Battle Field Angels (3 page)

More than six hundred years later, Roman military doctors were the most accomplished of any in the ancient world. Galen, a physician to gladiators, wrote more than four hundred wide-ranging treatises that included diverse topics such as nasal polyps, plastic surgery, and the treatment of cleft lip. A Roman military doctor’s kit included forceps, scalpels, arrow extractors, and catheters. Doctors recorded each case for medical schools back in Rome, boiled their instruments, and prescribed opium poppies as painkillers. Roman soldiers were trained in basic first aid.

Although Galen reinforced the concept that infected wounds retarded more dangerous inflammation, Roman military medicine achieved several milestones. Roman military physicians created the hospital system, wrote the first medical manuals, developed ligation techniques to control bleeding, and refined amputation procedures. But when the Roman Empire collapsed in the fifth century, its military medicine advances were buried in the debris.

In 1775, Congress created the Army’s Hospital Department. Surgeons received $1.66 per day, while nurses earned $2 per month. But the Hospital Department created confusion on the battlefield, where Continental Army physicians treated the wounded alongside the doctors attached to the regiments each colony sent to war. Sometimes one regiment’s doctor refused to treat the wounded from another regiment. Turf battles could hardly be afforded in the face of a shortage of medical personnel so acute that in some cases, one doctor and five assistants were assigned to as many as five thousand soldiers.

To make matters worse, Strawn and Stone might have been treated either by a trained surgeon or by a charlatan at Germantown. During the Revolutionary War, only about 3,500 doctors practiced medicine in the colonies, and only 10 percent of these had gone to medical school. Most had been trained as apprentices. None had to prove his qualifications in an era when doctors were not licensed. Almost anyone could claim to be a doctor, surgeon, or apothecary. Wounded soldiers had to take them at their word.

Volunteers such as Caspar Wistar often had no medical training whatsoever. Wistar came from a factory family that operated one of the largest and most prosperous glass factories in the colonies. The factory had been established by his grandfather in 1738. Wistar was one of many pacifist Quakers who either raised money for the war or who volunteered to help with the wounded. Only sixteen years old when he joined the Army, Wistar had developed an early interest in medicine and botany.

The day after the Germantown defeat, Washington’s medical corps, such as it was, faced dozens of surgeries. Most military doctors had little experience treating the mangled limbs and pulverized bodies caused by gunshots. The explosive power of the bullet typically blasted dirt and bits of clothing into the wound. If the bullet struck bone, a compound fracture usually resulted. Although some doctors had probes to trace the path of entry of a musket ball, most inserted their dirty fingers and poked around. If they could not easily retrieve the musket ball, they left it in the soldier’s body. Some Revolutionary War veterans lucky enough to survive carried the enemy’s ammo inside their bodies to their deathbeds decades later.

Much of the limb surgery after a battle centered on amputation. A practiced surgeon could amputate a leg in less than two minutes. An officer was given rum or brandy, if it was available, before his leg was cut off. Enlisted men typically had to bite down on a stick as Wistar and other assistants tightly cinched a leather tourniquet four fingers above the amputation line. Once the leg or arm had been cut off, the surgeon typically used a crooked needle to snag severed arteries and blood vessels, pull them taut beyond the bloody stump, and suture them closed. Amputation was so traumatic that those who had lived through battle only to lose an arm or leg to the army surgeon stood just a one-in-three chance of surviving shock and near-certain infection.

Military doctors also faced massive numbers of bleeding soldiers. Among the few techniques available for slowing the loss of blood was a screw tourniquet. If the bleeding stemmed from lesser blood vessels, medical personnel burned them shut through cauterization. Effective anesthesia was unknown.

Wounds to the head were altogether different. Revolutionary War surgeons learned to drill holes in soldiers’ skulls to relieve the swelling caused by a fracture or concussion. A Germantown casualty with a head wound had to sit upright in a chair and was steadied by several assistants. A surgeon cut the scalp away from the fracture, then used a trephine to drill a hole through the skull. Next he took a scalpel to probe the subdural matter to ensure it was free of excess fluid. Once the wound was drained, the surgeon’s mates packed it with dry lint and held it in place with a handkerchief.

In the aftermath of Germantown’s half-day battle, field hospitals were established in large houses, nearby settlements, and in clearings filled with tents. But recovery in Revolutionary War military hospitals proved more dangerous than facing the enemy in battle. Nine years after the war, surgeon Pierre Francois Percy described some of the challenges:

Sometimes days passed before a soldier reached a military hospital. At that point, doctors often found caked blood covering serious wounds and field dressings contaminated with maggots.

Filthy, unsanitary hospital conditions increased Strawn’s and Stone’s 2 percent chance of dying on the battlefield to a 25 percent likelihood they would die in a field hospital. Hospitals were so poorly equipped that soldiers were expected to carry an empty sack that could be filled with straw as a makeshift hospital bed. Each was expected to provide his own blanket as well.

Medical supplies were a rare commodity throughout the Revolutionary War. Wistar and the surgeons with whom he served had little more than ingenuity and grit with which to treat patients. Some sold the fat and bones left from patients’ meals to buy supplies. Sometimes they operated with razors instead of scalpels. In the days leading up to the Battle of Long Island in 1776, the 9,000-man army had been supplied with only 500 bandages, 12 fracture boxes, and 2 scalpels. More than 1,400 men had been wounded or captured or were missing.

