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Books and Documents > The Army Medical Department 1818-1865

CHAPTER 2

Laying the Foundation, 1818-1835

The War of 1812 did not dispel traditional American distrust of a strong permanent military organization. At the war`s conclusion, the U.S. Army was allowed for a few years to revert to its previous peacetime character as a small collection of regiments without either an overall command or a central organization. When, however, in the spring of 1818, the reform efforts of such men as Secretary of War John C. Calhoun finally bore fruit, one of the first three permanent staff departments Congress created for the Army was a Medical Department.

Organization and Administration

As formed in 1818, the new Army Medical Department strongly resembled the organization that had been created as a temporary expedient during the War of 1812. Medical officers, although commissioned, had no rank and thus remained outside the military hierarchy and without status. The principal departure from the previous pattern involved eliminating the positions of hospital surgeon and hospital surgeon`s mate, changes apparently dictated by a belief that the general hospitals they staffed would not be necessary for a scattered peacetime army of 7,000 men. The head of the new department, who reported directly to the secretary of war, was given the title of surgeon general. A subordinate Apothecary Department, managed by an apothecary general, was reestablished to handle the purchasing as well as the compounding of medicines. Francis LeBaron, the same physician who had served as apothecary general during the War of 1812, was reappointed to the position. Although at this time Congress allowed the apothecary general only one assistant, during the three years that his department existed he actually had two, just as he had had during the War of 1812.1

The classifications of post surgeon, regimental surgeon, and regimental surgeon`s mate were retained. Men serving as hospital surgeons and hospital surgeon`s mates, among them some of the ablest physicians in the Army, were offered commissions as post surgeons, despite the fact that they would thereby be reduced to a position inferior to that of regimental surgeons. Congress retained the ratio of one surgeon and two mates to a regiment and placed a ceiling of forty on the number of post surgeons.

The responsibility for setting up the new medical department was given to Joseph

1Unless otherwise indicated, material in this section is based on SGO, Annual Reports, 1818-61; John F. Callan, The Military Laws of the United States ... (Philadelphia: George W. Childs, 1863); War Department, General Regulations for the Army ...(Philadelphia: M. Cary & Sons, 182 1) and General Regulations for the Army of the United States ... (Washington, 1835); War Department, SGO, Regulations for the Medical Department, 1818; and Brown, Medical Department, pp. 107-214.

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JOSEPH LOVELL.(Courtesy of National Library of Medicine.)

Lovell, a conscientious and level-headed thirty-year-old surgeon then serving as medical director for the Army`s Northern Division. A graduate of Harvard and the Harvard Medical School, Lovell had occupied increasingly responsible positions during the War of 1812. The respect his colleagues held for him appears to have eased any resentment that the selection of so young a man for so great a challenge, over more experienced surgeons, might otherwise have caused. His appointment as the first surgeon general proved a wise one.2

In eliminating the positions of hospital surgeon and hospital surgeon`s mate, while at the same time giving specific assignments to each member of the Medical Department, Congress had placed the new surgeon general in a potentially difficult position. If he adhered strictly to the letter of the law and a war were to erupt, a possibility the legislature perhaps did not want to consider, Lovell would have no one ready to staff the general hospitals that would receive the seriously ill or wounded together with the overflow of smaller facilities. Lovell appears to have been well aware of the problems this arrangement could cause. In the regulations he issued for the department, he outlined an organizational framework different from that created by Congress, detailing the duties to be undertaken by hospital surgeons and mates and other staff members. He introduced the position of the medical director, who would be responsible for the medical care of the sick and wounded of an entire army or of a large geographical area. And for greater efficiency in the management of his staff, Lovell insisted that all surgeons, regardless of their duties, report directly to him in Washington.

In 1821 Congress abandoned its attempts to dictate the structure of the Medical Department and classified all medical officers as either surgeons or assistant surgeons. In so doing, the new legislation eliminated the Apothecary Department entirely, allowing Lovell to assign whomever he wished to handle purchasing. Although the physician appointed to serve as the chief medical purveyor in New York City continued for the remainder of his career in that post, the surgeon general was free to change the assignments of all of his purveyors as he wished.

The result of the reorganization was a medical department still too small to care for an Army divided into small units func-

2Ltr, Calhoun to Brown (25 Apr 1818), in The Papers of John C. Calhoun, ed. Robert L. Meriwether and W. Edwin Hemphill,10 vols. (Columbia: University of South Carolina Press for the South Carolina Society 1963), 2:259 (hereafter cited as Calhoun Papers).

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tioning independently yet flexible enough to minimize the effects of its inadequate size. The complete solution to the problem of understaffing was not within the surgeon general`s power. Already the law of 1818 had reduced by five the number of physicians serving in the Army. Although Lovell admitted that a sufficient number remained at that time to give each post one doctor, he emphasized that a single physician could not adequately serve the needs of either the very large or the very unhealthy post. Unimpressed, in the course of cutting back the size of the Army in general, Congress in 1821 again reduced the authorized size of the staff, from 64 to 53,of whom 45 were assistant surgeons. Among those the surgeon general dismissed was the once widely respected Benjamin Waterhouse, who had introduced vaccination to the United States but who had also acquired a reputation of being vitriolic and greedy, "a man of talents and sciences [who] has not made himself a good practical physician." Another physician of much military experience who was dropped was one whose "conduct for intemperance" had become "a matter of some notoriety," and whose mind was "too much affected to attend regularly to business."3

As the nation expanded westward and the number of posts increased, Lovell continued to make temperate but insistent protests against the inadequate size of his department. He pointed out that the standards of medical care offered to the nation`s soldiers would deteriorate if the ratio of surgeons to posts and men as established in 1821 was not maintained. He emphasized to the secretary of war that, because

