An 18th century physicians potions Courtesy of Dan Newman

Fending off disease was a fact of life in the 18th century as it had for a millennium and more, and while advancements in Western Medicine had been made in education, diagnosis, and even some treatments; medical practitioners still clung to the system introduced by the Greek physician Galen of a balance of “bodily humors”. This theory held that good health came from a balance of four humors-blood, phlegm, and black and yellow bile. Illness occurred whenever one of the humors caused an imbalance of these factors. Galen was the first to believe that bloodletting would relieve the patient of “diseased morbid matter”, and aid in their recovery.

By the mid-eighteenth century the theory was being challenged, most notably by Dutch physician and medical instructor Hermann Boerhaave who undertook to explain the causes of disease in terms of chemical and physical qualities, such as acidity and alkalinity, or tension and relaxation rather than the traditional humors, and also advocated that nature, that is, fresh air and exercise, be a part of the prescribed treatment.

Scottish physician William Cullen would challenge the Boerhaaven system in the latter part of the 18th century, and have considerable influence among his American students, a good number of whom would become medical staff for the Continental Army.

Cullen believed that either an excess or an insufficiency of nervous tension underlaid all disease. Too much tension was often characterized by a fever, to be treated by a depleting regimen including bleeding, a restricted diet, purging, and rest and sedation. A cold or chill, on the other hand, indicated too much relaxation and called for restorative measures.

One former student, Benjamin Rush, would become a prominent and influential physician and teacher in Philadelphia during the Revolutionary era, and would modify Cullen’s theory to blame all disease as the result of “excessive tension” which disturbed the blood vessels. While the theories behind the cause of disease were debated, treatment remained positively medieval. As noted by Dr. Gillet,

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.

During all this debate concerning the causes of disease, physicians continued to have little scientific data or understanding of the role of microbes in spreading disease, and that such diseases could be spread beyond direct physical contact. While long suspected, medical practitioners could only speculate that some of the most virulent epidemics were caused by “miasmas”, or “morbid, noxious airs and vapors” rising from stagnant water, decomposing garbage, and other filth associated with the crowded settlements of the colonies.

At home, most colonial women practiced some form of homeopathic medicine, using remedies that had been passed down through generations of women, often recorded as “simples” in diaries, bibles, ledgers, and “medical” books which gained in popularity during the 18th century.

Colonial gardens held a host of plants that could be used in potions, tonics, “blisters”, and teas that were often healthier and more successful than the dubious medicines marketed at the time. Wormwood, as its name implies, was often hanging to dry by the hearth, it’s leaves dried and brewed as tea to drink and rid the body of intestinal worms. Teas brewed from Chamomile flowers soothed nerves and headaches. Leaves of the mullein plant when brewed, was a highly effective decongestant. In a pinch, dried bay leaf could be added to snuff for the same results. The fern-like leaves of yarrow were ground or quickly chewed for a poultice to stop bleeding sores or blisters.

As the mother, and later, daughters, were the sole practitioners of grinding, mixing, and concocting these “simples”, those Fathers, sons, and brothers who once relied upon such remedies had to procure what treatment they could once far away from home. This homeopathy was also practiced by early physicians and would also prove to provide relevant discoveries by surgeons during the Revolutionary War who routinely left encampments on foraging missions to replenish their supplies.

Dr. Dutee Jerauld was one such early physician, having moved from his hometown of Medfield Massachusetts in 1742, and opened a practice in Warwick, Rhode Island. Initially confining his practice to the surrounding six to eight miles of his home, he became well known for his treatments for fevers and chronic diseases. Dr. Jerauld prepared infusions, syrups, and decoctions from indigenous roots and herbs, particularly favoring the prickly ash, which he used for rheumatic afflictions[i].

Even the most scientifically minded men of the era relied upon home, herbal, and plant-based remedies.

Bishop Berkeley, one of the most learned men in New England in the early 18th century, promoted tar water, in letters from his Newport, Rhode Island manor with specific instructions:

“Norwegian tar being the most liquid, mixes best with water. Put a gallon of cold water to a quart of this tar, stir and work them very strongly together with a flat stick, for about four minutes. Let the vessel stand covered forty-eight hours that the tar may subside. Then, pour off the clear water, and keep it close-covered, or, rather, bottled, and well-stopped for use”.

