- An Indissoluble UnionHow the American War for Independence Transformed Philadelphia's Medical Community and Created a Public Health Establishment
There is an indissoluble union between moral, political, and physical happiness; and if it be true, that elective and representative governments are most favourable to individual, as well as national prosperity, it follows of course, that they are the most favourable to animal life.—Benjamin Rush, "An Inquiry into the Cause of Animal Life"
As news spread through Philadelphia that Germantown was lost and that General Howe's army was on the march toward the revolutionary capital, thousands fled the city. Some wanted to get themselves safely within Patriot-held territory. Some simply feared another round of the pillaging that had become a common practice of both armies. Some, however, went to attach themselves to the Continental Army, and among these were a number of Philadelphia's medical men. When the war came, American forces harvested many of their best doctors and surgeons from Philadelphia, the richest intellectual soil in the nation. When they returned to the city at war's end, they came with a new [End Page 37] confidence and a new sense of purpose. Their experience, of trying to cure legions of sick and wounded, and of trying to bring sanitary order to the chaotic encampments, had provided them with years of intensive training that no hospital could match. But it also taught them how to think about their profession as one not merely concerned with the healing of individual bodies, but with promoting and preserving the health of entire populations. The medical men left wanting to save Philadelphians; they returned wanting to save Philadelphia.1
A number of works have treated the subject of medicine in the revolution, but few have engaged it as a political question. Most studies have focused on the mechanics of medical care. A few have explored the turbulent history of the medical department. Some physicians of the period have warranted biographical treatment, most notably the complicated and fascinating Benjamin Rush, the one true medical celebrity from the period.2 Historians have emphasized how medical men affected military operations, and in some cases, how wartime experience changed medical practice. My interest is in how the war affected the medical men not as caregivers, but as political actors.3
The war changed the medical men in four key respects: First, it plunged them into hands-on medical practice, granting them a depth of knowledge they simply did not possess before the ordeal. Second, it endowed them with the prestige associated with revolutionary service and made their names known to the thousands of men they treated. Third, it put them in conversation with generals and civilian leaders, allowing them to develop the political alliances and acumen that would serve them in their later careers. Last and most important, it taught them to think in terms of populations. Because their greatest task was not the treatment of wounds but the maintenance of health, the medical men habituated themselves to thinking about how environmental and social vectors spread illness. Moreover, they grew accustomed to having their advice noted, if not always heeded, and sometimes to having it enforced through military discipline. All of these factors contributed to constituting the early national medical community in Philadelphia as a politically active force.
The Medical Community of Colonial Philadelphia
Philadelphia was the nation's medical capital in 1776, but the city's medical community before the revolution was also something of a ramshackle, piecemeal assemblage. In this, it was a reflection of the broader medical community [End Page 38] of the Anglo-American Atlantic. The elites of that coterie were physicians, who occupied the highest social ranks and were the most likely to boast university degrees. Surgeons and apothecaries, by contrast were viewed as more akin to trades than professions, learned by apprenticeship rather than education. Such distinctions were less pronounced in the colonies than in Britain and continental Europe, but they were begin to emerge, especially in major cities like Philadelphia, which became home to a medical school in 1765. While many of the city's surgeons and doctors bore no formal credentials, a new...