BENJAMIN WATERHOUSE.(Courtesy of National Library of Medicine.)

of the small number of physicians in the department, the unrelieved duty time of an Army surgeon exceeded that of any other Army officer; some surgeons had served as long as ten years without a furlough. Lovell reminded the secretary that the shortage of Regular Army surgeons made it necessary at times to pay private physicians to handle department duties and that in some areas doctors willing to do so were hard to find. Furthermore, they were neither as careful in their use of supplies nor as capable of supervising the sick and wounded as their military counterparts. Lovell maintained that a Regular Army surgeon should perform the physical examination of recruits because it was more likely that an Army physician rather than a private physician would spot defects that would cause a man to be unfit for military duty. Despite Lovell`s arguments, it was not until June 1832

3First quote, Ltr, Calhoun to Monroe (18 Jun 1821), in Calhoun Papers 6:198; remaining quotes, Ltr, Foster Swift to Lovell (9 Jan 1821), RG 112, entry 12.

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that Congress authorized the president to name four more surgeons and ten more assistant surgeons to the Medical Department.4

Nevertheless, the law of June 1832 only partially alleviated the shortage of physicians in the Army. To guarantee care for the Army`s sick and injured, further restrictions on the leave taken by Army surgeons soon became necessary. After 1835, granting any leave longer than seven days required approval of the secretary of war.

Ironically, in the early 1830s, at the very time that Lovell was urging the appointment of more medical officers to the department, a new secretary of war, operating under the mistaken impression that the position of surgeon general was superfluous, proposed to abolish it, thus ending the Medical Department`s existence as a separate entity. Secretary John H. Eaton concluded that the surgeon general`s duties involved only supply and that these responsibilities were actually being handled by the Quartermaster`s Department. Lovell countered by pointing out that regulations prohibited the Quartermaster`s Department from buying medicines and hospital supplies, which since 1821 had been purchased by a Medical Department surgeon stationed in New York City. He also emphasized that the administrative responsibilities of the Surgeon General`s Office were broad and included "securing the professional responsibility of [the department`s] several officers, a strict accountability for public property and a material reduction of its expenses." Lovell`s argument prevailed, and the position of the surgeon general remained a the top of the Medical Department hierarchy.5

The caliber of the surgeons serving under him was another of Lovell`s concerns. He sought both to attract promising young physicians by increasing their salaries and to weed out incompetents by means of examinations for entry and promotion. His campaign for higher salaries was launched in the fall of 1818, when he pointed out to Secretary of War Calhoun that competent surgeons would be reluctant to join the Army or to remain long in it if their compensation was not increased above the $40 to $45 a month then offered, a sum less than that paid line officers with similar lengths of service. Calhoun`s initial efforts to have the salaries of Army surgeons raised were not successful. The surgeon general was himself paid $2,500 a year, a salary lower than that of many comparable officers in other branches of the service. Urged on by the pleas of his subordinates, however, he continued to emphasize the need for higher salaries. In 1828, for example, he commented that, except for the forage allowances for their horses, the most senior assistant surgeons received only $3 a month more than the greenest second lieutenants .6

At last, in 1834, the Medical Department`s entire pay scale, except for the salary of the surgeon general, was raised and the principle of greater pay for longer service established for its members. Congress allowed the most experienced surgeons the

4Ltrs, Lovell to Sec War (1 Aug 1830 and 13 Jan 1832), both in U.S. Congress, American State Papers ... V Military Affairs, 7 vols. (Washington: Gales & Seaton, 1832-61), 4:644-45 and 826-27, respectively (hereafter cited as American State Papers: Military Affairs); see also other Ltrs, surgeon general (SG) to various recipients (1823-33), RG 112, entry 2, vols. 5 and 6.
5Quote from War Department, SGO, Annual Report (1 Aug 1830), 1831, p. 3; Ltrs, Lovell to Calhoun (6 Feb and 21 Dec 1821), both in Calhoun Papers 5:597 and 6:579, respectively.
6Ltrs, Squier Lea to Lovell (2 Oct 1820) and William Turner to Lovell (I Jan 1828), both in RG 112, entry 12.

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pay of majors, $50 a month plus eight rations and forage for three horses ,assistant surgeons with at least five years of service that of captains, and the least experienced assistant surgeons that of first lieutenants. Those who served in either rank more than ten years were to receive double rations. Nevertheless, although their pay was keyed to that of Regular Army officers, Army surgeons still had not been given rank.7

The shortage of Army surgeons forced Lovell to sign contracts from time to time with civilian physicians, who were paid by the department on the basis of the size of the units to which they were assigned. Those caring for the sick and wounded of a unit of 100 or more men received $40 a month. For 50 to 100 men, the fee was $30 a month; for 50 or less, $20 a month. The doctor providing his own medicines or supplies might receive 25 to50 percent above these rates.

Although higher pay might encourage able physicians to enter the Medical Department, it obviously would neither discourage incompetents from applying nor cause those already in the department to resign. Lovell emphasized the problem he faced in this regard when he described one physician in his department as "so illiterate that he cannot spell his own name, "so old that he had no intention of ever joining his regiment, and so unequal to the responsibilities of an Army surgeon that he had been forced to resign an earlier appointment as regimental mate "to avoid an arrest for incompetence." Neither the legislation of 1818 nor the department`s regulations, however, made provision for weeding out such men. Appointments were made from each state according to the number of representatives it sent to Congress, but the regulations themselves required only that new members have a diploma of some type from a "respectable medical school, college, or society" or pass an examination administered by an Army medical board. Since the examination was rarely given, only Lovell`s vigilance could bar entry to incompetent surgeons or eliminate those already there. