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June 1, 1813, 25 miles off the coast of Boston, Mass. Surgeon Richard C. Edgar and Surgeon’s Mate John Dix had more than their share of patients to attend to in the cramped, dimly-lit cockpit hidden in the depths of USS Chesapeake. Out of the ship’s 379 crewmembers, 85 were wounded and 61 were killed outright or died soon after the 15-minute melee with HMS Shannon. In what may be termed as a "master class" of early nineteenth century war medicine, Drs. Edgar and Dix dressed wounds, applied tourniquets, sawed off limbs and cauterized stumps with “hot pitch.” Their most notable patient that day, Capt. James Lawrence, suffered from musket wounds to the right leg and intestines. His leg could be amputated, and he could be given laudanum for his pain, but the intestinal wound was fatal. In his anguished state, Lawrence is said to have cried out to his doctors to “keep the guns going” and, repeatedly, “Don’t give up the ship!” Lawrence would linger another three days before succumbing to his injuries. His final words, first spoken to Drs. Edgar and Dix, would survive to this day as a motto of the U.S. Navy.
During the War of 1812 (1812-1814) the Navy Medical Department was in its true infancy. Even without warfare, saving lives in the early nineteenth century was goal few could meet. When war began on June 18, 1812, medicine was still in its “heroic age”—there were no antibiotics, no anesthesia, no knowledge of germ theory, no professional nurses, no triage, no treatment of mental illness, very little clinical training available at American medical schools, and dental care existed only in a very crude form. Navy Surgeons and Surgeon’s Mates practiced their “healing craft” with ample supply of antiquated knowledge and almost sheer will.
Bloodletting, blistering, and purging were still in common practice. Shipboard medical kits contained the usual assortment of anodynes, antiarthritics, astringents, cathartics, emetics, diaphoretics, diuretics, rubefacients, stimulants and tonics—some of which was perfectly equipped to induce a host of iatrogenic disorders. Calomel (mercury chloride) and jalap (a poisonous root) were commonly used to stimulate the intestinal tract and rid intestinal irritation. Peruvian bark (later known as quinine) was used in the treatment of malaria and other malignant fevers. Potassium acetate was used to increase secretion and flow of urine. Opium and laudanum were used to relieve pain and induce sleep. Teas and tonics were commonly used to settle digestive complaints.
The expansion of the Navy during the War of 1812 was accompanied by an increase in the number of medical officers. During the war, Navy medical personnel (numbering 26 surgeon’s and 26 surgeon’s mates in 1812 and 44 surgeons and 47 surgeon’s mates by the end of the war) served aboard the full spectrum of warship—frigates, sloops-of-war, schooners, brigs, and gunboats. An Act of 1813, which provided for construction of new ships, allowed a surgeon and three surgeon’s mates to care for each of the four ships of 74 guns.
Back on shore, Navy medical personnel also served ashore at Marine hospitals (equivalent to Public Health Service hospitals), Navy medical hospitals, and Navy and Marine Corps Rendezvous (equivalent to recruiting stations). Permanent Navy hospitals were still over a decade away; all Navy hospitals at the time were makeshift and temporary facilities located on or near Navy yards in Brooklyn, N.Y., Charleston, S.C., Erie, Penn., New Castle, Del., New Orleans, La., Newport, R.I., Norfolk, Va., Philadelphia, Penn., Portland, Maine, Sacket’s Harbor, N.Y, Savannah, St. Mary’s and Sunbury, Ga., Washington, DC, and Wilmington, N.C.
For our Navy physicians in the War of 1812, operational medicine meant repairing damage caused by cannon balls, grape shot and musket fire as well as attending to those suffering from the shipboard occupational injuries and diseases of the day. The medical trade called for amputation, application of tourniquets, bandaging removing splinters, and cleaning wounds (i.e., removing musket balls, metal and wood from open wounds). Location of the wound was key—there was nothing a Navy surgeon could do for injuries to the abdomen and thoracic cavity other than administer opium for pain relief. Most surgeries were performed under lantern light in ship cockpits (or junior officer’s quarters) located in the depths of the orlop deck. Ambulatory patients were allowed to return to shipboard duties or given menial tasks. Those needing more time to recuperate rested in their hammocks located in the berth decks (directly below the gun deck!) as the ever-malodorous smells of dry rot, dead rat and bilge water wafted through the compartments. Patients requiring continued medical care were kept shipboard until they could be transferred to the nearest Marine or Navy hospital.
Early in the War of 1812, the Navy enjoyed great success. In a battle 750 miles east of Boston, USS Constitution knocked the HMS Guerriere helpless in little over two hours (August 1812). In October 1812, USS United States under command of Stephen Decatur captured HMS Macedonian and USS Wasp captured HMS Frolic. The Constitution again proved victor when it rendered the HMS Java a useless hunk in December 1812. And in February 1813, USS Hornet sank USS Peacock.
By spring 1813, the tide in the War of 1812 had turned. From the spring of 1813 to the spring of 1814, England exercised general control at sea and instituted a strong blockade of the American coast. The blockade smothered U.S. naval and privateering activities at their sources.
Captain Lawrence of the Chesapeake, with an untrained, inexperienced crew rashly accepted a challenge from the captain of HMS Shannon and sailed from Boston to defeat in June 1813. The loss of the Chesapeake was followed by the loss of the brig Argus in August 1814. After clearing British privateers from the South Pacific, USS Essex was destroyed by HMS Phoebe and HMS Cherub while seeking refuge in the three-mile limit of Chile (March 28, 1814).
From the perspective of 21st century military medical care it is easy to look back and marvel how anyone—patient and medical practitioner alike—survived disease and injury in the War of 1812. If the ailment did not kill you the “heroic” measures of doctors possibly could. Navy Medicine has come a long way in 200 years. Injured Sailors and Marines who would have been deemed hopeless causes are now being saved on a regular basis through the advances in wound management and internal hemorrhage control. The frontline medical care and rapid evacuation to higher echelon medical facilities have made every bit the difference between life and death in the wars in Afghanistan and Iraq. Loss of limb in combat is nothing new; but with the advances in prosthetic research and design, artificial limbs have becomes less so for amputees. And like never before, military members with traumatic brain injury and post-traumatic stress disorder are receiving the medical attention they deserve. If present-day science had been available to the early Navy physicians Capt. Lawrence may have survived martyrdom and his impassioned plea would have been forgotten long ago.