If their patients survived surgery, Wistar and the doctors frequently took as much as a quart of blood from injured soldiers whose wounds almost invariably became infected. The prevailing school of thought held that a wound infection was the result of an imbalance in the blood. Bloodletting drained “impure” blood from the patient to allow nature to restore this balance. A wounded or ill soldier’s hand was immersed in a bowl of hot water to swell the veins. Once a tourniquet was applied just above the wrist, a vein was sliced open at the heel of the hand. The soldier’s hand was once again submerged in the hot water to facilitate bleeding until the doctor saw the soldier’s face grow gray and his eyes flutter. Doctors put thousands of Revolutionary War soldiers into shock with this method.

Some men lying near Strawn and Stone likely had been burned in battle. If it was a minor burn, it was treated with wine or a superficial scalding of hog’s lard. More serious burns required bloodletting. Once the burns became inflamed, doctors resorted to a bread-and-milk poultice that was softened with butter or oil and changed twice a day. Wine and opium were the drugs of choice for pain, for burn and trauma victims alike.

Doctors were equally reliant on herbal ingredients as medicines, though they were constantly in short supply. Hellebore root served as a diuretic. American wintergreen was administered for urinary problems. Even the poisonous nightshade was used as an antispasmodic.

Whether it was herbal enemas, bloodletting, or packing a burn site with bread and milk, Revolutionary War doctors practiced a decidedly holistic brand of medicine. An inventory of a permanent army hospital’s medical supplies typically included powdered Peruvian bark (quinine), opium, camphor, calomel, jalap, powdered rhubarb, prepared chalk, castor and olive oils, barley, powdered Colombo, ipecuanto, tartar emetic, gambage, chocolate, tapioca, beeswax, wine, brandy or rum, vinegar, coffee, hyson tea, rice, sugar, and sago.

“It is nature alone that cures wounds; all that art can do is remove the obstacles, and to put the parts in such a condition as is the most favourable to nature’s efforts,” wrote Revolutionary War doctor William Buchan.

If Strawn and Stone somehow survived their wounds, their weakened condition made them more susceptible to disease. The disease mortality rate in the Continental Army was far greater than that inflicted by British gunfire. In February 1776, one in seven Continental Army soldiers was too sick to fight. Soldiers weakened by malnutrition and sickness were ill equipped to overcome their battle wounds. Most were rural boys who had not developed immunity to communicable childhood diseases. Many had relied on their mothers as the doctor in the family, who used herbal remedies she grew in her garden. But these homegrown approaches often were insufficient to treat the diseases that plagued the army. These young soldiers were as vulnerable to dysentery and malaria as they were to enemy fire.

Diseases in the 1700s often were poorly understood and misdiagnosed. No one knew that bacteria and viruses caused disease. Many doctors, including the military medical corps, believed all illnesses stemmed from nervous tension. A standard course of treatment included a reduced diet, aggressive digestive purges with enemas and diuretics, and frequent bloodletting to the point that patients passed out. Large doses of mercury were used to treat malaria, pneumonia, dysentery, typhus, yellow fever, tuberculosis, and other diseases. Doctors believed mercury cleansed the digestive and cardiovascular systems.

Isaiah Strawn and John Hoskins Stone were among the more than 500 soldiers who had been wounded at Germantown. More than 150 had been killed in battle. The British suffered more than 500 casualties as well. Though Germantown was another defeat, the Continental Army had fought so ferociously that the British retreated to reinforce Philadelphia.

General Washington regrouped and focused his attention on another British emplacement at Valley Forge. In the months following the Battle of Germantown, Washington ordered the construction of several new military hospitals, including one at Valley Forge. By December 1777, the Valley Forge facility listed 2,898 sick and unfit patients, a number that grew to 3,989 only two months later. It would be another six years of mounting casualties before America’s first war ended.

Strawn and Stone both survived the Battle of Germantown. Strawn refused to allow surgeons to remove the buckshot from the hollow, or, arch, of his foot. He carried it for more than sixty years as he and his wife, Rachel, raised six children who in turn produced fifty-four grandchildren. When he died in 1843 at the age of eighty-four, he was among the oldest surviving Revolutionary War soldiers.

John Hoskins Stone’s leg injury hobbled him for the rest of his life. His military career ended in 1779, when he was wounded a second time. Stone served as governor of Maryland from 1794 to 1797. He died in 1804 at the age of fifty-four.

The volunteer nurse, Caspar Wistar, never picked up a weapon during the Revolutionary War. He became a doctor in 1786 after attending the University of Edinburgh in Scotland. A noted physician, Wistar wrote
A System of Anatomy
in 1811, the first American medical text on anatomy. He was an advocate of vaccinating against disease, served as the chairman of the anatomy department at the University of Pennsylvania School of Medicine, and taught until his death in 1818. His scientific interests in paleontology and botany became so well recognized that botanist Thomas Nuttall named the plant genus
Wisteria
in his honor.

America’s military medical corps was created as a result of war and literally learned on the job. Medical books about inoculation, military hospital pharmacology, soldier health, and hospital administration were written by a handful of leading military doctors during the Revolutionary War. The experience of medical incompetence early in the war prompted states to establish doctor-licensing criteria that ultimately improved civilian healthcare.

The most notable advance was effective inoculation against smallpox. The death rate for smallpox dropped from 160 to 3 per 1,000 in late 1783, when General Washington ordered his army to be inoculated—the first time in history an army had been vaccinated against disease. Regardless, an estimated 17,000 soldiers died of disease in the war, compared with about 8,000 who were killed in combat. Strawn and Stone were among the 25,000 who survived their wounds, though many historians believe Revolutionary War statistics are conservative for lack of detailed recordkeeping.

Shortly after the war’s end, Congress disbanded the Continental Army to a force of fewer than one thousand men. Nearly eighty years would pass before America mobilized again for combat and looked to its medical community to save lives on the battlefield. It remained to be seen whether the lessons of America’s first war had been lost in the passage of nearly three generations.