By Peter J. Ward, Ph.D.
For West Virginia School of Osteopathic Medicine
Two hundred fifty years ago, events were unfolding that would change the course of history. The Continental Congress adopted the Declaration of Independence on July 4, 1776, marking the colonies’ separation from England and the eventual birth of the United States.
The early history of the country was marked by a break with existing authority and a wave of innovation that became a defining characteristic of the new nation. The practice of medicine in the colonies reflected this process. Just as the 13 colonies would be transformed by revolution into the United States, traditional medical practice would gradually evolve into scientific medicine.
Medical practice in the colonies began by imitating European models brought by colonists. People could consult a variety of healers. Physicians held the highest status, diagnosing diseases and prescribing medications.
Those medicines were then mixed and compounded by apothecaries. Barbers, also called barber-surgeons, treated wounds, pulled teeth and performed other surface treatments, including shaving and cutting hair.
The iconic barber pole originated in this era. Its red spiral symbolized a blood-soaked bandage wrapped around a pole, advertising the services available inside the shop. Midwives assisted with childbirth and other aspects of women’s health.
In some ways, this arrangement resembles the modern medical system, with a variety of professionals performing distinct roles. However, the reality was very different.
Medicine in the colonial period was still based on the humoral theory of health and disease, which dated back to ancient Greece and remained largely unchanged since medieval times. The theory of four humors is attributed to Hippocrates of Cos, the “father of Western medicine,” and was later expanded by the Greek physician Galen, who practiced in the Roman Empire.
According to the theory, the body contains four fluids that must remain in balance: blood, black bile, yellow bile and phlegm. Physicians attempted to restore balance through diet, massage, sweating, purging, administering enemas and bleeding patients.
These ideas remained dominant for nearly 1,500 years. They were first seriously questioned in the 16th century and were gradually displaced in the 18th and 19th centuries as anatomy, pathology, pharmacology and microbiology began to develop.
There were two medical schools in the colonies: the Teaching College of Philadelphia, now the University of Pennsylvania, and King’s College in New York, now Columbia University.
Affluent colonists could travel to Europe, particularly to Edinburgh, Scotland, for medical training. However, few could afford the cost of travel and years of study abroad.
Formal medical education of the time was not especially innovative. It relied heavily on lectures and textbook reading, often delivered verbatim to students.
Anatomical dissection was limited. A few bodies per year were available in cities such as London and Edinburgh. These were typically executed criminals, whose bodies were used for study as part of their punishment. Because the bodies were not embalmed and dissection techniques were limited, demonstrations were often unclear and still guided by outdated ideas from Galen.
Most practitioners, roughly 90%, did not receive formal schooling. Instead, they trained as apprentices under experienced physicians. While this increased the number of practitioners, it also meant there was no standardization or quality control. Anyone could claim to be a physician and begin practice, even without training.
Even well-intentioned practitioners faced significant challenges due to limited knowledge. About 25% of infants died in their first year, and nearly one in eight women died during childbirth, in part because women had more pregnancies at younger ages.
Diseases such as smallpox, typhus, malaria and dysentery were widespread, and physicians had few effective treatments. Isolating sick patients was one of the most effective measures, but overcrowding and inconsistent compliance made this difficult.
Available remedies were often ineffective. Alcohol and opiates could reduce pain but not eliminate it. Some treatments were harmful, including the use of mercury for syphilis.
Access to reliable medical care was uncertain, especially as the colonies moved toward revolution. At the same time, advances in science were beginning to reshape medicine.
Before those changes fully took hold, colonists would endure the hardships of war.
Battlefield surgery and the Continental Army during the American Revolution
The Revolutionary War began on April 19, 1775, with the battles of Lexington and Concord. Combat relied on firearms, but because single-shot muskets required time to reload, soldiers often fought at close range with swords and bayonets.
This resulted in a wide range of injuries. Army surgeons treated wounded soldiers while also managing disease and poor sanitation in military camps.
If a bullet passed cleanly through a limb, surgeons could cauterize the wound. Even in such cases, the risk of death remained high because there was no understanding of infection and no antiseptic treatment.
