Revolutionary Surgeons: Patriots and Loyalists on the Cutting Edge, with Dr. Per-Olof Hasselgren (episode 237)

Sponsored by Liberty & Co.

This week’s podcast is sponsored by Liberty & Co, who sell unique products inspired by the American Revolution. Their most recent offering is a selection of historic documents printed by the print shop of Edes & Gill that operates out of Faneuil Hall. 

Printer Gary Gregory adopted the name of the 18th century print shop that published the Boston Gazette, a notorious Whig paper that helped fan the flames of Revolution.  Gary uses a reproduction of a wooden English Common Press that was made in Colonial Williamsburg to print faithful reproductions of historic documents using authentic materials, equipment, and methods.  Among the prints available from Liberty & Co is a reproduction of Thomas Paine’s American Crisis, the legendary pamphlet that helped Washington inspire his soldiers to stick out the times that try men’s souls at Valley Forge.

You could also select a magnificent copy of the Declaration of Independence, carefully reproduced from the Dunlap Broadside, which was the very first printed version of the Declaration, with the first pressing struck in Philadelphia on July 4, 1776.  The Edes & Gill copy is printed at 3/4 scale, to be more convenient to frame and display in your home than a full 18th century broadsheet.

Save 20% on any purchase with the discount code HUBHISTORY.

Transcript

Music

Jake:
[0:04] Welcome to hub history where we go far beyond the freedom trail to share our favorite stories from the history of boston, the hub of the universe.
This is episode 2, 37 Revolutionary surgeons with Dr Per-Olof Hasselgren Hi, I’m jake in.
Just a few moments are going to be joined by Dr Per-Olof Hasselgren A practicing surgeon and author of the recent book Revolutionary surgeons, patriots and loyalists on the cutting edge.
The book’s a profile of 11 surgeons on both sides of the Revolutionary War.
Dr Hasselgren and I discussed the boston patriots, Brothers and Brothers in Arms, joseph and john Warren,
joseph is famous for arranging the lantern signal from old North Church and dispatching paul revere on his famous ride as well as for his heroic death at bunker hill.

[0:56] His little brother john followed him into politics and into the Continental Army before founding Harvard Medical School in the waning years of the revolution.
Per-Olof brings a unique perspective to our conversation examining the medical careers, these eminent physicians, to a physician’s eyes.
We’ll talk about how 18th century physicians learned their craft, how they earned a living and how they intermingled medicine in politics.
We also discussed how surgery was changing during the revolutionary era and the groundbreaking surgery pioneered by john Warren and by his son john Collins Warren but before we talk about the Warren Brothers and medicine during the revolution.
It’s time for a word from the sponsor of this week’s podcast, Liberty and co sells unique products inspired by the american revolution and many of them have themes tied to the historical events, locations and people of boston’s past.
One of their specialties is a range of beautiful prints, many of which are made using historical methods right here in boston by the historical print shop.
Edes and gill that operates out of Faneuil Hall Printer.
Gary. Gregory adopted the name of the 18th century print shop that published the Boston Gazette, a notorious wig paper that printed joseph Warren’s essay, a true patriot that helped fan the flames of revolution and nearly got war and locked up.

[2:18] Gary uses a reproduction of a wooden english common press that was made in colonial Williamsburg to print faithful reproductions of historic documents using authentic materials, equipment and methods.
Among the prince available from Liberty and Co. Is a reproduction of thomas Paine’s american Crisis.
The legendary pamphlet that helped George Washington inspires soldiers to stick out the cold winter at Valley forge with the opening challenge.
These are the times that try men’s souls. The summer soldier and the sunshine patriot will in this crisis shrink from the service of their country.
But he who stands it now deserves the love and thanks of man and woman tyranny like hell is not easily conquered yet we have this consolation with us that the harder the conflict, the more glorious, the triumph.

[3:10] You can also select a magnificent copy of the Declaration of Independence, carefully reproduced from the Dunlap broadside, which was the very first printed version of the Declaration,
With the first pressing struck in Philadelphia on the evening of July 4, 1776.
The edes and gill copy is printed at three quarter scale to be more convenient to frame and display in your home than a full 18th century broadsheet,
Liberty and Co also offers beautiful reproductions of paul revere’s engraving of the british troops landing at Long Wharf to begin the occupation of boston And a carefully rendered 1775 British military map of Boston created during the Siege.
You can get 20% off of any order and help support the show when you shop at liberty and dot ceo and use discount code hub history.
You check out that’s L I B E R T Y A N D dot C O and use the discount code hub history.

[4:08] I’m joined now by dr Per-Olof Hasselgren author of the new book revolutionary surgeons, patriots and loyalists on the cutting edge.
He’s a practicing surgeon at Beth Israel and he has an endowed chair at Harvard Medical School.
He also has a long standing interest in surgical and american history.
As you hear his charming accent. You may be tempted to think that dr Hasselgren is an unlikely scholar of the american revolution, But his extensive knowledge of 18th century surgical history, argues otherwise.
Per-Olof Welcome to the show. So I’ve invited you here today to discuss your book Revolutionary surgeons, patriots and loyalists on the cutting edge, which is,
Basically composed of profiles of 10 surgeons who are active in the American Revolution.
What were your goals? What were you hoping to achieve with this book?

Per-Olof:
[4:57] Well maybe first to satisfy my own curiosity when I sort of discovered how important surgeons had been during the american revolution, I got even more interested.
I come from another country. I come from Sweden originally and we don’t learn much about american history in Sweden.
Like you guys may not learn that much about european history. We do obviously And then I am a surgeon since 45 years and have been interesting historical history for many for many years.
And then when I came to this country was became interested in the american history and when I understood they emerged so to speak, I got even more that piqued my interest and that’s what generating my reading a lot about this.
And I realized that not much was written about american about surgeons during the american revolution.
I mean there are a lot of books about surgeons in the civil war, in the world wars etcetera etcetera. But relatively little information. A little few books, fewer books about surgeons in the american revolution. And so here we are.

Jake:
[6:01] What’s your surgical specialty?

Per-Olof:
[6:03] Switch protocol, endocrine surgery. So which means surgery of thyroid gland, parathyroid glands, adrenal gland, etcetera.

Jake:
[6:11] So how do you go from endocrine surgery to such an intense interest in the history of surgery and surgeons?

Per-Olof:
[6:20] Well, that’s not a natural leap from India insurgent specifically, but more from surgery as such.
And that sort of generated my uh my combine interest in the american revolution and the and the history of sorcery.

Jake:
[6:33] Mhm.

Per-Olof:
[6:37] Because there was not a lot of endocrine surgery specifically at the time of the american revolution that had not been sort of practice yet.

Jake:
[6:41] All right.
It sounds like there weren’t really surgical subspecialties at all during that era.

Per-Olof:
[6:49] That’s right. There was not even a subspecialty in terms of surgeon versus doctors in a sense, not a formal,
division of that, but so the surgeon was physician was interested in doing surgery, basically, and it was more common to have a mixed up of practice in those days, but,
some people got more into anatomy and dissection and surgery and and got that most of the time.
But I think there were only a few surgeons who did only surgery in their practices and obviously no surgeons still undergoing surgery at that time.

Jake:
[7:23] How many of the physicians in the book would have even had formal medical education?

