BOOK REVIEW: The Fevered Fight: A Medical History of the American Revolution, 1775-1783 by Martin R. Howard (Annapolis, MD: Naval Institute Press, 2023)
Medical care was at the center of the Revolution. When the War for American Independence began, the British army summoned its physicians, surgeons, apothecaries, and purveyors to tend to the men who sickened and died in battle. Continental forces lacked such an infrastructure; nevertheless, “American doctors carried the torch of revolution” with 1,400 physicians volunteering for the Continental Army and Navy (page 5). These professionals saved many lives through timely care despite the limitations of eighteenth century medical knowledge. At times, sickness even influenced the course of the war itself.
Martin R. Howard’s The Fevered Fight: A Medical History of the American Revolution, 1775-1783 is a comprehensive account of the role that health care played in the Revolutionary War. A hospital consultant and accomplished historian, Howard brings a wealth of knowledge to this study. He examines both the British and the American sides of the Revolution as well as French and German efforts, and he offers insights on each of the major battles of the war. This is not a thesis-driven book, yet it is remarkably readable and full of important information that will complement anyone’s knowledge of the Revolution.
The Fevered Fight begins with a general account of health care in the Anglo Atlantic. Howard introduces the uninitiated to the state of medicine two hundred and fifty years ago, its practitioners and their education, understandings of contagion and disease, and the approach to epidemics that ravaged the population. He explains army medicine in particular, including the treatment of gunshot wounds, amputations, and rudimentary efforts at hygiene. Smallpox was the great scourge of the era, although typhus, dysentery, malaria, scurvy, and scabies were often more deadly to soldiers.
Howard details the elaborate medical infrastructure that Britons had developed over centuries of worldwide war. Robert Adair led the effort as inspector of the regimental infirmaries, with assistance from the subordinate inspector of hospitals, inspector of regimental infirmaries, and superintendent general of hospitals for British forces in North America. The British army was well staffed with physicians and each regiment was required to have a surgeon (who would be considered a general practitioner in today’s terminology). Although training was uneven, the British army forbid the sale of medical commissions so as to promote only competent health care workers. The army maintained a number of general, flying, and regimental hospitals, and prioritized the acquisition of medical supplies. Although officers were prone to bickering and “mates were often poorly qualified and little trained,” the organization, experience, and competency of the British army medical services were such that Patriot physician Benjamin Rush thought them worthy of emulation (p. 33).
By contrast, the Americans had to create a military health service from scratch. In July 1775, Congress approved the Hospital Bill creating a medical department for the Continental Army, but “the legislation was necessarily drawn up in haste and it lacked the required specificity” (p. 39). As a result, the American medical corps suffered from disputes among directors general John Morgan and William Shippen as well as a lack of centralization of services. The Americans were furthered hindered by untrained doctors, a shortage of medical supplies, and poor quality hospitals. Nevertheless, the medical efficacy of the Continental Army improved quickly over time, and Howard argues that “the most powerful force in its growth was George Washington’s patronage,” especially his support for the mass inoculation of the troops (p. 50). By the end of the war, the Americans’ military medicine was as effective as Britain’s.
Following the overview of the two sides’ challenges and successes (as well as brief discussions of the medical services of the Hessians and the French army), The Fevered Fight proceeds battle by battle from Lexington-Concord to Yorktown. Such an approach allows for untold stories and unsung heroes to come to the fore. In the earliest battles, inexperience and disorganization plagued both sides. The transportation of the wounded off the battlefield hampered even the well-organized British army, such that following the Battle of Bunker Hill, “some British casualties were still being brought in forty-eight hours after the battle” (p. 65). The garrisoning of Boston proved debilitating to British efforts under Gen. William Howe as smallpox ravaged the city. Indeed, it was for reasons of health as much as strategy that Howe withdrew his troops to Halifax in March 1776, although this also meant that the Americans “inherited significant hospital stores which the fleeing army was unable to carry away” (p. 75).
