The Glorious Cause: The American Revolution, 1763-1789 (114 page)

The strain between the regimental and general hospital surgeons did not really ease off until Cochran took charge. Morgan was relieved of his post by Congress at the beginning of 1777, and William Shippen, his successor, resigned early in 1781. Both men, and Samuel Stringer of the northern department, felt betrayed by Congress and the army. In fact, Shippen had connived shamelessly to get Morgan's post, and Morgan, aided by Benjamin Rush, helped to force Shippen to resign. Shippen endured court-martial during his tenure and, though he was acquitted, his reputation was shattered.

These wars within the war contributed to years of shoddy medical services. Just how badly they undermined the health care of soldiers cannot be known, though the organizational weakness persisted until the end of the war. Had the institutional arrangements been first -- rate by the standards of the day, the actual medical service provided soldiers would have left something to be desired, for America did not brim

with physicians or medical knowledge. Recent estimates hold that there were some 3500 medical practitioners of various sorts in America when the war began. This figure probably includes quacks as well as reputable physicians and a great number of indifferently trained men who treated the sick and worked at other occupations as well. Probably fewer than four hundred had a medical degree.

Although generalizations about such a motley group cannot be reliable, it is unlikely that any theory of disease or therapy found wide acceptance among them. The physicians among them probably believed that sickness generally represented some variation from the normal pattern of the human system, an old idea which persisted through the eighteenth century. There were diseases identified as diseases, smallpox, syphilis, and tuberculosis, for example, but both theory and practice usually dealt with body conditions, such symptoms as fevers, fluxes, and dropsies. The assumption behind this practice was that a fever indicated that the state of the system was off, not that the body was afflicted by a disease. To be sure, some physicians had come to recognize that diseases were objectively real. While treating their patients, they had observed that a medicine might be effective against one set of symptoms but not another. From this experience they inferred that they faced two different diseases.
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These physicians easily reconciled this inference with the ancient assumption that there was one basic cause of all disease. The most common theory held that the body's humors were somehow awry, perhaps impure or out of balance, with one or more present in excessive or insufficient amounts. The treatment followed from the diagnosis, with bleeding, purging, and sweating all calculated to reduce excessive amounts, and diets and drugs intended to build up volume. Another basic cause of sickness, it was widely thought, might be a chemical imbalance, with body fluids showing an improper blend of acidity or alkalinity. The treatments in such cases often resembled those prescribed to restore humoral balance.
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The ordinary soldier, of course, lived largely oblivious to theory, though

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he, his officers, and the regimental surgeons may have shared a good deal of common lore about health and medicine. Judging from the orders that came down from on high in every American camp, one belief they did not share was that cleanliness was next to godliness. Away from home, the American soldier did not mind the filth that piled up in crowded camps -- or if he minded, refused nevertheless to follow rudimentary practices which would have kept them cleaner. Soldiers throughout the war apparently disdained use of the vaults, as latrine pits were called, preferring to void whenever taken by the urge. They also scattered food scraps, carrion, and garbage throughout camps. They had to be forced to change the straw that served as bedding. And some had to be ordered to bathe. The British, professionals in this sort of thing as in all things pertaining to military life, kept clean camps and probably suffered less from disease.

Dysentery troubled the American army throughout the war. The filth the army created accounted for some of it and so did the low standards of cleanliness in cooking. Most of the time soldiers cooked for themselves, though there might be bakeries which served a brigade. Unaccustomed to the task, the soldiers did not do it well, or cleanly. Diets ran to fat meat and bread when they were available, but on the whole the army suffered more from a lack of food than an unbalanced diet.