Per-Olof:
[7:28] So the former medic medic education uh was done by doing apprenticeships and most of the all of them that are described in the book had had formal training in that sense.
A few lucky ones said, or wealthy parents or other means to get to europe for further training and then they could end up in Edinburgh. Finally, usually they went to London first for a couple of years and these were a practical cutting and surgery.
But there were no medical schools in London at that time. And the academic education of physicians and surgeons, it took place basically in Edinburgh.
And among these servants that I’ve described, probably four or five of them had MD degrees when they came back from, from England.

Jake:
[8:13] The revolutionary era was basically 70 years before anesthesia was first used here in Boston and closer to a century before antibiotics became widespread.
So what would surgery have looked like during the Revolutionary era?

Per-Olof:
[8:30] Well because a lack of anesthesia obviously certainly needed to be fast.
So common saying is that it was fast, dirty and dangerous.
And so the fast part of that statement reflects the fact that patients obviously suffered or under pain.
And so most likely outside any quoting the operating room there would be screams and hollers and kicking and so forth.
That would be perceived not only by people in the surrounding but by the patient obviously and most about this audience.
So that was probably one aspect or in the other aspect of the pain obviously was that,
patients did not allow themselves to be cut into unless they really had had dangerous,
or a painful condition such as a blood stone for example, or you know, gangrene of the legs that I understood they would die if they didn’t if they didn’t take the leg off.

[9:31] So the and the other aspect of your question I guess is related to the antibiotics.
And so antibiotics, as you pointed out, came around much later on when the concept of bacteria had been discovered and listed propagator for sterile conditions during operations.
So in those days in the 1700s, I think they were lucky if they had clean or sanitized conditions. And one of these surgeons are described in the book in a mirage from philadelphia.
He worked hard on getting cleanly nous into the concept of of surgical care and medical care, although he didn’t also understand obviously that there were bacteria on.
But he just just by intuition you understood that if your dirty fingers that shouldn’t be good.
And so that’s a great difference from nowadays, obviously.

Jake:
[10:21] Was surgery changing during the Revolutionary War, and there would have been an abundance of patients that seems like it may have accelerated change.

Per-Olof:
[10:29] Yes. So surgery was developing and evolving or do the during that time. And uh so the 18th century, the 1700s has been characterized as as the year or a century of uh surgeon and anatomist.
So the foundation obviously surgery was understanding anatomy And that became widespread during the 1700s.
And hence the surgeons in those days understood better and better what the body looked like.
They’d been religious and other reasons people hadn’t done dissections that much before Always is in itself.
Having said that it’s also an ancient thing, but but it sort of took off during the 1700s in particularly in Europe,
physicians interested in surgery start to understand what the body looked like and that in itself promoted development of the surgical techniques and surgical,
procedures that could be performed a little more safely than previously.

Jake:
[11:26] You’re careful to point out in the book that although it’s about 10 of our Revolutionary War era physicians, you’re careful to point out that not every physician or not every american surgeon was a patriot,
but the first couple of chapters are about some of our favorite local patriots.
If you don’t, if you don’t mind, I’d like to ask you a little bit about the warren family.
Starting with joseph Warren, who kicks off the book.
I like to think of joseph Warren almost as the ultimate patriot. He was the mastermind of Paul, Revere’s Ride the hero of bunker Hill.
You start his chapter with the description of his death at bunker Hill.
I know at one point when he was alive, General Warren said that he hoped to die knee deep in british blood. How close to the truth did he come?

Per-Olof:
[12:10] Yes. So he he understood that blood would be shed during a revolution or during a breaking away from the english empire.
And he, as you pointed out, I think I quoted that even that,
we will probably walk knee high in the blood,
if this happens and you know when he was on at bunker hill and Breed’s Hill that is read out up on the top and,
when the red coach finally broke through the defense lines, which took them three marches up the hill, as you, as you obviously know,
but when they finally broke through, I mean they were, they were brutal.
I mean they killed everything in their way and they were blood flowing in those readouts. And so he got his wish fulfilled, one can say literally.

Jake:
[12:59] And he was a very recognizable figure, an orator, a politician, so he would have been recognized by the red coats as they came up into the readout.

Per-Olof:
[13:07] Yes. So they recognized him also. They were delightful to see him there to be able to kill him. I mean he was hated.
There are description when he walked around the streets of boston before the war story and the red coats arrest him and,
and he didn’t let him alone because they understood it would be he already was and would become an important leader of any movement that would develop to break away from the motherland, so to speak.
And so the saying was that the death of him was worth 500 lives for the British and there may have been true and so he was well recognized and it was probably a target.
So I guess when he showed up there at one of those defense,
lines, I’m not sure if they knew he was up there when, when they started the battle, but when they discovered that and I think they knew who they were killing,
and they treat his body badly after these deaths.

Jake:
[14:07] Do you want to describe what was done to him?

Per-Olof:
[14:09] If you read different historians descriptions of it and and other original sources, I think it’s not completely known, but I think,
it’s fair to say that he obviously was killed by being shot a close range,
and then they they stuffed this scoundrel into one whole together with another dead um revolutionary warrior,
and then they came back after later on I think the same day even and took the dirt away from his body stamped on the stamped on me.
I mean they were stomping on his body and mutilated the body and chopped his head off,
and and then they threw him back into that hole in the ground and we’ll actually take one year before he was, the body was discovered or was found and that’s in itself.
It’s an interesting story. So when he had died at the battle of bunker Hill, he’s brought his younger brother john came down from Salem Marie was starting a sort of practice at that time and was looking for his brother.
And obviously john got scared when he couldn’t find him and he finally realized that he was probably killed.
Juicer was probably killed and to the great story of him and his family.
And then later on about a year later I think there was a search patrol, we’re trying to identify the grave where joseph Warren had been, had been buried.

[15:38] And they found this um body and the remnants of the body and the head more importantly perhaps.
And this is sometimes called as the first forensic work in terms of looking at a dead body in trying to determine the cause of death and so forth.
I mean like like an autopsy after murder for example.

[16:03] And so the revere was in the group of people looking for the grave and revere said, Aha, I can see that that is joseph’s head because he has this prosthesis that I made for him.
So he had me, he was as you know revere was paul revere is a silversmith.
So he had made a prosthesis in this in joseph’s upper jaw in that when he found that he said, I recognize that that’s what this is, joseph said, and or use of skull.

Jake:
[16:31] The brutality that the british treated him with kind of goes to show how hated he was for being such a leader. But when you look back on his early life, he seems like both an unlikely leader and really an unlikely surgeon.
How did joseph Warren go from a boyhood on a farm in rural Roxbury, too, Harvard and then on to be a doctor.

Per-Olof:
[16:55] Well obviously where you just described that is going through school.
I mean he went to Roxbury Latin school I think it was called and then he went to Harvard at the age of 14, which was seemed to have been a common age at that time when the story college,
and he became interested in in an army relatively ill and that’s what’s brought sorrow.
Spiked is interested in becoming a physician and ultimately surgeon.
And then after college, his further education or his further life, so to speak. Cause also interesting because then he so he was supported by the local people living in Roxbury at that time.
His he was a his father died and his mother was taking care of him and his brothers and was trying to run the farm. So they were not wealthy people.