If a bullet remained lodged in the body, surgeons attempted to remove it using probes. Patients endured the pain without effective anesthesia.
More severe injuries occurred when bullets shattered bones. These fractures were difficult to treat, and controlling blood loss was critical. Field amputations were performed when necessary, though less frequently than during the Civil War.
Surgeons used a tourniquet to restrict blood flow, cut through tissue with a large knife and sawed through bone. The remaining tissue was then repositioned and sutured over the stump. Major blood vessels were tied off to reduce bleeding.
This procedure carried a high risk of death. About half of patients died from infection or shock following amputation.
Earlier treatments were even more harmful. Some surgeons believed gunpowder toxins caused injury and poured boiling oil into wounds to neutralize them.
A 16th-century French surgeon, Ambroise Paré, developed a better method after running short of supplies. He applied a mixture of egg whites, honey and turpentine to wounds. Patients treated this way recovered more often than those treated with boiling oil.
Paré also reintroduced the practice of tying off blood vessels rather than cauterizing entire wounds. Although battlefield medicine remained limited during the Revolutionary War, it benefited from these earlier advances.
Head and neck wounds were often fatal. In some cases, surgeons treated skull fractures by removing bone fragments pressing on the brain. They also performed trepanation, cutting an opening in the skull to relieve pressure or remove accumulated blood.
Although these injuries were severe, disease and poor sanitation caused even more deaths. About 6,800 soldiers died from combat wounds, while disease accounted for between 17,000 and 20,000 deaths.
Infectious disease during and after the American Revolution
Poor camp hygiene resulted from overcrowding, difficulty disposing of waste, food spoilage and exposure to parasites such as lice, fleas and mosquitoes. Common diseases included smallpox, typhus, malaria, dysentery, venereal disease and pneumonia.
Smallpox was highly contagious and killed about one in four infected individuals. The disease was introduced to the Americas by Europeans and devastated Native American populations who had no prior exposure.
An early form of prevention, inoculation, involved introducing material from a smallpox sore into a healthy person to trigger a mild infection and immunity. Because the material contained a live virus, the procedure sometimes caused severe illness or death.
Even so, the mortality rate was about 2%, or one in 50, far lower than natural infection.
Inoculation was introduced in Boston by Cotton Mather, who learned of the practice from an enslaved man named Onesimus, who had seen it used in Africa.
During the war, George Washington and the Continental Congress ordered widespread inoculation of troops. This helped reduce the impact of smallpox on the Continental Army, which suffered fewer losses than British and Hessian forces.
At the same time, advances in anatomy led to more frequent post-mortem examinations. Physicians observed direct physical damage to organs, including brain hemorrhages, tumors and lung infections. These findings challenged the humoral theory and contributed to the development of the study of pathology.
However, these advances came too late for Washington. After developing a severe throat infection, he was treated with repeated bloodletting. Physicians removed about 2.5 quarts of blood in 12 hours, which contributed to his death.
It was not until the 19th century that the true causes of infectious disease were identified. Scientists discovered bacteria and viruses and began to understand how infections spread, particularly through the work of Louis Pasteur.
Colonial American medicine lagged behind Europe’s, particularly in France, Germany and Scotland. However, it was improving. The emphasis on observation, experimentation and inquiry aligned with the period’s Enlightenment ideals, characterized by reason, empirical evidence and the scientific method, setting the stage for rapid advancement.
— Peter J. Ward is a professor of neuroscience at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg, W.Va. He earned a Ph.D. degree in anatomy education at Purdue University. Ward joined the WVSOM faculty in 2005 and has taught gross anatomy, neuroscience, embryology, histology and the history of medicine. He has received numerous teaching awards, including the WVSOM Golden Key Award and the American Association of Anatomists’ Basmajian Award, and has been a three-time finalist for the West Virginia Merit Foundation’s Professor of the Year selection. Ward has served as a council member and association secretary for the American Association of Clinical Anatomists. He has also served as a consulting editor, senior associate editor, lead editor and contributor for multiple medical publications, including the Netter Atlas of Human Anatomy.