Good officers did what they could to make camp life healthy. Washington set the standard with a flow of orders about sanitation, diet, bathing, all the concerns of a responsible commander who wanted to lead into battle men who were fit. At Valley Forge, for example, when the worst of winter had passed, he ordered renewed attention be paid to the cleanliness of troop quarters. Common opinion held that the air in each hut might be purified each day by burning of the powder from a cartridge. A small amount of tar might be substituted if gunpowder were short. Tents were to be taken down daily and the ground around them scoured. Soldiers in Washington's and Greene's armies were encouraged to bathe -- moderately. Immersion in water for too long a period might weaken the body, according to the folklore that made its way into regimental orders.
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Good junior officers and noncommissioned officers could do much

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to protect the health of their charges. The memory of a Connecticut sergeant building a fire for his soldiers when they were cold and hungry stayed with one of his men for fifty years after the Revolution. No manual of leadership or of army medicine prescribed that sort of performance, but it undoubtedly contributed to the health of soldiers. Charles Willson Peale, serving as the captain of a Philadelphia militia company, found beef and potatoes for his company's breakfast two days after the battle of Princeton. His men, so fatigued they could not look for food, had gone to bed without eating. Peale shook off his exhaustion and rambled from door to door at Somerset Court House until he had collected rations for his men. A few days later, Peale found that he had a sick Ensign, one Billy Haverstock, on his hands. Peale first got some sugar for Haverstock, a remedy that did not prove effective. Next he tried "a puke of Doctor Crochwin," an emetic given to feverish patients. His final entry in his diary about the case described the use of an old standby, tartar emetic, a mixture of antimony and potassium nitrate, which he gave in a double dose. Haverstock apparently survived this treatment.
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Had a physician treated Haverstock, he might still have recovered. Physicians followed just about the same lore as laymen, though they may have been more inventive in their uses of medicines. What made most of them so dangerous was their fondness for bleeding patients. When they did not bleed them, they often resorted to purging and sweating, techniques not certain to cure dysentery, malaria, typhus, typhoid, pneumonia, and smallpox, the diseases which afflicted American troops in their camps.

When surgeons were available they took care of the wounded. Bleeding the wounded sometimes served as treatment and not always with fatal results. Dr. James Thacher, who was taken into the medical department of the army as a surgeon's mate, reported that one of his senior colleagues, a Dr. Eustis, once treated "a dangerous wound" of the shoulder and lungs by bleeding. While dilating the wound, Dr. Eustis "recommended repeated and liberal bloodletting, observing that in order to cure a wound through the lungs, you must bleed your patient to death." Thacher reported that the wounded man recovered; the principal reason, Thacher believed, was the treatment he received.
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Perhaps the best guide for surgeons,
Plain, Concise, Practical Remarks on the Treatment of Wounds and Fractures
by Dr. John Jones, advocated rather different procedures.
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Jones was a professor of surgery in King's College, New York; he had received his medical degree from the University of Rheims in 1751 and shortly after served in the French and Indian War. The first concern in the case of a wound inflicted by a musket, he wrote, should be to extract the ball and, second, to stop the hemorrhaging. Jones's manual divided wounds into categories; each sort required its own treatment. But in treating all kinds, Jones urged that care be used to clean the wound and to dress it carefully. He had a sense of the limits of surgery, noting, for example, the danger of amputation when the wounded man was reduced to a "low and weak state."

Whatever the effects of Jones's prescriptions, the treatment of wounds remained a most problematic enterprise. Soldiers who survived serious wounds doubtlessly did so through a mixture of luck and their own strong constitutions. Most surgeons tried to give their best to their patients. In the Continental army, chronically short of medicine, bandages, nurses, and food, the "best" often could not prevent death.

The American navy played no part in the campaigns. The war created the navy, but it could not call into being a force of great power. The financial resources for a strong navy simply did not exist; nor for that matter did the conviction that a navy equal to Britain's was needed.

The war at sea commenced before there was an American navy with the first actions occurring within a few weeks of the battles at Lexington and Concord. Perhaps the earliest -- in June -- involved the citizens of Machias, a small port in Maine some 300 miles northeast of Boston. These Maine patriots captured his majesty's schooner
Margaretta
commanded by a young midshipman who had threatened to fire on the town if its liberty pole was not cut down. The midshipman reconsidered this threat shortly after making it, but too late to persuade the people of Machias not to respond. In an armed attack a group captured the
Margaretta
and two sloops which had accompanied her. The midshipman died in the defense of his command.
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Most of the actions of sea-going patriots in the first year of the war were not against vessels of the Royal Navy. Almost all of his majesty's ships were too heavily armed and too well sailed for the Americans to

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