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Surgery during the American Revolution was confined to amputations, wound care, trephining (opening the skull), and few other operations, largely because of limited pain control and subsequent infection. Operations on the abdomen were very rare, and open chest surgery was unthinkable. Some pain relief was achieved back then by opiates, such as laudanum, or by alcohol. Patients had to be restrained physically. Ether was one of the first anesthetics in clinical use. Although it had been discovered in 1540, it was not used for anesthesia until three hundred years later when ether was used at Massachusetts General Hospital during removal of a neck tumor. 

(Image : Early anesthetics, Getty Images) 

These practices were used to treat many conditions especially fevers well into the 1800s when the modern era of medical practice began. But at the time of the revolution, bleeding by “opening a vein” or by applying leeches was consistent with prevailing medical theories of the day. Back then, disease was thought to result from an imbalance of bodily fluids (or “humours”). So, it followed that by bleedings, emetics, and cathartics, health would be restored . With the best of intensions, doctors often made their patients worse.

(Image: Courtesy, Smithsonian Institution) 

No, discovery of germs (micro-organisms that cause disease) did not come until nearly 100 years after the American Revolution. Without a scientific basis for infection, doctors in the 18th Century did not know of ways to prevent infection. Infections were rampant after battlefield wounds and after surgery. Modern control of infection is based upon sterile technique, antiseptics and antibiotics. Shown in the figures are an artist’s conception of group A streptococci and a laboratory plate showing group A streptococci. This microorganism causes “strep throat” and may act as the “flesh-eating “ bacteria. (Courtesy: stockphoto)

Childbirth in the late 18th Century was a dangerous business, with a death rate of about 1 in 100 deliveries.  Chief causes were infection, bleeding, convulsions (eclampsia) and dehydration. Thomas Jefferson’s wife Martha died in 1782 four months after giving birth to her seventh child. Because she never recovered from the delivery, her death was most likely from an obstetric complication such as ongoing infection. There were no antibiotics, blood transfusions, intravenous hydration, anti-hypertensives, anticonvulsants, medications to improve desultory labor, or effective pain control. With the advent of these treatments in the 20th Century, maternal mortality declined in United States to 1/10,000 by 1980: one of the great public health victories of modern times. 

(Image : 18th Century childbirth, from Alamy)