Colonial Medicine: A Case Study

We learn much about diseases in the 18th century and the way they were treated by looking at a well-documented case history.

The soldier and statesman described here lived a long life but had to endure many serious medical issues. While he was an ‘out-of-stater’, he was in New York for many years during the Revolutionary War and through the first critical years of the founding of a new government.

As a child, born in 1732, he incurred “black canker” (diphtheria), a disease that often proved fatal. Most likely, he had other serious contagious diseases of childhood such as measles and mumps (we can infer this because he did not get them on repeated exposure during his later years).

When he was 11 years old, his father died from “consumption” (tuberculosis) as did his half-brother, with whom he was very close (including traveling long-distances together). Almost certainly, his life-long, frequently repeated and life-threatening episodes of “violent pleurise” (pneumonitis) were from exacerbations of pulmonary tuberculosis.

At age 17, while working in a swampland, he developed high fever and aching “to an extremity” that was typical of “ague” (malaria), a common summertime illness, especially in the southern colonies. Disabling relapses would plague him for the rest of his life.

At age 19, he was “strongly attacked by the small Pox” (said to be a “mild” case when the patient survives). Scabs on his face left prominent scars. On the positive side, he developed permanent immunity to the infection.

As he moved into adulthood, he stood more than six-feet high (very tall for the time), was robust in body with an athletic temperament. At the age of 21, he enlisted in the colony’s militia, having been appointed to a rank of officer.

In 1755, his militia, along with British troops, marched into the frontier to check on disputed territorial possessions in the French and Indian War. It was during this campaign that he developed “bloody flux” (dysentery) complicated by a rectal abscess. It happened at the worst possible time: during an ambush. The French badly mauled both militia and English regulars, killing or severely wounding all the other officers. He was forced into a leadership role. Horseback, he used a pillow on his saddle to ease the pain. After several close calls from bullets, he led a retreat that earned him a merited reputation.

Dysentery was to occur many times, “returning obstinately”, for the remainder of his life, on some occasions leaving him so weakened that his doctor declared him near death. Descriptions are too vague, however, to decide if the cause was diarrhea from unsanitary “camp” food or from a chronic infection – such as tuberculosis – or inflammatory bowel disease. With this affliction, whatever the cause, army life seemed a poor career choice.

When he was 26 years old, he retired from the militia to become a planter. He also became active in his state’s legislature. It was during this time that a relapse of malaria (or possibly it was typhoid fever) occurred. During the worst of it, he felt “very near to my last gasp”. It took a year for him to recover.

In 1774, with the growing insurgency against the British Crown, he enlisted in the Continental Army where he was granted officer rank. His health remained remarkably good throughout the duration of the Revolutionary War except for a severe case of “quinsy” (tonsillitis) during the winter encampment of 1779. During the long winter encampment a year later, with the army deprived of adequate food (including fresh vegetables and fruit), scurvy was rampant. It would be far-fetched to believe he did not also endure this affliction.

He continued his duty with the army until England finally acquiesced and acknowledged the independence of its rebellious colonies. Enduring six years of conflict, he finally retired to his farm. It is said however, that the strain of the war had left him visibly aged. It was during the victory celebration that his son died from “camp fever” (typhus) at the battle site in Yorktown. Added were worries over his plantation’s financial problems. It is said that these issues in conjugate caused him to go into a serious state of melancholy (depression).

During his subsequent five years as a gentleman farmer, he developed symptoms of “rheumatism” (arthritis). Pain and stiffness prevented him from raising his arms higher than his shoulders. He had difficult touching his face with his hand and turning in bed. Evidently (but not certainly) the symptoms slowly disappeared or at least diminished to a point of tolerance.

In 1789, at the age of 57, he reluctantly accepted a government position that took him, once again, away from his plantation. It was in this first year of public service that a “carbuncle” appeared in his upper leg. The abscess was extremely painful, preventing him from lying on that side. After a month and a half, it was opened and drained (by a Loyalist surgeon!), evidently with satisfactory recovery. It seems most likely (at least to this writer) that the abscess was an infection of bone (osteomyelitis), a complication of tuberculosis.

On a visit to Boston he encountered an epidemic of influenza and contracted the infection, but evidently had a relatively minor case. Another epidemic of influenza occurred a year later; this time he was severely stricken with the complication of pneumonia. His doctors as well as his family and colleagues worried that the end was near. Slowly recovering – looking pale and cadaveric – he wondered if he could carry out his duties. One intriguing aftermath is that – as he was recovering – he went on a three-day fishing trip with a friend off Sandy Hook, then spent a month of rest in Newport, Rhode Island.

Not unexpectedly, he incurred the natural changes of aging during his early 60s. “Near sightedness” (presbyopia) required increasingly strong spectacles for reading. “Hearing loss” (otosclerosis) was progressive and by 1789, he had difficulty with the spoken word at conversational volume.

Dentistry at the time was practiced with one good yank; ‘preventive’ dentistry was unknown. Like many others, he began to lose teeth early in adulthood. By the age of 50, he had but one tooth left. The process was punctuated by frequent tooth abscesses. At one point, a gum abscess eroded into the left cheek. It was opened and drained from the outside, leaving a large scar. Being tooth-less, of course, contributes to malnutrition. Also, the resulting sunken cheeks greatly affected his self-image and, even more important, his ability to speak with commanding enunciation to his troops and fellow officers.

A fall from a horse in 1794 caused him injury to his back and shoulders. The “hurt” caused prolonged disability.

In 1795, a persistent growth on his right cheek was removed, of course without anesthesia or antiseptics. Its prickly irritation was long-felt and suspected to be cancer. More likely, it was a benign skin lesion (keratosis).

He retired from public service in 1797 at the age of 65 to return to the tranquility of plantation life. Having spent eight years of industrious labor amid the strife of a new and contentious governing body, he returned to life with his remaining family. Within a year, symptoms of malaria reemerged resulting in loss of 20 pounds despite intensive and eventually successful treatment with Peruvian bark.

In 1799, he developed hoarseness after being exposed to a wet chill that he assumed was just another common cold coming on. A sore throat followed and soon the symptoms of quinsy were recognized. He was then 67 years old, an age far exceeding the life span of most people of the time. Swollen tissues gradually blocked the airway at the glottis. Weakened and short of breath, he expressed his desire to “go in peace”, but not before seeing that his wife was taken care of while thanking his doctors for their services (an early version of the “Do Not Resuscitate” order).

This case report helps us understand the medical issues of colonial times and better appreciate what people endured then in their “pursuit of happiness”. Here are summarized the health adversities of one person who continued – despite them – a long career, contributing mightily, both as a military officer and a public servant, doing what he could for his new country.

This essay is based on a presentation given at Fort Montgomery, Bear Mountain State Park, on June 7, 2015: “How to become a Revolutionary War Doctor”.