[17:42] So the local people in Roxbury think supported him economically to go to college and they pay that back after the Harvard years by being a schoolteacher in Roxbury for about a year,
and then he pursued the medical interest by applying for and being accepted for apprenticeship with James Lloyd,
was one of the premier surgeons and physicians in boston at that time, he was sort of a society high society type of,
physician, but he took on joseph Warren and he had an apprenticeship of two years,
and then he got his c so therefore the that sort of goes back to the first question I asked how many were formally trained and had an education.
So the formal training as I said for joseph Warren and later on for john as well, was an apprenticeship, And the typical thing was that they were like maybe 3-5 years.
His first friendship was two years and and maybe because he was smart and a good student, or maybe because of economic restraints.
But then at the end of an apprenticeship, the master would issue a diploma confirming that this and that person has gone through the training and is not considered able to independently practice medicine.

Jake:
[19:00] Only about a year, not much more than a year after Dr Warren started his own practice,
There was a smallpox epidemic in Boston 1764, and I’ve talked about this epidemic pretty extensively in the past on the podcast, but always from patient’s perspective, usually using the lens of john Adams.
He wrote so much about his experience, But what would a smallpox epidemic like that have been like from the perspective of a physician like joseph Warren?

Per-Olof:
[19:30] So Joseph Warner as you pointed out 1764, just shortly after he’s finishing his apprenticeship Was starting is an opening, is up up his own practice.
And then Boston was hit by another round of smallpox epidemics. It the best known smallpox epidemic in Boston mostly 1 1721. Because that’s when inoculation really started to take off.
You had dr Boylston and then uh what’s his name kind of matter? Right.

Jake:
[19:59] Cotton, Mather and Anisimov.

Per-Olof:
[20:01] The exactly right. So that story you obviously are familiar with and and they suffered I mean a lot of a lot of harassment from the public and from clergy etcetera etcetera.
So that influenced them. I think that aspect had sort of vanished at the time of use of warrants help with inoculations.
So at the time the governor in massachusetts ordered a group or assembly group of physicians among them to serve a warrant to inoculate post oni ins for free.
And obviously it was a dangerous proposition because they dealt with live virus, although they didn’t know about virus at that time, but they dealt with material will matter that they understood could could give themselves smallpox.
So they sort of became heroes. And I think you know, his joseph’s participation in the smallpox,
In the inoculation campaign 1764 helped him to become one of the heroes in Boston and sort of got him on to a running start in terms of then billion that reputation and generating patients for his practice.

Jake:
[21:13] It’s about a decade, a little more than a decade between that smallpox outbreak and his death, what would he have been doing in the meantime to grow his practice?

Per-Olof:
[21:25] So I I mean I know there were there were advertisements in in those states, the newspapers, I haven’t seen any ad for from him, but,
other for example dr Benjamin Church advertised about his skills and that he was coming back from England and that was one of the advantages having the the,
foreign training that you came back with an MD degree and,
and could really bragging boast about that.
And joseph Warren, I’m not certain he advertised at the same in the same way.
But I think like for any good surgeon, like for any anybody wants to build a sort of practice or medical practice one, you need to be a good doctor and you need to be a compassionate doctor and you need to treat the patients well.
And I think he did that and he treated patients regardless of their status in the society which I think obviously was appreciated.
And he also obviously needed income. So he charged patients. Was a practice for fi type of practice.

Jake:
[22:23] Of course, Blue Cross and Medicare wouldn’t have existed yet.

Per-Olof:
[22:26] Right. Right. And but he I mean the impression you get when you read documents about more other biographies about him is that he was not primarily interested in the money.
He was humanistic person I think and really wanted to help people.
And that obviously helped in terms of building a practice. And he he had patients from all different layers of society, both from the loyalist side, so to speak and from the higher society and from from wigs.
And I don’t think he really at least initially didn’t care about that.
He didn’t pay attention to that later on when he became a uh an active patriots, probably that would play a greater role in his, uh, not in the way he treated patients, but probably in terms of which patients came to see him, I would assume.

Jake:
[23:14] And ironically, it sounded like his care for some of the poorest people in boston helped generate the most reliable revenue for his practice.

Per-Olof:
[23:24] So. There was this outsource, there was a type of a socialist medicine in a way and I think I even make that parallel in the book, if I remember correctly.
But so there was there was patients who were in the care for that for those patients were paid for by the states by massachusetts state.
And it was also like, like today we have a similar situation with java a physician working at the via, he gets a salary and fixed salary and there are no fees to be paid for by the patients. And the same thing at the Adams House.
And it also became a, a source of controversy, I think because uh they were expecting, I mean, the the surgeons who did that, we’re expecting a good compensation from the State,
and they were accused of being too interested in that maybe not joseph weren’t that much as his brother. Later on.
It was criticized for that to be two, try to suck as much out of that system as possible in terms of economic remuneration.

Jake:
[24:30] And during this period when he was building his practice and finding a way to make a living from it, what was joseph Warren’s family life like?

Per-Olof:
[24:39] So he married a uh at least comparatively wealthy woman um Elizabeth Hooten.
And interesting enough, there was described in the local press at that time that this young successful doctor is marrying Elizabeth Newton.
A lady of good resources was something like that was the expression and I think they were they were, there were some rumors that he actually married her for the money, which I don’t, I mean from when I read, I don’t think that was the case.
I think they had a good marriage and they had four Children and she died at a relatively young age tragically.
So all of a sudden it was a widow with four Children to take care of so many.
He was, I think you will say um good catch looked upon as a good catch for women.
So I don’t think he had would have had a difficulty finding another wife later on, although he never had time to really establish that completely.

[25:44] Um So he found there was one lady who he probably most likely was engaged with and the planned they planned to marry later on all that is also somewhat uncertain from historical,
documents, but he also probably had some affairs on the side.
There is the story about the young woman who got pregnant already when she was a teen teenager.
And what has raised historian suspicions is that on the day I think was the same day as the battle of Bank Carrillo occurred.
He was a little delayed coming there because he had seen a pregnant patient. Yes. What’s to explain his own documents.
And I think the suspicion is that the the assumption may have been that he was to see her and make sure that her pregnancy was doing well before he went to the battlefield.
And he said he will be back later on. You know, I just need to take care of this Red Coast first. But obviously it didn’t make it back.
So he had and he may have had other women in his life as well.
So there is this story about mrs gauge, Marianne no name.
You know Marianne, I think first name.

Jake:
[26:57] Who is the wife of general thomas gauge?

Per-Olof:
[26:59] Exactly right. Was the commander in London boston at that time.
And so the rumor about you know, he he called the alarm because he was alerted to the effect that the british was coming out of boston and go into Lexington and concord.
And so the question was, how did you know about that? So there is these historical rumors, so to speak, that somebody whispered in his ear and that may have been Margaret gauge, although that is also somewhat uncertain.
There are other historians who claim that Margaret Cage may have been the mistress of Paul Rivera than joseph Warren. So people conducted those type of affairs in those states as well.

Jake:
[27:44] As the imperial crisis starts heating up, joseph, foreign takes on more and more of a high profile political role in wig politics.
But I’m also curious how he experienced some of the, the big events during that era as a physician.
So what was dr Warren’s role in the murder of Christopher, Seider or Snyder and in the boston massacre?

Per-Olof:
[28:09] So when Christopher sided was killed, joseph Warren was the one who got charged to the autopsy of him and he could,
release a pretty clear report confirmed that he died from the shot. Yeah.
From from the yeah, the customs officers.

Jake:
[28:31] He was a customs officer. But yeah, I don’t think of his name off the top of my head either.