Howard emphasizes how medical health shaped the course of the war. He speculates that Washington’s decision to besiege Boston rather than attack the city was motivated by a fear of smallpox. Similarly, he observes that Americans’ lack of immunity to smallpox and inadequate inoculation efforts doomed Benedict Arnold’s assault on Quebec in December 1775. He also considers whether or not the British employed biological warfare by deliberately sending men infected with smallpox to the American side in Boston and Quebec. Definitive answers for this are impossible, although we do know that in Virginia Lord Dunmore’s efforts to raise a troop of formerly enslaved men collapsed as soon as it began because African Americans had lower levels of immunity to smallpox than white colonists.
British medical organization was far better during the army’s invasion of New York in August 1776. Soon after the city fell, the British army established seven hospitals in Manhattan that effectively kept the number of casualties low. Conversely, the disorganized Americans had nothing comparable, such that by the time Washington retreated across New Jersey, “it remained normal for a third of the rebel army to be incapacitated by wounds and disease” (p. 102). Despite victories at Trenton and Princeton, American medical care remained abysmal. The general hospital opened at the Brethren’s House in Bethlehem, Pennsylvania, was a death trap with the mortality rate reaching “a frightening 25 per cent” at the time of its closure in March 1777 (p. 113).
The situation reversed the following year in upstate New York. The British army faltered along the Hudson such that after the John Burgoyne’s defeat at Freeman’s Farm, “a quarter of Burgoyne’s army was sick or wounded” (p. 125). Conversely, Horatio Gates’ American army “became healthier as the campaign unfolded” (p. 120). Effective efforts to control smallpox and an absence of typhus meant that sick rates for Americans after Saratoga were between 6 and 9 percent. However, sickness among the Continentals hindered American efforts to defend Philadelphia in October 1777, and their misery continued the following winter at Valley Forge.
When the war shifted south, fears of poor climate worried both Britons and Americans. “The South was well known to be unhealthy by both doctors and the local population,” Howard observes, and this fear was borne out as the fighting continued in 1780 and 1781 (p. 154). Although returns from Henry Clinton’s army showed a sick rate of 15 to 16 percent when the British captured Charleston in May 1780, this percentage doubled by the time Lord Cornwallis’s army triumphed at Camden three months later. Although Continentals fared better than redcoats, a lack of medical personnel and Congress’s decision to exempt the Carolinas and Georgia from the American medical establishment blunted the comparatively robust health of the American army. Fortunately, John Cochran took control of the Continental Army’s medical services in January 1781. Cochran, whom Howard describes as “the only successful director general of the War,” bolstered American military health care through effective leadership including delaying Congress’s orders that he close hospitals (p. 42). Rampant sickness in the ranks continued to plague the British army as it moved north to Virginia. By the time Cornwallis surrendered at Yorktown in October 1781, 38 percent of his army was sick or wounded.
The Fevered Fight concludes with a thoughtful assessment of the role of health in the Revolutionary War. Disease was considerably more deadly than muskets and bayonets; all told, sickness accounted for up to 80 percent of British war deaths. Poor health played a role in the failure of Arnold in Quebec and Cornwallis in the South, although how decisive it was is still open to debate. Somewhat disappointingly, Howard concludes that “one searches in vain for real and sustained systemic improvement” to either the British or US health care systems because of the Revolution (p. 202). Although the Americans adapted quickly to the demands of war, nearly all advances were forgotten once the army disbanded. For the British, the Revolution precipitated far less change than the Napoleonic Wars that followed. Nevertheless, smallpox epidemics and the politics of solutions proposed anticipated struggles with more recent pandemics.
Martin R. Howard does an exceptional job of collecting the varied scholarship on the medical history of the American Revolution and weaving it into a single, highly accessible volume. His attention to both the unique challenges of the eighteenth century and the implications for strategies and tactics are laudable. Howard’s interest in how health care experiences varied on the basis of nationality, race, and gender is particularly welcome.
As with any good book, we are left wanting more. Debates over women’s work as nurses deserves more attention as does the unique challenges that sexually transmitted infections posed. Similarly, a tantalizing reference to one Continental soldier’s “disorders of the mind” is left unexplored. Nevertheless, The Fevered Fight is an excellent introduction to Revolutionary health care and makes this volume necessary reading for anyone wanting to fully comprehend the War for American Independence.