Due to the exclusion of women in medical schools and societies in Revolutionary America, occupations in healthcare for women were limited in titles. Men held positions of surgeons, physicians, and apothecaries, and were the only candidates for recruitment into the high ranks of the medical department of the army. However, women found multiple ways to practice their medical skills despite their lack of educational privilege and recognition as medical authorities.
Nurses
Serving the Revolutionary causes alongside Washington’s soldiers were the unsung heroes: the army nurses. Although the fledgling “nurse corps” was based off the respected model of the British military, most of the nurses and matrons hired into the medical department were wives of the soldiers. These caregivers were untrained and inexperienced but fueled by their commitment to the cause and the small pay that came with it. With a ratio of one nurse to every ten sick, military work gave women valuable experience and credibility that they could transfer to their medical pursuits outside of the military.
As the war waged on through winter in northern regions, casualties from illness and injury increased. The terrible hospital conditions at Valley Forge in the winter of 1776-1777 prompted General Wayne to declare that he would rather fight the British under worse odds than have to inspect camp hospitals. Smallpox, typhus, dysentery, typhoid, malaria, scurvy, scabies, pneumonia, and venereal disease kept thousands of soldiers and a great number of entire troops in treatment. When military hospitals were full or out of supplies, sick or injured soldiers were transferred to nearby holding locations, makeshift hospitals, or private homes of families who supported the war effort.
Although not considered nurses, patriotic ladies were urged to supply rags and bandages for the failing medical department of the Revolutionary War. In the absence of nurses, sick soldiers received sugar, tea, and beds from concerned women who noticed the inefficient conditions of the army’s ill. The one success that the medical department could pride itself on was its success in inoculation. While the typical prevalence of smallpox in a European army might be around 16%, Washington’s inoculated army experienced less than 1% of soldiers contracting the disease. Inoculation season was in the early spring, so as inoculated soldiers recovered from the procedure in the following months, nurses attended to them. Dr. William Shippen, Jr., a prominent Philadelphia physician who took over command of the military medical department in 1777, supervised the protocol, which consisted of the inoculation itself, a diet of rice and corn meal, doses of niter, calomel, and several cathartics, and the cleansing of soldiers’ uniforms by washing and smoking them. The inoculation effort was also successful because of the generosity of women in homes nearby the army camp. To prevent the inoculated soldiers from exposure to smallpox before their immunity set in, women took in the men to their homes for nursing in exchange for the protection of army guards while the soldiers remained there.
Working alongside army physicians gave nurses great opportunities to network. The nurses gained legitimacy and authority by word of the army physicians. Some nurses, such as Mrs. Adams, the matron of Yellow Springs Hospital, and Mary Watters, an Irish immigrant, took special care to counter the ingrained stereotypes of hired nurses as drunkards, tramps, and thieves. Mrs. Adams was praised for her organizational skills and decorum, and was especially noticed as a gentlewoman by an army chaplain who invited her to tea in 1778. The sociable relationships Mary Watters and Mrs. Adams developed with respected army physicians helped them to establish practice as a nurse, doctress, and apothecary after the war.
Despite Mary Watters’ impressive experience and gentle disposition as a nurse, Dr. Benjamin Rush noted in his letterbook that Watters always acquired the name of the physician her patients normally consulted before she paid the patient a visit. “Upon being complemented” by the patient, Watters replied, “Indeed Madam I know nothing but what I learned from _______ (mentioning the name of the physician who tended her) in the military hospitals.” Dr. Rush interpreted Watters’ actions as an act of deference, but based on Watters’ spunk and prudence, it is clear that she was playing an intelligent game. While gaining the physicians’ approval, she also put forth her own experience and authority as a wartime nurse. Her shrewd entrepreneurship led her to such great success as a doctress and apothecary that she was able to set her son up in the publishing industry, which effectively increased her own advertising and gave her son a good career.
