The Revolutionary Period.—At the time of our Revolutionary War the science of military surgery was scarcely yet created and even with the Continental armies the barber-surgeon had a certain place, in which he was almost a menial, and above which he could scarcely raise himself. The English troops were better equipped in this respect than were the Hessians, for instance, while during the latter part of the war, especially when the French sent some of their best men to this country, our raw and untrained army surgeons came in contact with a better class of men and by whom they were, to some extent, inspired. Nearly all of the prominent medical men, save the Tory physi cians of Massachusetts, entered the army or took public service, and in the Massachusetts Provincial Congress of 1775 there were 22 physicians. Both the colonial and general gov ernments dealt very stingily with their medical departments and the professional equipments provided were almost meagre. The history of surgery in those days is mostly the history of a few prominent individuals who made it what it became and who deserve to be briefly men tioned. The brothers Joseph and John Warren took a very prominent part during the earlier portion of the war. It was the former who started Paul Revere on his famous ride. He was elected president of the Provincial Congress and just before the battle of Bunker Hill was made major-general of the Continental forces, preferring• this office rather than the office of physician-general which he had been offered. During the battle he showed a wonderful spirit of self-sacrifice and, declining his rank, acted as a private, and with musket in hand fought nobly, and was shot dead just at the conclusion of the battle. The younger brother, John War ren, lived to achieve fame and reputation, and transmitted them to a posterity by whom they have been well preserved. He constituted a brilliant contrast to many of the regimental surgeons who had been too often appointed by political influence without regard to attainment. Some regiments were even organized without a surgeon and came into camp without the slightest provision for disease or injury. In 1776 Congress enacted that there should be one surgeon and five assistants to each 5,000 en listed men. The former was to be paid $1.66 per day and the latter each $1 a day. The reader can imagine the care 5,000 men would receive from six physicians whose services were compensated at this rate. At that time such a thing as camp hygiene was almost unknown and a hospital corps and ambulance drill were quite lacking. But John Warren then but 23 years old, proved extremely efficient in the organization and completion of, and accom plished a great deal for the improvement of his department. The first surgeon-general of the Continental armies was Benjamin Church, of Boston, who was given the title of director general and chief physician and was paid $4 per day. Church gave promise of effi ciency in his department, but before long was detected in correspondence with the enemy, for which he was court-martialed, imprisoned for one year and allowed to leave the country and was then probably lost at sea. His place was taken by John Morgan of Philadelphia, already mentioned above. He had the politi cians to fight and after a long and arduous struggle, failing to satisfy them, he was dis missed from the service, although he was finally acquitted of all blame. This was a time of unrest, excitement and suspicion and had Washington himself been a weaker man, he could scarcely have withstood the dissensions and jealousy with which he was continually surrounded. Morgan was succeeded by Ship pen, his old associate, who remained in office from 1777 to 1781. Under his guidance the medical department almost prospered and was at least conducted with dignity and great bene fit to all concerned. Smallpox, which had been the scourge of the soldiers as well as the people in general, was kept down by the practice of inoculation, which had been generally accepted by nearly all men from Washington down.
From the Revolution to the Civil War.— The most conspicuous figure in the history of American medicine, which practically - began with the conclusion of the Revolutionary War, was Benjamin Rush, of Philadelphia (1745 1813), an exceedingly versatile, many-sided, er ratic, obstinate, skeptical man, constant only to his religion which he considered to be a prp fessional duty. He was hated by many of those
to whom his methods most strongly appealed. He had rare didactic gifts, but his teachings were abused by his students and followers. As a young man he had spent three years in Europe and had taken his degree at Edinburgh. He had come especially under the influence of Cullen, whose views he had imbibed and later accepted in a modified form. He served two years in Congress, where he advocated and signed the Declaration of Independence. In the same year, 1776, he got his first army medi cal experience. Rush seems to have been one of the few men who failed to come under the influence of Washington's personal magnetism, and he endeavored in some ways to belittle his commander-in-chief. After a rather ignomini ous exposure he retired from service and took up his practice in Philadelphia. From that time on he became noted as author, teacher, prac titioner and politician. He proposed a cabinet position whose incumbent should be called Secretary of State for Peace. He wrote exten sively on many subjects, not all of which were medical. He finally exposed the weakness of Cullen's doctrine and fell rather into accord with that of his great rival, Brown. He taught that yellow fever was not contagious, but warmly advised purgation and excessive letting of blood in its treatment. At his death he was one of the few surviving signers of the Dec laration of Independence. He made many con tributions to science and it is said of him that since the death of Washington no man was so deeply and universally mourned. A list of his writings would include several pages of titles and would show the mental and physical activity of this great man.
The earlier portion of the 19th century in the large cities of the country was characterized by unfortunate dissensions and jealousies which for many a year kept back medical progress. Prejudice against the study of anatomy was as strong as ever, and the difficulties surrounding dissection were often very great. The so-called Mob" occurred in 1788, when an ex cited crowd tried to break up a dissection which was being carried on in the old New York Hos pital, where the provincial legislature at one time held its sessions. The students and doc tors took sanctuary, for the time being, in the jail, the militia were called out, seven rioters were killed and the doctors got no sympathy. Although this was before the 19th century actu ally began, it nevertheless indicated the spirit of the times. The great benefit of the Revolu tion came from the presence of the educated and more cultured French and other foreign officers who came to this country and brought their books and wisdom with them.
The greatest figure in American surgery dur ing the earlier part of the previous century was Philip Syng Physick. He was born in 1768 and died in 1837. He came of a good family and had a good education. But it was not until 1789, when, in London, he had the good for tune to be talcen into the family of John Hunter, that he developed those qualities which helped to malce him great in after life. Had he been willing to remain in the old country he might have become Hunter's partner. He had the best that the old country could afford, spending sotne 11 years in study, all told, which was a remarkably good preparation for practice 100 years ago. He yielded to the claims of his native land and quicicly built up a practice after his return to this country. He had much with which to contend, including indigestion, an absolute lack of humor, in fact a tempera ment such as to malce him unpopular, the only thing that saved him from this being his brains. In spite of all this he left behind him the reputation of being the Father of American Surgery. One of his most celebrated cases was that of Chief Justice Marshall, from whose bladder he removed an astonishing number of calculi. In 1805 he became professor of surgery in the University of Pennsylvania, which chair he held for 13 years. Though chunsy and, un couth in person he was singularly dexterous with his hands, and excelled in deftness with the knife, and with all forms of orthopedic apparatus. He gained great reputation in his treatment of fractures and dislocations, many modifications of which he made which proved very advantageous. For some years he had promise of a successor in his nephew, John Dorsey, who, however, died before his uncle, and never lived out his promised career.