Berkeley attested “what from I have already seen and tried”, that the resultant “tar water”

…may be drank with great safety and success in the cure or relief of most if not all diseases; in ulcers, eruptions and all foul cases, scurvies of all kinds, disorders of the lungs, stomach and bowels; in nervous cases, in all inflammatory distempers; in decays and other maladies. Nor is it of use only in the cure of sickness; it is also useful to preserve health, and guard against infection and old age; as it gives lasting spirits, and invigorates the blood…[ii]

Benjamin Franklin swore upon the effectiveness of quinine upon the common cold as in his own experience, “three or four Doses of Bark taken on the first Symptoms of a Cold will generally put it by…”

Franklin, who was one of the founders of the first civilian hospital in Philadelphia, routinely read through the latest medical journals, and was a patient prone to self-diagnosis. Nevertheless, he allowed himself to be treated for numerous ailments by a Dr. Fothergill, including the prescribing of a powder of Contrayerva, an herbal remedy taken from the root of the plant for relief from Franklin’s bouts of vertigo. The drug reportedly gave the patient a good night’s sleep[iii].

Alcohol was also viewed as a medicinal treatment and even a preventative. Home remedies included Hot Toddies to ward off colds and congestion. During the Revolutionary War, Washington believed rum to be a restorative for the soldiers. A gill was given for guard duty, as well as “fatigue duty”, and on special occasions. His own preference for a flask of homemade cherry brandy aside, the Commander-in-Chief struggled throughout the war to provide rum for the troops, even going so far as to deplete hospital stores, and to instruct his officers to confiscate whatever rum might be in the vicinity of encampments, though as historian Joshua Shepherd notes, “It was a two-edged sword”:

Regimental orderly books are replete with a plethora of infractions – desertion, assault, insubordination, theft – which frequently stemmed from a soldier being inebriated in the first place.

As Shepherd explains, “Young soldiers, away from the watchful eyes of parents and family for the first time in their lives, were prone to get into far too much mischief, the results of which were by no means harmless.

At the time General George Washington took command of American forces in Cambridge on July 2, 1775, the whole of New England was in the throes of a smallpox epidemic. The result was that one of his first acts as Commander-in - Chief would be to ask Congress to establish a Department of Medicine for the Continental Army. Once formed, physicians were recruited to serve as both surgeons imbedded with the troops, and in occupied houses and buildings converted into hospitals throughout the colonies. The department would face many challenges during the war, chief among them that:

“The colonial physicians who formed the American Army’s Medical Department in 1775 were all civilian practitioners, many without any military experience. A small percentage had earned M.D. degrees, but most were either apprenticed or self-trained, and few made any attempt to specialize in the manner customary in Europe, where a choice was usually made among medicine, surgery, and pharmacy[iv]”.

To make matters worse, these physicians often found themselves dangerously short of medicines. When the British evacuated Boston on March 17, 1776, one of the first tasks of the soldiers who had undertaken the long siege through the previous fall and winter was to find whatever stores of drugs and supplies the enemy had left behind.

What supplies they found were immediately suspect however, as Dr. James Warren testified that:

“When he entered the workhouse which the British had used as a hospital, he found the medicines in great disorder with small amounts of yellow and white arsenic mixed in with them. After learning that another physician had already removed twelve to fourteen pounds of this poison from among the drugs…[v]”

Warren recommended the confiscated drugs be destroyed. Washington agreed and approved the confiscation of the well-known apothecaries of two Tory doctors in town.

Portrait of Sylvester Gardiner as painted by Copley

One of those whose pharmacology was raided was Dr. Silvster Gardiner, born on the estate founded by his family on Boston Neck in North Kingstown, Rhode Island in 1707. He had grown a sickly child, and with long confinements in bed came a love of reading and learning. When his older sister married Rev. James McSparran, he moved with them into their home so that he might get a proper education.

As his interest grew in medicine, his family’s wealth allowed him to study in London and Paris for a period of eight years.

Gardiner had returned to New England by 1734 and settled in Boston. Not long after beginning his practice he was chosen to be a vestry at King’s Chapel. A strong advocate of raising oversight of medical practice in the city and began to publish his convictions in letters to the Boston newspapers, as well as authoring articles for the benefit of the public, including an article printed on the measles in 1736.

He established his pharmacy on the corner of Washington and Winter streets, at the “Sign of the Unicorn and Mortar”, and later built a palatial home among the other fine houses on Winter Street[vi]. He founded the “Medical Society of Boston” and gave lectures on anatomy. Gardiner also performed surgery at least once within his society, performing the removal of a large stone from six-year-old Joseph Baker, who suffered from growth of calculi from birth. As noted in one account of the operation,

“This calculus was oval and seven inches in circumference. For three days urine drained through the incision; following this, it returned to the natural channels. By three weeks, the urinary flow was natural[vii]”.

When the Revolutionary War began, Dr. Gardiner had broken his long-standing friendship with John Hancock. Now faced with his stores being raided and his name reviled, he fled to Halifax, Nova Scotia with some two thousand pounds sterling. After the war, he successfully petitioned Congress to return the confiscated farm on Boston Neck to his family.

Re-enactor Dan Newman as a Regimental Surgeon, circa 1776

American surgeons whether in the established hospitals or assigned to tented “flying hospitals” in encampments, strived to improve their knowledge of medicines and treatments. Some of those more famous who left diaries of their experiences included Dr. Lewis Beebe, Regimental surgeon James Thacher, and Issac Senter.

Perhaps the most detailed account of medicinal practices of the era was written by a civilian physician.

The “Therapeutic –Alphabet or A Pocket Dictionary of Medicine, Midwifery, and Surgery published in 1787 by Matthew Wilson, Doctor of Medicine and Theology, was the culmination of 29 years of practice as a physician in Delaware. The work provides an unmatched insight into colonial medicine, and while never published in his lifetime, some eighteen representative pages were printed in Dr. Maurice Bear Gordon’s 1949 history Aesculapius Comes to the Colonies: The Story of the Early Days of Medicine in the Original Thirteen Colonies.

Dr. Wilson listed all known diseases, ailments, and complaints known during his years of practice, in Latin, with vivid descriptions of symptoms and occurring stages of the illness, as well as the treatments and cures known to be successful.

The doctor identified “Catarrh” as “the most common Disease in our County, yet the least examined or understood. When People are taken with it, they only say they are very poorly, & have catched a bad Cold, & no further Notice is taken of it, till it frequently ends in dangerous Pleurisies, Peripnemonias, Consumption, &etc.[viii]”

Known remedies included “Drinking large draughts of Hydromel warm”, a kind of mead-like drink, a potion called “Tissots Elder Flowers, Balsam Traumatic, Vomits, Blisters, Anodynes wt Camphor, …Flannel Shirts, smoking tobacco…etc” If these failed to bring about the desired recovery, Dr. Wilson noted that “it will be necessary to give gentle purges[ix]”.

“Recipes” are provided for these “gentle purges” as well as suggesting a “gentle anodyne” to be taken with “large draughts of rosemary or bran tea” for the patient’s anxiety. He includes concoctions for effective cough syrups, and for maintaining the health of patients after recovery. The fact of the matter remains that even into the closing years of the 18th century, physicians and practitioners of medicine still offered a wide variety of cures based upon their own experience and locality.

It was also the era when bottled medicine began to be sold at pharmacies and by peddlers traveling with a myriad of goods in their well cupboard’ wagons. These medicines, often concocted by both scientifically educated physicians and home-schooled practitioners were for common ailments of the time. Newspapers played a role in this industry from the beginning as well, for as early as 1750, a “testament” appeared in the New York Gazette addressed to

18th century standard medicines Courtesy of Dan Newman

“…Anyone that is afflicted with Gravel [kidney stones]…there is a prepar’d by Doctor William Clark, living in Freehold, East- New Jersey, an Oil which has not only given Relief but by continuing it for some Time, has so eased me of that dreadful Disorder that I am now capable of doing any Business…The Virtue and Efficacy of which Oil, in the Cure of the above mentioned Distemper, will be made evident by my own words, if questioned by any Person, upon Enquiry…[x]”

The Pennsylvania Gazette published another testament of a cure, passed along by a subscriber who in his travels met a “reputable Farmer” who suffered from “that excruciating Disorder”. The Farmer related the story of how he had met “a certain Gentlemen he believes to be a Doctor” who passed along a remedy he believed would help relieve his discomfort.

“Take, says he, the Saw-dust proce(e)ding from good mellow Pine, boil it in clear Spring Water, let it settle, and then strain it off; drink freely of this , and you will soon find Relief…The person, glad to alleviate his Misery, tried the Experiment, and in ten Hours after found it gave him Ease: He used the drink three or four days, and declares his Pain quite left him, and that since that Time he has scarce felt anything of his Disorder.”

The author, who signed his letter as Civis, concludes in a postscript that “As they saw Abundance of Pine in the Jerseys, the Dust may be had in great Plenty: three quarts is a suitable Proportion to a Gallon of Water, and may be sweetened to make it Palatable.”

