American History Hit: "How to Survive the Revolutionary War"

Host: Don Wildman
Guest: Dr. Sanders Marble, Senior Historian, Army Medical Department Center of History and Heritage
Date: August 25, 2025

Episode Overview

This episode plunges listeners into the grim realities faced by soldiers—and the medical practitioners who tried to save them—during the American Revolutionary War. Host Don Wildman speaks with Dr. Sanders Marble, an expert on military medical history, to explore the limited understanding of medicine and surgery at the time, the prevalence of wounds and disease, the creation of the Continental Army’s medical system, and the lasting lessons that reverberate into modern care.

Key Discussion Points & Insights

1. The Unimaginable Hardship of Revolutionary Warfare

• The show opens with a vivid, immersive scene: a wounded soldier is carried into an Eastchester, NY field hospital, where the stench and chaos replace sanctuary with suffering (02:08).
  • “The stench in the room hits like a cannonball to the throat... This is no sanctuary. It's more like a barn...” — Don Wildman [02:43]
• Don sets the theme: in the 1770s, medicine is primitive, and survival as much a matter of luck as military valor.

2. Typical Injuries and Surgical Realities

• Common Wounds & Treatments:
  • Gunshot wounds by low-velocity, large musket balls were prevalent, causing distinct bone and tissue damage. (05:07)
  • Surgeons’ “toolkits” lacked tourniquets and pressure bandages; their primary frontline decision was whether a patient was bleeding. (05:56)
  • Blunt force trauma, stabbing, and even crush injuries from accidents were common (12:24).
• Surgical Skill & Training:
  • Surgeons were rarely highly skilled, as most doctors avoided surgery—due to deadly post-operative infections (06:03).
  • Training was predominantly through apprenticeships, sometimes doubling in length for those who hadn’t attended college: “See one, do one. Congratulations, you're a doctor.” — Dr. Marble [06:44]

3. Understanding (and Misunderstanding) Infection

• Miasma Theory Over Germs:
  • Disease was thought to spread through “miasmas” (bad air), not contagion as we define it, although empirical observations hinted otherwise. (07:37)
  • "They don't think of mosquitoes, they don't think of germs because the germs are microscopic and they don't have the tools to see that." — Dr. Marble [08:03]
• Field Hygiene:
  • Surgeons did notice makeshift environmental causes: “They know that if your latrines are near your kitchen and both... near your sleeping tents, more guys get sick.” — Dr. Marble [08:56]

4. Absence of Anesthesia and Speed as Strategy

• Anesthesia was decades away; patients might down rum or chew leather to endure the pain (09:58).
• “The trick to effective surgery is fast surgery. The fastest surgeons at the time could have a leg off in under 10 seconds.” — Dr. Marble [10:34]
  • Don, aghast: “Wow. Really?” [10:44]
  • “If I have to have an amputation, I don't want it that fast. But that was what worked then.” — Dr. Marble [10:45]

5. Surgical Procedures and Instruments

• Searches for musket balls involved probing wounds with unwashed metal rods and forceps, often moving infection between patients.
• Foreign bodies such as cloth or dirt were removed when found, but lack of sterilization made infection likely. (11:32-12:24)

6. Broader Medical Organization and Leadership

• The Continental Army almost immediately establishes a medical department—within six weeks of its creation, July 1775 (16:09-16:24).
  • Driven by logistics: “The medical department... is as much to let the rest of the army work smoothly... as it is to take better care of the soldiers.” — Dr. Marble [15:35]
• Elite, university-trained physicians often held high positions, but outcome differences were negligible given medical limitations.
  • “The guys at the top are the best trained on paper... Again, this is not affecting their patients outcomes, but they are well trained.” — Dr. Marble [18:41]
• Anecdote: Dr. Benjamin Church, the army’s first head surgeon, was exposed as a double agent and disappeared at sea (17:09).