Per-Olof:
[28:35] No right, right. So there’s so many names in this, but I don’t know.
So so that was that was his task at that time when he came to the boston massacre, he was involved in that as well.
He was part of a delegation that went to Hutchinson and said you better get the british troops out of boston because this is getting bad now.
I mean we can’t we can’t live with this. And so it was part of that.
So but there was another one of the revolutionary surgeons who then got charged with doing the autopsy of attacks, who was killed early on during the massacre. And there was Benjamin church who did their autopsy.

Jake:
[29:10] Who has his own chapter in your book, Hutchinson had been a patient of Warren’s right, but it sounds like politics got in the way of their personal relationship.

Per-Olof:
[29:11] Exactly right.

[29:19] I think it ultimately did. But I think they were good friends and as you said, had a good patient doctor relationship initially.
And as I was indicated before, I mean when things started to crystallize in terms of where the country was, where the continental was going,
with the division between the british and the americans, it probably came more and more difficult to keep up a good relationship between them.
And yeah, I think the patient dr relationship that at least I describe in the book about his headaches and stuff like that,
was earlier on before the friction really had started to to generate the relationship between them.

Jake:
[30:04] As joseph, Warren became more politically involved, or at least more visible politically, what sort of role was he playing? What was what was his role within wig politics?

Per-Olof:
[30:17] So he was a member of the Sons of Liberty, obviously, and he was a he was mentored, I think by Samuel Adams and became involved in that way. He became involved in the massachusetts Congress.
He became involved in terms of being a driving force behind the committee, the Committee of Communications, and then of course the Suffolk uh,
points that were made and brought to the Congress later on about the liberty of people etcetera, etcetera.
So he was very active and he was very prominent, but he all the time, I think he came all the time. He did keep his surgical business or sort of practice going.
Actually was in his circle office on the night before the Lexington concord events.

Jake:
[31:09] Aside from bunker hill, that’s probably the thing that people most know joseph Warren for is for orchestrating the two, if, by sea lantern signals that old North Church and then the midnight ride of paul, revere and William Dawes.
But how did Warren personally react to the intelligence that the british were going to march on Lexington and concord?

Per-Olof:
[31:33] You know when he realized that the, that the skirmish had actually started that the most sexual activities going on or an engagement going on, he closed his practice.
He turned his patients over to use this the future massachusetts governor and, and and told us that you take care of the patients.
I have to write out there and and help out on the battlefield. So he was, he was both at Lexington, but he probably arrived more in time for the engagement in concord.
And so he was portrayed by his military colleagues to being very braved, indeed, even reckless.
And he got, he was involved both as a military trying to kill red coats and but also trying to treat injured soldiers on the field.
Three was very active indeed.

Jake:
[32:27] Yeah, that’s an aspect that I’ve not read nearly as much about. You always hear about the signal and the dispatching of the signal writers and you hear less about his personal involvement in the battle.
How did he spend? There are roughly two months then the Lexington and concord fight happens.
The big sort of mid april and then bunker hills and Mid June June 17, I guess so. How did how did dr warren spend the couple of months intervening?

Per-Olof:
[32:58] So I think he continued to have a very important political role because now is when the siege of boston started really, they closed off boston and try to get the british out of the, of the city,
and john Hancock, he was more an eager person too.
I mean he advised joseph warren to get in and get them out there, get them out of the town, but I think you said were much more careful and he understood that probably we don’t have the resources or the military power to do that at this point.
So maybe c which is a better way to sort of store them out.
And he was very involved in that in the politics during those days and and dealt with the,
political, I think there were negotiations for example about exchange of prisoners, but there were obviously patriots being locked in inside boston and vice versa.
They were loyalists who were locked out of the city and there were negotiations in which there’s a warrant to took apart trying to arrange for families to be reunited on either side of the alliance.
They don’t think those negotiations really in uh resulted in a lot of happy re reunification, but families continue to be split on on the both sides of the city limits.

Jake:
[34:18] Right. And then, of course, as you already described, he was killed at the battle of Bunker Hill. And will you remind me how old was he at the time he died?

Per-Olof:
[34:29] I think it was 34.

Jake:
[34:31] It’s amazing how influential somebody who died, that young could be across generations. And it’s the political inspiration, but it also ends up being pretty influential in medicine. And that’s do really to his choice of apprentices.
You mentioned William Eustis briefly, but will you uh talk a little bit about the men who apprenticed as physicians with dr joseph Warren?

Per-Olof:
[34:53] Right, so I think he had a total of five apprentices during his relatively short carrier 10 years as you indicated earlier and the common denominator between those where they were all all from Harvard, so they had a similar background.
So they were presumably well educated young men and there were three in particular that were interesting from a american revolution standpoint and that is useless who later on got into politics and became,
I think it was an ambassador in Holland for some time and then he came back and became the governor of, of massachusetts.
Another one. Another apprentice was Samuel Adams Jr so Samuel Adams son, which is an interesting connection obviously.
And then most importantly his younger brother, his younger brother, john Warren who apprenticed with joseph.
So joseph was john’s I think here in life and which made the tragedy at bunker Hill even even greater.

Jake:
[35:54] So what was the age difference between john warren and his brother? Joseph?

Per-Olof:
[35:59] It was 12 years, 12 years in between, if I remember correctly as 12 years.
So he was, but he also went very similar type of education in Roxbury Latin School and then Harvard at age of 14 and then he had an apprentice apprenticeship with his older brother.

Jake:
[36:19] One thing I guess that would have been different for for john, When I think about Joseph witnessing his father’s death, he was 14, 13 or 14 years old when his father died.
But John would have been I wonder if john would have even remembered his father.

Per-Olof:
[36:35] So right, so I think he was to only two or three years old and uh, I am, I bravely argue in the book that he would remember that event the rest of his life, but john was actually there when it happened.

Jake:
[36:50] That’s traumatic in a young child’s life I guess because their father died when john was so young, mary warren there mother played a really big role in, especially in john’s life.

Per-Olof:
[36:51] Yeah, right.

Jake:
[37:03] I I loved your description of thanksgiving at the warren home. And as we’re recording this for just a couple of weeks out from thanksgiving here in the US.
Will you give our listeners just a brief introduction to marry and what our holiday celebrations were like?

Per-Olof:
[37:18] So she was very keen on traditions and she had every year she had her sons with her family come for the traditional thanksgiving dinner and she always made certain that she had made food enough so she could send them back home,
with a package of food for another couple of days.
And she was described as a loving loving mother obviously and I think there was a close relationship between the mother and their sons maybe in particular joseph as long as he lived and then john,
and there are letters preserved from those times and she always talked to him about my my son, my my boy etcetera.

[37:56] Even when they were growing up too grown up enough to be surgeons in chief at the Cambridge Hospital and so forth. And so I think it was a very close relationship obviously further fostered by the fact that she was a widow and relied on their help.
And I think the same thing they were loving sons. So joseph, when he was at Harvard, I don’t think he stayed around and did whatever the other students did during the free time over the weekends etcetera etcetera.
I think he came home and helped her, his mother with the farm with practical things at the farm and and he felt responsibility also because she had been very supportive economically in particular.
And joseph started the the apprenticeship with James Lloyd.
He needed some, he I think he got a good deal anyhow, but I think he was helped by the fact that she put up some money as well to support yourself during that apprenticeship.
So it was I think it was it portrays at least when you read about it like a warm, very religious and very morally high standards.
She was very strict I think in terms of keeping them the moral standard up and the religion up and I think it looks like it was so warm.
Family was a loving mother.

