only way to cure, which, of course, led to many allopathic catastrophes.

In 1796, something happened that would eventually change the face of medicine. The word "eventually" is the key here, for this "medicine" was laughed at, derided, and defamed at every turn. Individuals were expelled from the medical societies who even consulted with these "irregulars." It was the advent of homeopathy.

Samuel Hahnemann was a German physician and chemist who had grown disillusioned with orthodox, heroic medicine. He felt that nature had more healing power than any medicine in the pharmacopoeia. Diet, exercise, fresh air and minimal medicine was his approach.

He noted that a drug always created two responses in humans. The first was the response of the drug, the second was the response of the body (patient). We all know what happens when we drink alcohol, I’m sure. First there’s elation and giddiness. The following morning is the hangover. The first part is the drug’s response. The hangover is the body’s response. Hahnemann arrived at the law of minimal doses as a way to avoid the side effects of the drug while allowing the body’s own response to help heal.

So here we see nature brought back into the equation again. Heroic medicine was administered in proportion to their belief in the organism’s inability to self heal. Hahnemann's school preferred to let nature heal.

Medicine, as we know it today, owes so very much to Hahnemann; his Law of Similars and his Law of Minimum Dosage. It is a debt that has not only never been paid, but few even acknowledge Hahnemann’s influence at all. He and his followers have been historically labeled quacks right up to the tacit acceptance of many of his theories in the late 1800s and beyond into today. Websites, books, and articles are dedicated to calling homeopaths quacks, without ever recognizing that before Hahnemann’s theories were adopted, allopaths (orthodox physicians) killed patients in droves.

The Death of Our First President

The 18th century ends with the death of George Washington, our first president. Anyone versed in American History knows he died of some kind of sore throat, either strep throat or acute laryngitis.

This is very far from the truth, the whole truth, and nothing but the truth. We have an interesting eye witness report by George Washington Custis, Martha Washington’s grand son from her first marriage. He was 19 at the time. He tells us that the physicians worked on him to no avail: "The medical gentlemen spared not their skill, and all the resources of their art were exhausted in unwearied endeavors to preserve this noblest work of nature." []

Today some of us realize that our first president did not die a natural death; he was killed by his physicians.

Tobias Lear, Washington’s secretary, attended the General at his death bed and gives us a very different account. [ and]

The family physician, Dr Craik, was sent for in the morning. The doctor arrived fixed up a mixture of molasses, vinegar and butter but the General could not swallow a drop. Lear tells us he gagged and nearly choked to death right there on the concoction: "Whenever he attempted it he appeared to be distressed, convulsed and almost suffocated."

A man named Rawlings appeared on the scene to help out. He bled the president. Martha pleaded with him not to take too much. Washington, himself, was not a fan of orthodox medicine, but when the bleeding was stopped, he asked that more be taken. Some are led to conclude that in this we see a very sick man willing to do anything to feel better. They then bathed the outside of this throat in salvolatila [no one seems to know what this is today] and bathed his feet in warm water. Dr Craik blistered the outside of Washington’s throat, and took more blood. A mixture of vinegar and sage tea was made up and Washington was instructed to gargle with it, again nearly suffocating, but it did bring up phlegm. Washington tried to cough but could not.

A Dr Dick and a Dr Brown arrived just minutes apart from each other in the early afternoon, and all three of them bled Washington one more time. It was reported that the blood came very slowly and that it was thick. They administered mercury (in the form of calomel and tarter) but the president could hardly swallow.

At one point, Washington gave up and pleaded with his doctors to let him die on his own. He was drooling from the mercury and weak with blood loss. After he passed out, his doctors, against his wishes, went to work on him again blistering his legs and feet and bleeding him.

Finally, somewhere between ten and eleven in the evening, his breathing became easier as he lay there quietly. He had already given instructions for his burial and satisfied, offered his last words, "Tis well." Dr Craik took the patient’s hand to feel for a pulse, but the president’s hand went limp and dropped from his. Martha asked if he was gone, but no one could speak. Lear raised his hand as a signal that the president had passed on. "Tis well," she too said, adding softly that she would soon follow him.

The question arises, would he have died if left alone? We’ll never know. We do know that his care surely helped him along to his end post haste. This kind of treatment is not good for healthy people, let alone someone with a terrible sore throat.

One Last Look Before We Go

Before we leave this discussion, I want to return to the venerable physician, Dr Benjamin Rush. Much of History has overlooked his failings in medicine, yet we have brought them out of the closet and into the light of day. Do we think little of the good doctor? No, not at all. Being wrong is a part of being human. Dr Rush’s greatness lay, if not in his "art," in his open mindedness and his quest for truth. He willingly learned and grew in his practice. He was open minded enough to experiment with a variety of therapies. Beyond medicine, his greatest love was his love of freedom and his new country. He was proud to be a part of something that brought freedom of religion, speech, and thought to the world. At the Constitutional Convention he told legislatures: "The Constitution of this Republic should make special provision for medical freedom. To restrict the art of healing to one class will constitute the Bastille of medical science. All such laws are un-American and despotic." He went on to say: " Unless we put medical freedom into the constitution the time will come when medicine will organize into an undercover dictatorship and force people who wish doctors and treatment of their own choice to submit to only what the dictating outfit offers."

In a tribute to this great man, Dr Daniel Brainard, shortly after arriving in a young, small, Midwestern village known as Chicago, established a medical school there and named it the Rush Medical College. It, like Chicago, got it’s charter in March of 1837. []

Rush Medical School graduated the first African American to earn a medical degree in this country. It also graduated Dr Nathan Smith Davis who founded the American Medical Association. Sadly, and ironically, it also graduated two of the foulest creatures ever to gain a medical degree; two insidious racketeers who held a stranglehold on medicine for over half a century and whose shakedown tactics and racketeering hauled in so much money and led to so many deaths as to make their fellow Chicago resident, Al Capone, look like a girl scout selling cookies. Stick around to read how this Medical Mafia came into power, how medicine became a monopoly, a protection racket for the drug interests, and how patients died at the hands of doctors convinced they were doing the right thing because the foundation of their education was built with blood money. It is quite possible that these two scoundrels, through their terror tactics and influence, killed more Americans than all of our wars combined. If you want to know why there is no cure for cancer, these two individuals are the key: Morris Fishbein and George Simmons. Stick around. It's going to get interesting.



References and Further Reading:



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