7. Rampant Disease: Smallpox, Malaria, and Others

• Smallpox devastated troops, especially early in the war and in specific campaigns (Quebec 1775-76).
  • “Smallpox had a death rate between 3% fatality and 30% fatality rate, whereas in a the inoculation death rate was 1% or less.” — Dr. Marble [23:47]
• Washington’s bold order: inoculate the army, sometimes against laws and popular opinion.
  • “Washington... ignored local laws and in some cases state law about not inoculating.” — Dr. Marble [24:24]
• British soldiers, from denser cities, were generally more disease-hardened, except for “new world” illnesses like malaria (24:53).

8. Treating (or Not) Wounds and Preventing Gangrene

• Surgeons would sometimes reoperate if gangrene developed, but amputation was the main (albeit desperate) “cure.” (26:28)
• Common treatments for illness—bloodletting, purging—did more harm than good in most cases.

9. Medical Logistics: Supplies, Staff, and Congressional Involvement

• Severe shortage of both personnel (few formally trained doctors, no nurses or vets) and supplies, worsened by inflation and British blockades (27:17-28:17).
• Surgeons resorted to asking locals for supplies: "They are going out and trying to find bushes and leaves and roots that they can use as medicine." — Dr. Marble [28:17].

10. The Cost to Medical Staff

• Doctors died at higher rates than combat officers due to constant exposure to disease (28:47).
• Their efforts, while sometimes futile therapeutically, were demonstrably patriotic.

11. Legacies and Lessons for Modern Medicine

• The Revolutionary War taught more about disease prevention (basic hygiene, camp layouts) than about treatment (30:08).
• After the war, the army and its medical system were quickly disbanded, only to be rebuilt from scratch with each new conflict, leading to a “reset” culture up through the Civil War.
  • “We kind of have that idea [of sequential care] in civilian medicine, but that largely comes out of the military.” — Dr. Marble [32:03]

Notable Quotes & Memorable Moments

• On the speed (and horror) of amputations without anesthesia:

  • “The fastest surgeons at the time could have a leg off in under 10 seconds.” — Dr. Marble [10:34]

• The surgeons’ necessary but gruesome improvisation:

  • “They would then tweezer out the ball and ideally any clods of dirt, any pieces of fabric... and then they would reuse these same tools unwashed on the next patient.” — Dr. Marble [11:45]

• On smallpox and vaccination:

  • “He [Washington] says it's now a 5149 proposition and I will order inoculation of troops. Vaccination is the modern term. It's actually introduced about 20 years after the Revolutionary War. And smallpox is the only disease they can do this for.” — Dr. Marble [23:35]

• On the constitutional, almost improvisational approach to military medicine:

  • “All the things that went into supporting [the army] certainly all went away with it every time a war stopped. And then we had to find our way back to those systems when it was necessary.” — Don Wildman [30:56]

Timestamps for Important Segments

• Field Hospital Immersion Scene: [02:08–03:39]
• Types of Injuries & Medical Skill: [05:07–06:44]
• Understanding Infection (Miasmas): [07:37–09:24]
• Absence of Anesthesia & Speed Surgery: [09:58–10:45]
• Surgical Tools and Techniques: [11:32–12:24]
• Formation of Medical Services: [14:55–16:24]
• Leadership and Notable Doctors: [17:09–20:07]
• Smallpox Scourge & Inoculation: [22:09–24:24]
• British vs. American Disease Exposure: [24:53–25:54]
• Medical Supply Shortages and Organization: [27:17–28:17]
• Doctors’ High Death Rate: [28:47–29:35]
• Impact on Medical Organization Post-War: [30:08–32:16]

Further Resources

• Army Medical Department Center of History and Heritage:
  achh.army.mil
  (As recommended by Dr. Marble [32:30])

Tone and Conclusion

Candid, visceral, and occasionally darkly wry, this episode brings home the realities of combat and medical care far removed from modern expectations. The speakers’ respect for their subjects is clear, but so is their awareness of the sometimes shambolic, desperate improvisation that characterized Revolutionary War medicine. For anyone wishing to understand what it took to survive (or not) as a soldier—or a surgeon—of the Revolution, this episode is an unflinching window into history’s battlefields.