The New Jersey Gazette would also publish such advertisements, as the following in 1779 for

“Dr. RYAN’S

Incomparable worm-Destroying

SUGAR PLUMBS

Necessary to be kept in all FAMILIES”

Imported from Great Britain, where they were “exceedingly valued by all people who had had of them…they are one of the best purges in the world for gross-bodied children that are apt to breed worms, and have large bellies…”

Dr. Ryan’s Plumbs cured people of all ages, not just by its gentle purging of the bowels, but,

“Likewise settled aches and pains in the head, swellings, old sores, scabs, tetters, or breakingsout, will be perfectly cured and the blood and skin restored to its original purity and smoothness; they purge by urine and bring away the gravel, and effectively cure all obstructions in the urine, or ulcers in the kidneys. They at once strike at the true cause of scurvy , and entirely destroy it, and all scorbutic humors and effects, root and branch, so as never to return again…[xi]”

Even in this age of enlightenment, disease and its cures were still very much a mystery. Consider the cures that brought fame to German-born Pennsylvania physician Henry William Stoy. The doctor had first come to America where he had been ordained as a minister in 1752. He had settled originally in Lebanon County but moved to Philadelphia where he accepted a position and there married Maria Elizabeth Maus. His congregation objected to the union, and by 1763 he had returned to Europe where he studied in his hometown of Herborn, Germany.

He returned to America in 1767, accepting a pulpit at Berks County, but was on the outs with his congregation by 1772, when he was known among them as a “stirrer up of strife”. He resigned and removed to Lebanon, where he began to practice medicine while he continued to preach as a guest of rural churches, and involved himself in politics.

The remedies he concocted for hydrophobia and hysteria became well known, and “made his fame penetrate wide areas”.

His cure for hydrophobia consisted of one ounce of red chickweed, and four ounces of theriac (a mixture of several drugs of the physicians choosing as an antidote to poison) mixed with a quart of beer. Doses were a wineglass full of the concoction. This was to be drunk and well digested. The doctor’s remedy for hysteria contained a dram each of “opium, castor, saffron and maple seed”, mixed with four ounces of Lisbon wine.

Such was his fame as a physician that he was sought out by Washington, who in October 1797, sent his slave and body-servant Christopher with $25.00 “…to bear the expenses to a person at Lebanon in Pennsylvania celebrated for curing persons bit by wild animals…[xii]”.

Newspapers of the era printed cures for common ailments and injuries. Daniel Updike II, the oldest surviving son of Lodowick Updike, the plantation owner of Cocumscussoc, above Wickford, Rhode Island, and one of the wealthiest and well-educated young men of his time; copied a number of these on the inside covers and fly leaves of the 1796 daybook he kept for his father’s estate.

Among these cures were one for the Ague, prescribing that the sufferer “Wear the leaves of the Lignum Vitae under your feet a few days and a cure soon follows”

The cure is telling for the fact that the suggested remedy would likely be familiar only to those who did business, mostly slave and rum trafficking with the Caribbean islands, as the leaves required come from trees indigenous to the West Indies and have been an export for their medicinal qualities since the 17th century.

Another cure for the “remedy of the bite of a Mad dog” as Washington had sought for his slave, was to

“…wash the bitten part with 20 or 30 kettles full of water poured from the spout of the kettle or a mug-and afterward burn the wound as deep as the bite has penetrated, with the end of a case knife or any other iron made nearly (?) hot[xiii]”.

Methods of surgery on the other hand, were far advanced than pathology by the beginning of the 18th century.

18th century Surgeon’s tools Courtesy of Dan Newman

From its beginnings as practiced by carpenters, farmers, shipmasters, and others of many professions; surgery was performed as needed by whatever practitioner was available nearby. Just as the minister who attended to the sick in his parish often evolved into a physician, so too did those carpenters and farmers, well acquainted with the use of the saw and cauterization, become the first surgeons in the colonies. The most common surgery was amputation, often carried out with several townsmen present to hold the patient down while the limb to be amputated was fractured with a hammer, and then a knife was used to cut through the soft tissue. The limb was then cauterized, bandaged, and the patient taken home[xiv].

Though such early surgery methods were crude, innovative surgeons found ways to save and prolong a patient’s life. They adapted, early on, the indigenous methods of boiling vines or stripped wood to render it pliable and so bind a fractured bone. Later innovations came with accessibility to more modern technology.

Cotton Mather recorded in his journal of the suffering of Abigail Eliot, who had lost part of her brain in an accident, “yet with insertion of a silver plate in her head, she lived happily ever after[xv]”.

