An Age-Old Problem
Throughout the course of history, the bane of most armies
was not enemy swords, spears, bayonets, bombs, or bullets. Up until at least the
second world war, disease and infection killed or disabled more men than
battle. Even with today’s Corona Virus Pandemic, there are reports of infections
in the military at much higher rates than the regular population. Like so many people
around the world, I have been sitting at home and watching a global epidemiological
disaster unfold, while trying to ignore the inconvenient fact that I am at the
center of it. As are we all. This led me, naturally, to ruminate on the topic
in terms of the times of the Yankee Doodle Spies.
 |
| The Black Death wreaked havoc and terrorized over centuries of outbreaks |
Disease in War
In a strange irony, war brings people together. Not just the
face to face clash of foes but the necessary formation of close-knit units who
are thrown together to eat, sleep, train and fight. Camps and garrisons become
breeding grounds, especially when hygiene is not maintained. It is that very closeness that makes them so
vulnerable when various outbreaks occur.
 |
| Gathering of soldiers in military camps was ground-zero for the spread of disease |
Epidemics have weakened armies, sometimes rendering them
unfit for combat operations, outbreaks have frozen military operations, and of
course, there is the effect on civilian populations armies come in contact with.
Geography plays a role, with both bitter cold and steaming hot climates playing
a role in the spread of illness. Swamps, littorals, and cities all present
environments supportive of various types of disease. And of course, the
transports of armies, placing soldiers in strange new lands where they can
encounter new diseases and bring their own to impact the locals.
Yankee Doodle Disease
The American Revolution in many ways exemplifies all of
these factors. Men from farms and forests thrown together with men from towns
and seaports. Undernourished, often poorly dressed and exposed to the elements,
these men (and women) often faced a foe worse than any redcoat or Hessian. A
foe invisible to the naked eye and who, in most cases, the best medicine of the
age did not comprehend and could not combat. Simply put, they faced an array of
germs that packed a punch as bad as any .69-inch musket ball or 17-inch
bayonet. Diseases such as smallpox, dysentery, and malaria, were
commonly suffered by American and British and Hessian soldiers alike. They were
an enemy that did not choose sides. Given the close-quarters environments of 18th
century encampments these diseases would spread through a camp like a windstorm
across the high plains.
 |
| Disease killed more men than musket balls or bayonets |
A Different Kind of Battle
The soldier of the American Revolution faced highly
professional armies equipped with the best weapons of the late 18th
century. But if musket and cannon did not kill the soldier, the state-of-the-art
treatment for a wound or illness might. Data indicates the typical combatant stood
a 98% chance of surviving battle, but around a 75% chance to walk (or limp)
from the hospital. Unsanitary conditions, lack of knowledge of vectors, lack of
practical remedies combined in a tragically unfair fight for the wounded or
sick patriot. No antibiotics, but plenty of bleeding. No anesthetic, but plenty
of bullets to bite. And if things really looked serious? Not to worry, there
was an abundance of trained surgeons and their assistants who could cut off a
limb or bleed the lifeblood from you.
 |
| State of the art medical kit of the Rev War |
A Different Kind of Surgeon
During the time of the American Revolution, pretty much
anyone could claim to be a doctor and begin practicing medicine as long as they
spent a few years of apprenticing with another doctor. Very few were trained
surgeons from Edinburgh or London. And even if they were, medical science of
the day was based on theories (often bogus), not on real scientific knowledge. This
was especially true when it came to illness, especially infectious disease. Doctors
of the period thought most illness was brought about by “an imbalance of the
humors” -- blood, yellow bile, black bile, and phlegm. How to regain the
balance in the humors? The typical
procedure used was bloodletting or sometimes herbal concoctions to help induce
vomiting or bowel movements. Lots of ways to restore the balance.
 |
| Bleeding was a common treatment for bad humors |
A Different Kind of Pharmacist
Medicine in the time of the Yankee Doodle Spies was hard to
come by. Prior to the war, medicine, like almost everything else, had to come
from England. One reason we rebelled.
The war broke that supply chain until the French alliance in 1778. A new
supply chain from France brought medicine to America. But even when medicine
reached the army camps, most were of limited value, if not dangerous. In a
medical field that lacked anesthetics, opiates were the go-to painkillers,
followed by hard liquor, and the previously mentioned bullet. For various
ailments, some surgeons used mercury compounds, lavender spirits, and cream of
tartar.
 |
| Medicines of the day were, interesting |
Climate Change
Disease would strike in any climate. Winter brought seasonal
flu and resultant pneumonia that drowned the soldier in his own lungs. And
the years of the American Revolution had some savage winters thanks to a
mini-ice age. Many died at Valley Forge, Morristown, Newburgh, and other winter cantonments.
Summer, especially in the south and in the swamps and low-lying coastal flats, brought the
noxious vapors, often malaria but more often deadly yellow fever. Of
course, the vapors, typically called miasmas, were not the vector. Insects
provided that. In the case of the latter, the lowly mosquito.
 |
| Swamps along the Georgia and Carolina littoral were a breeding ground for the"noxious and bilious vapors" that plagued both sides |
The war in the south was impacted greatly by
disease. It was one of the biggest concerns of the British high command, who
had experience sending soldiers into warmer climes. The outbreak of disease
chronically weakened General Charles Cornwallis’s army in the Carolinas,
impacting battles and strategy. At critical junctures, key lieutenants got ill,
as did Cornwallis. When he finally had a reasonably fit and equipped force in
hand at Wilmington, he decided to move north to Yorktown and not back into
South Carolina in part to get his army into a healthier climate. We know how
that turned out.
 |
| Disease factored into the strategy of Lord Cornwallis, with unpredictable results |
Mother of All Maladies
Smallpox was a real killer in the time of the Yankee Doodle
Spies. And it could leave permanent scarring when it did not actually kill you.
Armies and their camp-followers were very susceptible to the disease and
outbreaks threatened both sides. Smallpox in some ways resembles the Corona Virus in its
manifestation. It spreads from direct contact, not other vectors such as
insects. It can incubate a fortnight before victims are symptomatic. It manifests
with some of the similar to Corona and the flu bringing fevers, headaches, and body
aches.
But the smallpox piles on with the outbreaks of pustules on the body. Soldiers
suffered for about another fortnight before succumbing. It killed one out of
three people infected (.3 mortality rate in Dr. Fauci terms) and the survivors
take weeks and weeks to recover. Of course, the tell-tale scars make sure you
(and those around you) never forget.
The Continental Army suffered outbreaks during the siege of
Boston and the defense of New York, again large numbers of soldiers in a
relatively confined area. There were two approaches to combating the disease,
neither helpful when you are trying to wage a war.
 |
| Soldiers from a over a half-dozen states gathered outside Boston, providing conditions ripe for the spread of disease |
Social Distancing
The first was quarantine, the social distancing of the day.
Hard to do when men are organized in unit sets, such as companies, regiments, and brigades. Harder to do in winter quarters, where men huddled freezing around smokey campfires and shared common meals together. Meals often sparse and un-nutritious. The Continental Army could not telework. Well, at least not for
long.
 |
| Winter cantonments such as Valley Forge, Morristown and Newburgh offered little chance for social distancing |
Variolation
As controversial in the time of the Yankee Doodle Spies as
today, the smallpox was one of the few diseases preventable by inoculation, then
called variolation. The variolator used a lancet with fresh matter taken from the
pustule of someone with active smallpox. The matter was then scraped on the
arms or legs of the recipient, or introduced through the nose. There were risks to this, recipients often developed
the symptoms like fever and a rash. But fewer people died from variolation than
if they had acquired smallpox naturally. In a study conducted during an outbreak
in Boston in 1722, those without variolation died at the rate of 14%, the
variolated died at 2% (.14 versus .02 in Dr. Fauci terms). This might have been
one of the first instances of data in medical science.
Surgeon-in-Chief
In addition to being commander-in-chief and spymaster-in-chief,
General George Washington was the final arbiter on the use of medical
procedures to battle outbreaks. He himself had a mild version of smallpox
earlier in life during an expedition to the West Indies. Yet military exigencies
in 1775 and 1776 precluded him from ordering widespread variolation. The British,
meanwhile, were using it on any recruit coming to America.
 |
| The year 1777 required forced inoculation to prevent the army from wasting away from smallpox |
By 1777 the
situation changed. A series of outbreaks that year would take as many as 100,00
lives in North America. Only 2.5 million lived in the colonies, not counting
the native tribes in the colonies, the Spanish-America and Canada. But a pretty
large “numerator” as the good doctor would say. Washington had to take the risk
that mass inoculation would not debilitate the Continual Army and finally
approved the procedure, beginning with all new recruits. By the following year,
however, a considerable number had still somehow avoided the procedure. This
time, Washington gave strict instructions that these men would undergo inoculation. Washington made variolation for smallpox "settled science."
Father of Public Health
Just as the ravages of infectious disease helped bring the death-knell of the Roman Empire, Medieval Europe and other civilizations, the
great outbreaks of smallpox in America during the struggle for independence
might well have done what masses of redcoats and Hessians could not do, break
the will of the patriots. It is not
hyperbole to say that the mass inoculation ordered by Washington saved the army
and thus the American cause. And he may be able to add the honorific, the “Father
of Public Health” in addition to the “Father of His Country.”
 |
| First in War, First in Peace, First in Public Health |
