In The Earl's Revelation, we briefly meet an army surgeon. We know more or less what they did, but goodness, how did they manage to do it so far away from proper equipment and assistance?
To be faithful to the medical world of 1817 requires a certain tolerance for the grim and the makeshift. Fortunately, readers tend to forgive a novelist when the finer points of a regimental hospital’s supply chain are not perfectly reconstructed. Still, the research itself is irresistible, especially when it concerns the men who stitched, sawed, purged, and bled their way through the aftermath of battle.
My first step was to understand what an army surgeon in 1817 would actually know. The field of military medicine was still shaped by late‑18th‑century theory. Sir John Pringle’s emphasis on sanitation, ventilation, and order in military hospitals, revolutionary in his day, remained foundational decades later. His work, written long before germ theory, nonetheless urged cleanliness to prevent contagion, and army surgeons continued to rely on these principles when treating the wounded.
The practical reality, however, was far more chaotic. Most military surgeons of the era had limited formal training. In the American Revolution, only about ten percent held medical degrees, and although standards improved slightly by the early 19th century, apprenticeship remained the dominant path into the profession. By 1817, a British or American army surgeon was still likely a young man with theoretical knowledge, a few years of practical experience, and a willingness to work under brutal conditions.
Treatment itself was a blend of battlefield improvisation and inherited medical doctrine. The first priority was triage, though the term itself was not yet used. Surgeons and their mates moved among the wounded, determining who could be saved and who required immediate amputation. Without anaesthesia, speed was essential. Amputations were performed with terrifying efficiency, often in under two minutes, using bone saws and knives that were cleaned more for practicality than sterility.
Beyond surgery, treatment followed the prevailing medical theories of the late 18th century. Physicians still leaned heavily on humoral ideas, bleeding, purging, and restrictive diets, to restore balance to the body. Even as thinkers like Boerhaave and Cullen challenged Galenic doctrine, their influence had not yet displaced older habits. Benjamin Rush’s aggressive “depleting regimen,” which included bleeding until fainting and vigorous purges, remained widely practised among military physicians trained in the late 18th century.
Institutionally, the British Army had begun to formalise its medical hierarchy. Matthew Kaufman’s study of the period describes a structured system of regimental surgeons, surgeon’s mates, and administrators overseeing hospitals and supplies. Figures like John Hunter and George Guthrie shaped surgical standards, emphasising anatomical knowledge and practical skill—an influence still felt in 1817.
What fascinates me most is how much of this world was built on determination rather than certainty. Surgeons worked without anaesthesia, without antisepsis, and without a clear understanding of infection. Yet they saved lives, many more than one might expect, through discipline, experience, and sheer endurance.
References
American Revolution Institute. (2022). Saving soldiers: Medical practice in the Revolutionary War. https://www.americanrevolutioninstitute.org/wp-content/uploads/2022/04/Saving-Soldiers-catalog.pdf
Geake, R. A. (2025). Plasters, purges, and potions: Eighteenth‑century medicine in the colonies through the Revolutionary War. https://www.smithscastle.org/the-cocumscussoc-review/2025/3/13/plasters-purges-and-potions-eighteenth-century-medicine-in-the-colonies-through-the-revolutionary-war-by-robert-a-geake
Kaufman, M. H. (2001). Surgeons at war: Medical arrangements for the treatment of the sick and wounded in the British Army during the late 18th and 19th centuries. Greenwood Press. Surgeons at War: Medical Arrangements for the Treatment of the Sick and Wounded in the British Army during the late 18th and 19th Centuries: Contributions in Military Studies Matthew Kaufman Praeger - Bloomsbury
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