By the late 18th century, medical institutions were giving instructions on anatomy, and books were published, but few home practitioners in America had ever physically dissected a human body. Dr. Gordon tells us that one such opportunity came in Vermont with the first execution in Haverhill, the hanging of a black man. Gordon writes that

“The gallows was erected in an open field, and a large concourse assembled to witness the melancholy spectacle. Dr. McKinstry, of Newbury, Vermont secured the body, which was rapidly carried to a cabin on the great Ox-Bow Meadow. All the neighboring physicians were invited to be present, and were requested to bring any dissecting instrument they might deem of use. Tradition says that one brought a hand-saw, another an axe, still another a butcher’s cleaver, and the fourth came armed with a large carving knife and fork[xvi]”.

Though but a part-time calling, there is ample evidence that many who served as surgeons endeavored to become educated in their profession, and were often innovative in finding solutions to save, and prolong a patient’s life.

A regimental Surgeon’s tent photo by the author, Smith’s Castle 2015

By the latter part of century, a plethora of pamphlets, periodicals, almanac, and books fully described and illustrated common surgical procedures. A quarter century later, when the revolution broke out, there were several well-regarded books on surgical procedures and practice that were published to assist the Army surgeons in the field.

One of these was the Austrian Surgeon Baron Gerhard van Sweeten, whose work, The Diseases Incident to Armies with the Method of Cure was republished in 1776 along with extracts from British Army Medical manuals for the benefit of the Continental surgeons. Another indispensable book proved to be William Northcote’s groundbreaking discussion on wounds of veins, arteries nerves, and tendons.

Northcote, who had penned A Concise History of Anatomy, From the Earliest Ages of Antiquity, was unparalleled in his teaching on the subject during his time as an academic. Among the practices her discovered was the method of healing ruptured tendons in the field. Northcote specified that

“If tendons were wounded, they were to be splinted, but not sutured to avoid suppuration, which would tend to shorten them. If major nerves were completely severed, the limb would have to be amputated, because the arteries below the cut would not be able to function without their nerve supplies. However, nerves that were only partially severed could be expected to heal after Peruvian Balsam had been poured into the wound[xvii]”.

The medical text published by Dr. John Jones is widely accepted as the first American textbook on the subject. Within its pages were many detailed instructions and illustrations for treatment of different kinds of wounds; incised, punctured, lacerated, and contused. He introduced techniques that are still in practice today, including debridement, excision of jagged wounds to convert them into incised wounds, and dilating puncture wounds, rather than closing them.

Jone’s heartily criticized some old practices, including the indiscriminate amputation of any limb with a compound fracture. He worked along with other doctors in finding practices that could save the patient’s arm or leg from the surgeon’s table. His recommendation to like-minded surgeons was that upon uncovering the wound, treatment should begin by

“Removing foreign matter from the wound and applying soft dry lint to permit free drainage and promote a speedy suppuration. Cautious bleeding, to draw off inflammation was also recommended. If drainage were excessive, amputation should then be considered[xviii]”.

Jones would admonish the surgeons utilizing his text to always be mindful of the Hippocratic Oath, and

“As good surgeons, be in the first place well aware of the necessity of the operation before he proceeds to perform it, and secondly he ought to consider whether the patient will in all probability be better for it, or whether he may not be the worse”

Much as surgery had advanced, medical historian William C. Wigglesworth would conclude that

“During the Revolutionary War, as in all wars, great strides were made in treating wounds of the abdomen and chest, but subsequent infection precluded any real improvement in post-operative mortality and morbidity. Surgeons had gone about as far as they could without understanding the nature of infection and without anesthesia”.

The war against infection and the spread of diseases would consume those doctors who enlisted as surgeons, and faced the conditions in the overcrowded hospitals, and sought ways to alleviate the large mortality rate throughout the war.

[i] Gordon, Maurice Bear, M.D. Aesculapis Comes to the Colonies: The Story of the Early Days of Medicine in the Thirteen Original Colonies Ventnor, Ventnor Publishers 1949 p. 251

[ii] Ibid. p. 254

[iv] Abrams, Jeanne E. Revolutionary Medicine: The Founding Fathers and Mothers in Sickness and in Health New York, New York University Press 2013

[v] Gillet, A History of the Army Medical Department pp. 56-57

[vi] Gordon, p. 89

[vii] Ibid

[viii] Gordon, p. 287

[ix] Ibid 292

[x] Ibid p. 384

[xi] Ibid p. 386

[xii] Ibid p. 460

[xiii] Geake, Robert A. A Cocumscussoc Reader, Vol. I Providence, Rhode Island Footprints Press 2017 p. 59

[xiv] Wigglesworth, William C. Surgery in Massachusetts 1620-1800 p.223

[xv] As quoted in Wigglesworth, p. 218

[xvi] Gordon, p. 132

[xvii] Ibid p. 221

[xviii] Ibid. p. 222