Medicine in the American Revolution

 Howard, Martin R. Fevered Fight: Medical History of the American Revolution 1775-1783. Yorkshire and Philadelphia: Pen & Sword Military, 2023.  

Military strategy and combat actions primarily comprise warfare accounts by military historians. Martin R. Howard argues in his new, one-of-a-kind book, Fevered Fight: Medical History of the American Revolution 1775-1783, that the practice of medicine can be equally crucial to military success or failure. Uniquely, he presents the medical history of the American Revolution, interleaving into one narrative the American and British military medical establishments and practices. Penning a wide-ranging survey, Howard includes information on Hessian, French, Naval, and Native American disease and combat care, where available. A Fellow of the Royal Historical Society[i] and a former medical clinician, Howard has the technical background to correctly interpret the impact of disease and medicine on armies and military campaigns. Additionally, he previously authored books on French Revolutionary and Napoleonic Eras in Europe and the Americas.

In the first of three sections, Howard provides a baseline establishing the state of medicine and its military practice at the start of the American War of Independence. One of the book’s strengths is a comparison and contrast organization delineating the Rebel and British approaches to military medicine. At the war’s outset – the numbers of physicians and surgeons were similar, with four thousand in Britain and thirty-five hundred in America. The British medical practitioners tended to be university-trained, while the Americans followed an apprenticeship model with only a few formally schooled physicians. Remarkably, fourteen hundred physicians and surgeons served in the American army. Readers will learn attention-grabbing differences in organizational approaches, such as the official roles of physicians, surgeons, and apothecaries in the British establishment. Americans blurred these distinctions with few formal apothecaries with the Army.

The second section describes the role of medicine and surgeons in the war’s ten significant campaigns and battles. British and American doctors operated general hospitals in the rear of combat lines and regimental hospitals close to the front. In the case of high-intensity combat and movement, “flying hospitals” provided immediate care for combat wounds and disease. General army and regimental physicians and surgeons staffed these facilities. Lessor-trained surgeon mates supported all facility types and, in many cases, provided valuable medical care. Neither army experienced close relationships between the commanding generals and the physician leaders. In particular, the Rebels engaged considerable infighting among their physician managers, which sometimes got in the way of accomplishing their mission and providing quality patient care. The infighting among the most senior Rebel leaders was vitriolic, leading to high-profile dismissals and resignations.

In almost all ten campaigns, readers will learn about the lack of medical supplies, shortages of trained medical professionals, and lack of proper hospitals and shelters. The author presents copious vignettes about soldiers’ medical care culled from letters, diaries, and journals. Another strength of the book is the substantial evidence from primary sources written by physicians and surgeons on both sides of the conflict. Researchers seeking the most comprehensive published and unpublished primary sources on medical practitioners will find them in Howard’s notes and bibliography.

In the third section, Howard offers a retrospective assessment of the impact of disease on the American Revolution and the war’s impact on the practice of medicine. Howard concludes that the human cost of the war is hard to estimate. Based upon sick returns, he estimates that eleven percent of British soldiers died during the war, with a morbidity rate of sixteen percent for the American forces. Howard anticipates that the American death rate is likely much higher as the record-keeping was notoriously lax for the deadly 1775-6 Canadian invasion and the 1780-3 Southern campaigns. He cites that the lower British morbidity rate was due to greater natural disease immunity as many Crown troops embarked from larger cities and were better fed, clothed, and sheltered in America.

Howard addresses the question of whether disease affects the Revolution’s outcome. John Adams asserted that “smallpox was ten times more terrible than the British, Canadians, and Indians, together.” Like Adams, Howard concludes that disease, especially smallpox, greatly affected the Rebels’ 1775-76 Canadian invasion and was a significant factor in its failure. On the other hand, the British forces under Lord Cornwallis in the Carolinas and Virginia suffered greatly from camp fever and other diseases. Many soldiers and officers, including Cornwallis himself, were unfit for duty due to southern fevers. While diseases disabled many under Cornwallis’ command, Howard does not ascribe fevers as the reason for his defeat but concludes that “disease tortured an army already destined to defeat.”

The final question Howard answers is, what was the impact of the Revolution on the practice of medicine? He concludes that there were several advances, such as treating combat wounds on the battlefield and limited drug trials, but much of the Revolutionary Era needed more medical innovation. He believes no doctors are prominent for their medical and surgical research. However, he cites several American physicians, such as Benjamin Rush and Joseph Warren, who became eminent during the war for serving in the Continental Congress and the military.

Howard notes the importance of proper hygiene techniques while in camp or on a campaign. He believes the American Revolutionary Army did not stress disease-preventative measures despite George Washington’s abstemious habits. Another recent historian cites the Rebel adoption of French castramentation principles to operate healthy encampments and winter quarters after the disastrous Valley Forge winter.[ii] It would have been interesting if Howard had offered an opinion on the Rebels’ improved camp design and buildings intended to reduce disease.

Howard’s final assertion that American doctors gained valuable experience during the war, which improved post-war medical care, is less controversial. He discerns that the war facilitated the development of medical societies and the exchange of medical knowledge and treatment protocols through medical publications. Additionally, the Revolution stimulated the development of American apothecaries and an emerging unique American surgical culture after the war. For example, Pennsylvania regimental surgeon Hugh Martin published a treaty on the treatment of cancers.

Readers looking for an integrated survey of late eighteenth-century medical practice and its role in the American Revolution will benefit from reading The Fevered Fight. Some bibliophiles may be frustrated as no introduction presents the author’s thesis, main arguments, and conclusions. The author could have also provided a summary medical assessment of each campaign chapter as he did for the Canadian invasion and Cornwallis’ Southern campaigns. However, demonstrating impressive research and clinical expertise, the two-hundred-page monograph provides a vivid overview of the competing armies’ medical staffs and is chocked full of eyewitness accounts by physicians and patients.

Other books on Revolutionary War medicine and surgeons.

Hasselgren, Per-Olof. Revolutionary Surgeons: Patriots and Loyalists on the Cutting Edge. New York: Knox Press, 2021.

Fenn, Elizabeth A. Pox Americana: The Great Smallpox Epidemic of 1775-82. 1st ed. New York: Hill and Wang, 2001.

Wehrman, Andrew M. The Contagion of Liberty: The Politics of Smallpox in the American Revolution. Baltimore: Johns Hopkins University Press, 2022.

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[i] Royal Historical Society Fellowships are awarded to those who have made an original contribution to historical scholarship, typically through the authorship of a book, a body of scholarly work similar in scale and impact to a book, the organization of exhibitions and conferences, the editing of journals, and other works of diffusion and dissemination grounded in historical research. https://royalhistsoc.org/membership/fellows/

[ii] Steven E. Elliott, Surviving the Winters: Housing Washington’s Army during the American Revolution, Campaigns and Commanders, volume 72 (Norman: University of Oklahoma Press, 2021).