More gruesome than the injuries of battle were the means of mending them: field medicine offered no anesthesia, no modern antiseptics, and no antibiotics. David Podolfino interprets the life and duties of the military surgeon.
Harmony Hunter: Hey, welcome to the podcast. I’m Harmony Hunter.
Fighting a war is a gruesome business, and surviving a wound sustained in the field can be made doubly challenging by the conditions soldier and surgeon find themselves working in.
David Pondolfino joins us today to talk about military medicine and the science of saving soldiers from their injuries in the field. David, thank you for being here today.
David Pondolfino: You’re welcome. This is nice to be here.
Harmony: Just by way of introduction, you are staffing the military encampment which is in place in the summer weeks and you are interpreting military medicine; field medicine. Tell me about that interpretation that you do. What you’re trying to lay out for folks.
David: Generally I have my instruments out on the table and I have, I try to provide an assortment of instruments that a man in practice in this time would or might have had. Some of those include instruments that are sort of makeshift simply because as we may know anyway most of the really made things came from England anyway and certainly surgical instruments did. So once the Revolution starts, you can’t get anything from England so you’ve got to find things to substitute sometimes: knives and saws and various others. The things that are made out of very fine steel are very hard to get.
Harmony: And you’re interpreting the character, the person of a military surgeon?
David: Well, yes. I’m doing a man who is serving as a regimental surgeon. Every regiment has to have its own surgeon. The surgeon then has the task of picking two surgeon’s mates from among the enlisted men of the regiment and then he teaches them -- sort of in an apprentice system manner -- their duties which are basically going to be doing routine visits and treatments and things that the surgeon really can delegate to somebody else on a regular basis. And he has to have an assistant with surgery. Surgeries, by the way, are done as rapidly as possible because there is no anesthesia.
Harmony: You mentioned some of the routine procedures that a surgeon might see. What are some of the routine injuries or things that we might see?
David: Well, every morning at reveille, the men have to present themselves for roll call. Any men who are sick or injured or in any way incapacitated, they report sick on roll call and they remain in the tent and then the surgeon or one of the mates has to go around and see each one of these men who’ve reported sick and they determine whether the man is actually fit for duty or not. And so that’s one of the routine things that gets done every day.
The role of the surgeon in the regiment is he is technically an officer, although he doesn’t have a field command. Most surgeons are paid as a Major and he has absolute control over the medical department so he’s a member of the Colonel’s staff and if you’re a patient of his he outranks you no matter what your rank is, and that’s regulation so in other words he can give the Colonel orders.
Harmony: So doctor’s orders are really doctor’s orders.
David: So it’s a heavy responsibility and the surgeon’s mates carry that as well. When they make a determination the surgeon then backs them up and that’s it. In other words you declare a man’s unfit, he’s unfit.
Harmony: So I’m understanding, as you’re talking, that the job of a surgeon is probably only half dealing with injuries, but the other half might be fighting disease in the camp?
David: Oh actually 80% of what a surgeon is doing is treating diseases in the camp.
Harmony: Which could kill as many men or more as actual combat injuries?
David: Actually two men died of diseases in the camp for every one on the field.
Harmony: What are the primary diseases?
Harmony: So in the 18th century camp, then, what are the diseases that men are suffering from?
David: In the average Continental Army regiment most of the men come from the countryside. You’re going to see, and this by the way goes to the Civil War as well, you see things like measles, mumps. Measles and mumps carry with them extremely high fevers. Fevers are very hard to deal with when you’re not able to give the person adequate fluids. And in an adult, measles, particularly, you might as well have smallpox.
Harmony: It’s that deadly?
David: Yes. They die in droves from measles. Mumps is very similar because of the high fever and mumps also carries other debilitating things along with it in adults. All these diseases, that we think of as childhood diseases, so if you get this as an adult, it’s dangerous.
Harmony: People forget, most of these diseases are forgotten. Now we vaccinate against them, but they’re deadly epidemics and terrible suffering.
David: Of course. Well that’s the reason we vaccinate against them.
Harmony: You mentioned the other half of what you do, or the other 20% to be more accurate, involves some of those tools?
David: Is would treatment.
Harmony: Tell me about what are some of those tools that you lay out on the table; some of those wounds that you’ve been treating.
David: Well the setâ€¦a good portion of the set that’s on the table there’s a few dental tools, there are a few general tools, instruments, there are a few general instruments. The rest of the set is for amputations.
Harmony: And that’s one of the most common procedures that the surgeon would find himself performing?
David: After a battle, with bullet wounds, yes, that would probably be something that wouldâ€¦you doâ€¦let me put it this way, you would do far more amputations in the Army than you would do in a civilian practice ever.
And the reason for that is the nature of the wounds that you’re getting. The muskets fire a lead ball, its 70 caliber, that’s almost Â¾”. It’s heavy, it’s made of lead and its intended to debilitate. It’s intended to do tremendous damage when it strikes and it does.
For one thing, ball tends to flatten when it strikes because it’s heavy lead and they travel at a fairly, what we think of nowadays, as a fairly low speed so that when it strikes you it’s like being struck. I mean it’s like being punched. The wound of entry will be the size of the ball. The wound of exit will be considerably larger if it continues through just through tissue, not bone.
David: if it only goes through tissue, then you’re lucky because chances are we can dress that and that will heal. If it strikes a bone in your arm or your leg, it will shatter the bone. If you had an x-ray in the 18th century what you would see, you would see a gap in the bone about an inch wide with little pieces of bone, little pieces of lead and little bits of tissue in there.
Harmony: It really shows you what these men suffered. It really kind of makes real the suffering of war when you think about the injuries and then the treatments. Think of an amputation in the field with no anesthesia, no antibiotics to follow up afterwards.
David: Oh, no.
Harmony: So the rate of healing must have been all over the place?
David: If you were young and strong and basically healthy, you had a pretty good chance to survive an amputation. It depended much more on where the amputation was done on your arm or leg. The farther down your arm or leg we have to amputate the better chance that you have to survive it.
Harmony: Well it’s a terrible subject, but a fascinating subject. If people walk by the encampment they’ll see a real crowd around your tent and people clambering to listen to this area of history which is fascinating and pathetic at the same time to think about the options that were available to these men who gave their lives and their livelihoods for it. So we have to remember that service and it really gives us new appreciation for what daily life was like for them.
David: One of things I try to include when I’m interpreting in the camp and that is that in all my experience in practice and my reading one of the guiding principles that I’ve always used when I interpret is, medical training is not easy at the best of times. In practicing medicine or any other medical field practice is a very tough thing to do particularly when you’re trying very hard to do it right. I don’t think I have ever known anyone in the practice who did not get into it with the idea that they’re there to help people and I believe that these people 200 years ago did the same thing. I don’t think anyoneâ€¦you couldn’t devote seven years of your life to study if you weren’t doing this to help people and I think we have to remember that when we look back at some of the things that they did and some of the mistakes that they made largely due to ignorance and be respectful.
Harmony: What a great topic you’ve shared with us today. Thank you so much for coming by and giving us insight into this area of the past and I hope folks come by and see the military encampment and visit you out there in the Historic Area and learn a little bit more. Thank you so much for being our guest today.
David: Thank you.