Jake:
[39:13] I think I remember reading that she lived into her nineties and she was very, very active into her mid or late eighties at least.

Per-Olof:
[39:21] Yes. I think that’s the case. Yeah. Yeah.

Jake:
[39:23] Sounds like quite a lady.
So speaking of john War and the younger brother, up until his apprenticeship with his older brother, joseph, john Warren’s education seems to have run pretty parallel to Josephs. They both went to Roxbury latin.
Both went to Harvard, both had medical apprenticeships, but after he finished his apprenticeship with joseph, it seems like Jon Warren really struggled to establish a practice that would support him.
Why did he end up moving and choosing to to try and establish a practice in Salem?

Per-Olof:
[39:57] Because I think even if they were not that many doctors around in those days it was still a saturated market in in boston and I think both he and joseph understood that.
So I think joseph helped him give advice. You should probably look at somewhere else. And I, there was another certain just recently died up in Salem and left the practice after himself.
So now there was only one basically only one doctor Holyoke was up there.
And so I think they both felt this may be a good opportunity even so he, as you, I think you pointed out that he’s struggling thusly in terms of getting his foothold established in Salem,
because he came in as a young inexperienced surgeon or physician and the people living in Salem, my understanding was that there was only one doctor in the world and there was dr Holyoke, he had been there for a long time and,
and all of the previous doctor had died, there was still Holyoke there.
And so I think john experienced that difficulty to breaking in, so to speak.
And then after only about a year or so the war started and and that obviously abruptly finished his carrier up in Salem.
But I think he, he had started to gain some ground when this happened. And you know, he was advised by friends and colleagues.

[41:24] Uh, so when, when the bunker hill battle that happened, he said well enough of this medicine, I’m going to help out in the war because there’s a war coming that’s obviously three, he sort of thought about exchanging his scalpel to a gun,
and but he was advised by people up in Salem I think, but also by his colleagues and friends that you should serve yet.
It’s a good thing you want to serve the course, but you should do it as a certain in the in the army instead.

Jake:
[41:56] Obviously he wasn’t a publicly a politician the way joseph was. But is there evidence that he had strong political leanings, Orwig beliefs before the war broke out?

Per-Olof:
[42:06] Yes, I mean, I think he was influenced by his brother. I mean he spent a couple of years as an apprentice and an apprentice in those days. Lived in the family in the, in the house or the master and obviously this was really family.
They were brothers. So yes, I think he could not avoid it to be influenced by joseph’s political activities and so forth.

Jake:
[42:27] How old would john have been, or how long after his apprenticeship when joseph died? And john joined up as a Continental surgeon?

Per-Olof:
[42:35] Probably 22, was a young man and it was obviously that young mini mood and tried to establish himself as a certain asylum as well, which may explain some of the difficulties he initially experienced.

Jake:
[42:48] Right, what would John’s first posting? Our first assignment have been like as a Continental?

Per-Olof:
[42:55] He became a regimental surgeon in those days.
They were tested at this time. I think John morgan was the short in general for the army.
Penniman Church. Short carrier had already been ended.
And so john went through those examinations and was approved and first it became a a surgeon in one of the units.
But then he also got involved with the, you know, with the Dorchester, with the Rochester Heights And with the Events in March of 1776 when the British had to evacuate Boston.

Jake:
[43:37] That’s interesting. I’ve read some of Dr Warren’s letters dr john Warren’s letters to George Washington.
He was one of the very first people who were admitted into boston after the british evacuated. He was called to examine medical supplies that were left behind.

Per-Olof:
[43:53] Mm hmm.

Jake:
[43:54] And he describes these medicines that were laced with arsenic.
But I’ve never been really clear whether it was a deliberate attempt to poison people or just some sort of accidental contamination in the chaos of trying to evacuate this town.
What do you think happened there?

Per-Olof:
[44:10] So I think there was deliberate, I think, you know, the red coats, I mean the british forces were really upset that they had to leave boston and they had to leave without being allowed to plunder the city,
because there was forbidden and there was no time for it.
So I think they just wanted to make it as difficult as possible for the patriots when they came in to take it over. That’s what I think.
I don’t recall any evidence for that. But I you’re right in pointing out that he was one of the first rebellions who were allowed in by George Washington. And the reason for that was that he was inoculated against smallpox. There was the fear for smallpox.
So Washington was scared to death for the smallpox epidemic. And they understood obviously that if they were were to spread among his soldiers, the course will probably be lost because,
the, the number of protected soldiers initially it was very low,
as opposed to the british because the smallpox epidemics have been more prevalent in europe.
And inoculations had already been accepted. There is more than on the american continent.
So he said, anybody who can prove that he had been inoculated or that he had had Smallpox can go in and they were, I think about 1000 soldiers and soldiers who went into the town after the british left.

Jake:
[45:31] Washington eventually would order the whole Continental Army to get inoculated, but that early in the war, it was still very controversial. It was way less universal at the beginning of the war.

Per-Olof:
[45:42] Yeah, I mean it was forbidden. Congress had forbidden it and Washington forbid it because it wasn’t without danger,
as you know, because basically what the inoculation meant was that you gave the soldiers smallpox,
and they would be better than being sick for a while, not as seriously as after a natural, you know, uh contagion, but still.
And so they were they was very controversial as you said, the whole inoculation story still even less than 1721.
So you’re right. So initially there was not only,
decided but it was forbidden, but then he made a 180 degrees turn around when he realized that this doesn’t prevent the smallpox completely. So we better inoculate the army.
And then of course he ordered everybody all all unprotected soldiers to be inoculated.

Jake:
[46:38] After the british evacuation of boston, john warren is going to serve through the new york and New Jersey campaign that sees,
the american army get pushed slowly out of new york through New Jersey onto sort of the doorstep of the patriot capital at philadelphia.
What was the role of DR warren during that campaign?

Per-Olof:
[46:59] After the after the evacuation of boston at that time, George Washington thought that the british would sail down to new york.
So that’s why he marched his troops down to new york.
So he was astounded by the fact when he found out that actually they had sailed up to Halifax.
But then, you know, he had all the troops on there and then later on, a couple of months later, after the, I think, sometime in May,
john warren, together with some other surgeons got on their horses and riding down to new york to help Washington with the more casualties when they, because they were convinced it would happen.
So he ended up being the chief, or at least a prominent certain at the General Hospital in Long Island and saw the disastrous results of that battle with thousands of americans being killed.
And at that time john morgen was also the was still the general surgeon surgeon general of the Continental Army.
And so there were a lot of interactions between john morgan and john Warren at that time.
And then so then he followed the army on the retreat across.

[48:15] Hudson River and Manhattan and over to New Jersey and travel down with the end, retreated on New Jersey together with the forces.
And he was actually also at the Trenton later on, and at the Princeton battles.
But then it sort of the relationship between George Washington and john Warren at that time. Got Southworth.

Jake:
[48:41] So is that how he ended up coming back to Boston in the spring or summer of 1777?

Per-Olof:
[48:46] Yes, I think that’s why because at that time there was a new surgeon general. So there was a lot of fights between and a lot of jealousy and rivalry between the different surgeons, unfortunately.