Midwives
In the eighteenth century, a shift from exclusively female midwives to both male and female midwives began. Although men interjected themselves into this traditionally female role for the purpose of gaining more medical authority , they tended to serve as a consultant for the female midwife who actually performed the deliveries.
Publications such as Treatise on the Theory and Practice of a Midwifery (1752) by Dr. William Smellie gave literate women and male medical students and apprentices access to his expertise and discoveries in the field. Midwifery had traditionally been grouped in the realm of religion, but studies and publications of more natural, physiologically healthier birthing practices began the shift of obstetrics from religion to science.
The introduction of the forceps, a medical tool used to help deliver the baby once its head descended into the pelvis, shifted the profession to the medical community as untrained midwives did not have access or authority to use such scientific tools. Male midwives had the ability and education to intervene in dire circumstances to save the mother or the baby and the mother in childbirth, but traditional female midwives were still hired by the majority of patients due to cost and availability.
Many women held childbirth as a sacred event to be shared between women as a mother is at her most vulnerable and raw state when giving birth. American midwifery was unique in the fact that whichever midwife was available at the time of need was the one who got the job, and gender politics were not a major barrier to helping a patient. Female midwives certainly learned more skills and newer practices from the men who had the privilege to study obstetrics in formal schools, but women dominated obstetric knowledge long before men due to tradition and centuries of experience.
Medical Entrepreneurs and Apothecaries
Due to the freedoms of an unregulated consumer market, wartime demand, and math- and science-based business education many women received in Quaker schools, women were able to mobilize their knowledge of healthcare into an economic asset during the Revolutionary War. By assuming the roles of doctresses, nurses, and apothecaries, women began to legitimize their place in the field of healthcare.
The lack of regulation in the market and by licensure to practice in the colonies gave way for women to step up to roles they would not normally hold in European societies or under the traditional Christian structure. Medical authority and legitimacy was dependent on a female healer’s ability to convince medical consumers that her advice and practices were safe, effective, and economical. Family history in healing and word of mouth were a woman’s best claims to legitimacy, which would open doors for her to treat more and more patients.
“There is not a dose of physic to be got in this town without coming to me for it. . . I feel quite alert at the thoughts of doing something that may set me a little step above absolute dependence.”
Margaret Hill Morris to Hannah Hill Moore, February 5, 1778, and MHM to Dr. Samuel Preston Moore, February 1, 1779
Varying social classes of women took action as medical entrepreneurs. Forms of service with low overhead costs ranged from provisions of medical services based on credit, to provisions based on cash payment, to selling home-processed herbs and pharmaceuticals. The other end of the spectrum, which demanded high overhead costs, included owning structured businesses like apothecary shops that required start-up funds, capital investment, operating budgets, and credit lines with European drug manufacturers. Women with modest financial assets, including free and unfree African Americans and Native Americans, participated as entrepreneurs mainly in the former types of enterprises. Herbs grown in a garden and cooking equipment commonly found in the home gave these women almost all they needed to elevate their medical knowledge into an economic asset. Elite Euro-American women who had the funds to pay high overhead costs or who had inherited a business from male kin were more often proprietors of formal shops and medical enterprises.
Many women found paid medical occupations to be a natural next step for them when they needed to earn money. A woman’s expertise in gardening, food preparation, distilling, dyeing, and familial healthcare intertwined with the art of healing in a way that many women simply had to gain legitimacy in order to have a visible presence as a respected healthcare provider. The domestic roots of healthcare have concealed woman’s contribution to healthcare in the labor force. However, despite the limited documentation of such contributions classified with man’s achievements in medicine, these women went beyond the domestic sphere and into the economy to set themselves up for success. It is the women’s healing work and their knowledge of herbs and pharmaceuticals that war-torn communities did not fall to the influx of disease, shortage of physicians, and scarcity of medical supplies.
Femina Medicus: Women in Medicine During the Revolutionary War 