Jake:
[48:59] The different surgeons being you had regimental surgeons, you had hospital surgeons.

Per-Olof:
[49:03] Yes. So there was one type of friction, but there were also friction and jealousy between the individuals within the same camp, so to speak.
I mean, the primary center obviously between morgan and shipping.
So at that time after the Trenton and Princeton battles, shipping had been appointed by Congress and by George Washington to be the new showed in general.
And all of a sudden john warren felt left out because john Warren had been appointed at the time when john morgan was in charge.
So, and now shipping was charged with getting his own people in.
So he felt a little sidestepped, He sidestepped. And he wrote to George Washington and said, hey, I feel like I’m our luck here. And I don’t feel I have a role any longer. So I’m applying to more formally for the promotion. I think I deserve.
And George Washington was pretty dismissive. I think at least when you read the letters back and forth, it’s only basically that he said, well, tough luck, you’re out of it.
And and then john john Warren obviously got tired of that situation and said, I’ll go back to boston and which I think was a good thing for medicine and surgery at least, and for his personal life.

Jake:
[50:22] Well, speaking of his personal life, you write that he was young, good looking and a successful surgeon, which I read as john Warren was a catch.

Per-Olof:
[50:34] Yeah, right.

Jake:
[50:34] Uh, so his romantic, romantic life took off pretty soon after that. Can you describe who won his heart?

Per-Olof:
[50:41] So that was Abigail who was the daughter of the governor of Rhode island.
And she she herself was probably catch. I mean she was described both by john Warren and later on by by johnson and Abigail’s son Edward as being very good looking and had a very,
it was very popular.
She probably was even popular among the higher up officers at that time.
She ended up when the british had been threat fel in Rhode island.
She ended up in Cambridge in Italy just at the time when George Washington came there and she, I was entertained or she just moving around in the circles of George Washington etcetera etcetera.
And there are some indications at least describe some historians that he had a good eye to her as well.
Later on the war when when the the forces were more centered in philadelphia. She was down there as well and and probably made success. And so she was probably catch as well.
But he was, I mean john was lucky enough to catch her and they got married and had I think a happy marriage.

Jake:
[51:57] As they’re getting started in their marriage, john’s trying to support the the family on a fairly limited salary.
It sounds like of a general hospital surgeon, as he was still in a military role as a hospital surgeon.
How was he also trying to build a private practice and grow some income?

Per-Olof:
[52:18] Well, so just like his brother, I think he was a successful surgeon and he became popular in boston.
And he, in terms of income. He also wanted advantage of the appointments at the Adams House,
and I think that’s when he received some criticism that he was sort of pushing that maybe a little too hard.
And and so some of the politicians in massachusetts at that time, I felt it was greedy and and so forth.
But he, so he developed a successful surgical practice,
and actually the couple of groundbreaking surgeries groundbreaking for those days,
and also became interested in the training, more formal training of surgeons, in addition to all the other intellectual and philosophical and humanistic interest that he had time to develop.

Jake:
[53:10] So speaking of sort of these groundbreaking or landmark surgeries that dr john Warren would have performed, there was one that was described in a lot of detail in the book as one of the first successful laparotomy ease.

Per-Olof:
[53:24] Correct.

Jake:
[53:26] So can you describe for the listening audience what a laparotomy is and what he accomplished by performing that surgery?

Per-Olof:
[53:34] So laparotomy means opening of the abdominal cavity. And again, we have to remember this was done without general anesthesia as the patients were a week. So there was in itself a groundbreaking thing. And this, right.

Jake:
[53:43] Yeah.

Per-Olof:
[53:45] And this was probably the second at least documented laparotomy performed on the american continent.

Jake:
[53:50] Who was the patient in this case?

Per-Olof:
[53:52] And the name of the patient is not given. But it’s described as a young negro woman.
And she had noticed a mass in her abdomen since quite some time, probably several months.
And so laparotomy, as I said, we’re obviously painful and dangerous.
And John Warren’s laparotomy happened 1759.
No, the 759 is the first one I referred to. And that was John Barred uh followed a couple of years later by John Warren, Slippery Man, this young woman.
And so it’s described. It’s described in detail in Edward’s biography about his father.
So I guess he had told him about what happened, which described how he makes the incision in the abdominal wall in the enter the abdominal cavity and put their fingers in obviously without operating gloves and without sterile conditions.
And they found this big mess in the left replacing the left ovary.
And they took that out before they did that they sort of entered that it was a cystic lesion sort of a second type of collision.
And they found interesting material inside that inside that cyst.

Jake:
[55:04] They described it as being stuffed with hair.

Per-Olof:
[55:06] Right. So it was probably what we call the terror toma nowadays.
So Terror toma is the type of tumor that develops from pourri potent cells like stem cells, you would probably call them today and they can develop into different types of tissues.
So sometimes you can find here find hair, you can find c basis glands and see basis material like so soapy material and you can even find cartilage and bones and teeth etcetera, etcetera.
But they did find hair that he described pretty well and they took that out and somehow the patient survived because most patients, many patients did not survive their surgeries.
But she survived and she became sort of a quote on with celebrity in boston with all physicians, interesting to look at this to see this patient.
And so she had a lot of visits in her in her hospital room and then when she was discharged home, she survived also longer time.
She she seems to have thrived and she is described by Edwards as being ultimately corpulent overweight lady who lived for several years.
He doesn’t describe exactly how old she became.

[56:15] So that was something that made john Warren obviously famous as well.
And um and sort of spread the rumor about him as a magic type of surgeon.
He also did some other interesting surgeries that was also groundbreaking and I didn’t relay that or refer to that in the, in the book.
But one of the other procedure was a disarticulation at the shoulder regions.
There was a soldier who had sustained severe injuries to his arm.

[56:43] And in those days was considered a no man’s land to try to dis articulate up in the shoulder region, but warned that I’m understood the boston way to save that patient, and he did, and he became famous for that as well.
And that may have been the first such procedure in the world.

Jake:
[56:59] Describe if you don’t know what what does it mean to dis articulate a shoulder.

Per-Olof:
[57:02] So that means to amputate the whole arm from the shoulder joint and down.

Jake:
[57:08] Rather than sort of at the elbow that would have been more common.

Per-Olof:
[57:11] Well at the Alberta, or just transacting the bones in the middle of the upper arm or middle of the arm.
So it was more in an atomic type of procedure in that sense. But it was considered dangerous because they have a lot of nerve structures and the blood vessels and so forth in the armpit, up in the accelerant arm.
That could be dangerous, and was considered, as I said, almost you can’t you can’t get to that area.

Jake:
[57:37] Would that have been during his wartime service, then? That helps to highlight the reputation that john Warren had as an anathema, says that he was somebody who had studied the human anatomy in great detail.

Per-Olof:
[57:39] Yes.

Jake:
[57:51] And I guess, probably through that reputation and through his growing reputation in boston.
Not that many years after his return to boston, as the war was sort of winding down toward a negotiated peace, his alma mater came calling.
How was the idea that ends up becoming Harvard Medical School born?

Per-Olof:
[58:14] So I think was a an idea that john Warren had for some time and discussed with his friends and colleagues and those discussions, I think spread to the, to the leaders of the Harvard College, Harvard University.
And he obviously was aware of the fact that there were already two medical schools established in America at this time, one in philadelphia in one in new york and being in boston, I guess he felt that we should have won up at Harvard as well.
And then he got charged by the by the leadership at Harvard too to develop a plan for opening a medical school.
So that happened in 1782.
So he then became the founder of sort of basically one man was behind that.
Obviously he didn’t do quite alone, but I think he was certainly the leader, the well acknowledged leader of that effort.
And then he became the first professor surgery.

Jake:
[59:11] It sounds like at first when the school opened there were basically three professorships or three areas of study within the school.

Per-Olof:
[59:18] Right? So there was the surgery, Anatomy was a combined type of charge.
And then you had the Professor of Physics which was basically internal medicine and then you had the chemistry aspect of it in pharmacology as well, the pharmacy sp Roy.
But the, I think the Chemistry, the physics and disorderly anatomy, we’re the first in the initial professorships.

Jake:
[59:47] And Warren was then the first professor of surgery, He said,
there was an interesting little aside in the book as he was trying to recruit the rest of the initial faculty and deciding how the internal workings of the school would go.
As he was asking some of the folks in other medical schools around the country.
How seniority worked? Was it who had been in practice longer? Who?
And they said no, it’s just who got hired first.
That worked well for him because he was the 1st 100.

Per-Olof:
[1:00:16] That’s right. No. So he consulted him particularly with his colleagues in philadelphia, how they had arranged that because the seniority question was important.
And as you said, is that the seniority in terms of, you know, being best educator, is it in seniority in terms of being longest on in the position etcetera etcetera. And you’re right.
So the the longevity or the time of appointment was an important factor.

Jake:
[1:00:40] Where would the medical school have been located when it first opened in boston? Or was it in Boston? At 1st? I guess I should ask.

Per-Olof:
[1:00:46] Right? No, it was in Cambridge and it was all over.
I mean I was so they used apartments, they used smaller rooms they could find both for,
for the different types of specialty they were teaching and obviously with today’s our is pretty primitive both in terms of,
size and scope and localities.
And there was a fight between the faculty and in the location because there was a strive to move things into boston,
because it was expensive and uncomfortable for the faculty having for the people who lived in boston at that time, having to travel across the river and all all to Cambridge.
And and in particularly winter time, you know, it wasn’t very convenient, but ultimately they’re more into boston.

Jake:
[1:01:39] At the time, the first students graduated from Harvard Medical, would their study have taken the place of an apprenticeship? Would they go on to an apprenticeship? Would there still be something akin to today’s residency after Harvard Medical?

Per-Olof:
[1:01:54] Yes, so they also did apprenticeships. But the, the education in the medical school obviously took over much of that and the emphasis was great.
For example, at least from a service standpoint on the dissections and the in the learning of the anatomy.
But then obviously there was no residency, but they obviously needed a practical aspect of learning it’s and and in addition to the theoretical,
so the last section was one of those practical aspects.

Jake:
[1:02:27] The focus on learning anatomy through dissection is interesting because by the time john Warren was a professor of anatomy, he could more or less openly advertised that he was going to be giving a lecture involving dissection where,
just a few years before, when he was a student, basically anybody who wanted to do a dissection and had to be a grave robber.

Per-Olof:
[1:02:51] Yes, at least to some extent. And so that’s, that’s a shady area in itself.
I mean, it’s the regulation of retrieving corpses and so forth. Our laws in massachusetts that allowed that section and retrieval of executed criminals, for example.

Jake:
[1:03:11] It was a specific sentence that one could be sentenced to dissection for dueling in particular, I think.

Per-Olof:
[1:03:19] Yes, but it was badly needed obviously if you wanted to learn an enemy and but still, even if they kept within the framework of the law, it was still controversial in many places.
For example, shipment down in philadelphia when he started his anatomy school, he got harassed by by people and,
people was were there were mobs demonstrating outside the house where they knew that sex were going on and stones were thrown into the windows etcetera etcetera.
And new york’s or similar things during, during barge time when when there was a riot in new york, the doctor’s riot in new york, which was basically an opposition or riot against dissections that took place.
And they’re also a racial aspect because in new york at least they, the grave robberies mainly took place at the graveyards for outside the city limits where the,
black people were buried, they weren’t allowed to be buried inside the city limits.
And so there was a lot of controversy, a lot of violence going on against that.

Jake:
[1:04:26] I want to ask about John and Abigail. Warren’s home life a little bit because they found themselves. I think I read that they had 10 Children to care for and that was joseph, surviving Children, but also their own house.
How did it break down? How many Children did john and Abigail have themselves?

Per-Olof:
[1:04:43] I think that five surviving five surviving Children, I don’t remember.
I think they all said some Children died in in infancy, if I remember correctly. But yes, when the family was established, they had five surviving own Children.
John was sort of family father. He is described as being very keen on keeping the traditions in the family and and also religious and attending church regularly, etcetera, etcetera.
And um, so they actually had a house, they ultimately go to home done at the school street, I think, you know, a street of Washington street.

Jake:
[1:05:24] What was that home like? It sounds like it was a pretty large house.

Per-Olof:
[1:05:28] Right. So it’s described as a pretty large house. And it was sort of, so even though they, for example, his wife Abigail did not like the concept of slavery. And I think john was also opposed to it.
Like many people were in those days.

Jake:
[1:05:43] Well, it’s interesting John Warren’s parents enslaved a handful of people and joseph had at least one enslaved servant in his life.
So I was really curious to read that john and abigail were so early and ardent about abolition.

Per-Olof:
[1:05:59] Right. So, I mean, I think it was a big a loser. I mean, john’s wife said they talked about slavery. Is this curious or something, something like that, this curious institution in this society.
There were a lot of opposition to the thought of it. So both john and Abigail didn’t like the idea of slavery.
And I think some of the people are described in the book, You know, there was a girl coming home to shave his to cut his hair every now and then and there were other tests being performed.
And I’m not even sure if they were in slavery, they were paid as servants at that time.

Jake:
[1:06:37] I think that given the timing, it was probably right in the middle of massachusetts gradual emancipation.
So they were probably in some form of indenture rather than actually enslaved during, during those few years.

Per-Olof:
[1:06:51] And I mean, several of the other surgeons that I described in the book are also against slavery. I mean, Benjamin Rush, for example, was obviously very opposed to slavery and and was active in the in that moment.

Jake:
[1:07:05] Speaking of Benjamin Rush, that brings to mind the one,
surgery that dr john Warren performed that most people probably have the most awareness of would be the mastectomy performed for Naby, the only daughter of john and abigail Adams.
But most people are aware of that through the HBO miniseries about john Adams and in the miniseries, they portray it as though Benjamin Rush had performed the surgery.

Per-Olof:
[1:07:36] I haven’t seen the Minister’s myself, I probably should because it sounds interesting. But anyway, if it’s portrayed that way, it’s probably inaccurate. And I think it’s pretty, pretty well documented that that john Warren together with his son and some other assistants performed the surgery.
However, Ben Amira’s played a role in it when Nebbi started to feel the lump in her right breast.
She was living in upstate new york at that time, as you know with her family and she felt this lump in the right, pressed for quite some time and it’s actually very interesting description of a breast cancer.
And she finally told her mother that and then her parents, both john and Abigail.

[1:08:17] Told it came down to boston to see a real doctor and so she traveled on to boston and consulted different doctors in boston.
But she also knew that her father, john Adams, who at this time was the ex president, obviously also a good friend of Penha Me Rush and Ben Amira’s at that time was probably one of the most highly respected physicians and surgeons in the country.
And so she wrote the letter to Benham eras herself and described the symptoms etcetera etcetera and the science and what she had felt.
And she she described the um how it seemed to grow first and then it was shrinking,
and it was red and skin on top of the um which may indicate that she had an inflammatory breast cancer, which is one of the most aggressive tons of types of breast cancer, but anyhow.
And then so Ben Amira’s read the letter and he replied with his own letter relatively soon but not directed to her.
So he sent a letter to her father because he was concerned at least he was thinking he was concerned that she would be scared and upset if she read what he wrote.
And he wrote that you should let that let the knife fly immediately. Because this sounds like the answer.

[1:09:30] And he wrote about his 50 years of experience with that disease and and said that you know any other treatment would just be future would not be good for her. And so she then consented to the surgery.
So it was it wasn’t quite dramatic experience for jOHn and Abigail Adams I mean her parents and obviously with the patient herself and probably for john warren itself. In addition to that.

Jake:
[1:09:57] And if this, if there was happening in 1811, that was well into john Warren’s career. He wasn’t a new surgeon by any means. At that point, he was that one of the most respected surgeons in the Commonwealth, the anonymous at Harvard Medical School?
What would the experience of a major surgery like that have been like for the patient, The family and the surgical team in 1811.

Per-Olof:
[1:10:23] I think horrendous for all of them. So it’s described in some historians descriptions of it, that that Nebbi obviously was a brave person. She understood what was awaiting her.
And she was described as coming to the operating room, which by the way, was the second level bedroom upstairs, her parents bedroom.
And she that’s that’s right, that’s right.

Jake:
[1:10:44] And the house in Quincy, that people can still go visit anytime?

Per-Olof:
[1:10:49] And then she came, came in the room, composed and calm, seemingly calm, dressed in her sunday clothes and with a hymn book from which she was singing through the procedure,
but still obviously must have been tremendously painful because there was no there was no general anesthesia.
And.

Jake:
[1:11:10] And what were the instruments like the doctor Warren was using for the surgery?

Per-Olof:
[1:11:14] So basically two or 3 instruments or four instruments if we count what he used at the end.
So basically a type of fork with which he could lift the breast from the chest wall and then a sharp racing racer type of knife,
that he chopped the breast off when she lifted off and then some additional lives.
And it’s interesting to read the descriptions of it because he also found in large lymph nodes in the armpit at the same time.
And I think the understanding that this was a dangerous and they and the fatal type of disease, there was well understood.
And I think the concept of that type of tumor cancer spreading to the lymph rose was also well established because when he discovered that he went in and raised into ss described raced into the,
into the armpit and took those lymph throughout as well.

[1:12:08] And then of course the fourth instrument that I referred to as a special. Um So once the breast was off the chest wall, there was no skin enough, not skin enough to close with stitches to close the defect.
So how to stop the bleeding well. So they used these glowing heated spatulas.
So in the operating room, quote unquote, they all said little oven upon which upon which the spatulas were heated and and with a glowing special. Um and they used them to cauterize the area to stop the bleeding.
And that in itself must have been a tremendous experience.
And I think it was even too much even for john and abigail today, I didn’t, they were present during part of the procedure, but I think at that time they walked out of the room, they couldn’t take it any longer if the descriptions are to be believed.
But I mean, so it was a so what was the experience like for the patient and for the parents and for the patient and for the sergeant’s, I think horrendous.

Jake:
[1:13:08] It sounds horrifying.

Per-Olof:
[1:13:10] But she she survived the procedure and after a couple of months he could travel back after a family in upstate new york.
But unfortunately she developed, I met a recurrent breast cancer.
She started having headaches and probably she had brain metastases and she came back to to her parents home in a bay in a poor condition and died after only a couple of weeks.
And john Adams was the one who took care of her ultimately, and took care of a daily.
I mean, taking care of his hygiene and when she needed the bathroom etcetera, etcetera, Amber was feeding her A. B. L. Couldn’t put up with her. She couldn’t just end it.

Jake:
[1:13:50] Right, That very famous surgery comes close to the end of dr john Warren’s career.
In the end, he died in 1815, just a few months before Harvard medical reorganized and appointed his son, John Collins Warren as the school’s first dean.
What what were the circumstances of john Warren’s death?

Per-Olof:
[1:14:16] He died from pneumonia but he also at his autopsy. So he was undergoing autopsy after his death.
He was found to have severe arteriosclerosis of his heart vessels the coronary artery disease.
So and he had suffered from angina or chest pain a long time.
But I think the immediate death cause of death was probably pneumonia.
He was out he didn’t spare himself not even at the end towards his life.
And he did home visits to sick patients even in bad weather even towards the end he stayed home he didn’t see any patients the last couple of weeks I think.
But up until very close to the end he kept struggling and trying to see patients and family didn’t like that. They advised him to stop and take it. I mean calm down a little. But that was his nature I think.

Jake:
[1:15:10] And the younger john Collins, Warren would go on to preside over The first use of anesthesia with William T. G. Morton in 1846.
How did the Warren family come to have such an incredible influence over the practice of medicine in boston for almost a century?

Per-Olof:
[1:15:30] Must be some good genes somewhere around smart people.
And I mean john Collins was also present at the mastectomy of Abbey of Nabby.

Jake:
[1:15:39] Oh, I don’t think I realized that.

Per-Olof:
[1:15:40] Yes. No he he had come back from training in England at that time and he had started to build his own practice and he was one of the assistants at the time.
And he admired his father much. He said well you know I think I’m a pretty good surgeon but I will never reach the level of my father.
He said about john which I think is also remarkable.
But then obviously he went on tv pretty grandiose carrier himself with the ether anesthesia and all what he did for sewer in boston.

Jake:
[1:16:10] There’s a passage are you describing john Warren? He said that he was a devoted husband, father and family man. He was religious, impatient, quick to lose his temper, ready to fight for his honor.
And then, on top of all that, he was a skillful, brave and highly regarded surgeon. So it sounds like you also have a lot of admiration for john Warren.

Per-Olof:
[1:16:30] Yes I think john warren was one of the most outstanding um surgeons at the time and an interesting individual with a lot of aspects and facets to his life,
and yes, so I admire that a lot and I mean just to dare to do the type of operations he did also writing.
I mean it’s interesting to you know, I think the first paper published in New England in the future. New England Journal of Medicine was actually by john Warren and it was about coronary artery disease interesting enough which he suffered himself.

Jake:
[1:17:08] Well, our listeners may not believe it, but that covers just the first two chapters of the book. Revolutionary surgeons, patriots and loyalists on the cutting edge.
If people want to follow you or your work online or do you do twitter or social media.

Per-Olof:
[1:17:24] So I have a facebook account and also website parole of Hasselgren My name 1st and 2nd name in one word dot com.

Jake:
[1:17:34] Well dr Per-Olof Hasselgren I just want to say thank you very much for joining us today.

Per-Olof:
[1:17:39] Thank you very much for having me.

Jake:
[1:17:41] To learn more about dr Per-Olof Hasselgren and his book Revolutionary surgeons, patriots and loyalists on the cutting edge Check out this week’s show notes at hub history dot com slash 237.
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Music

Jake:
[1:18:36] Stay safe out there listeners.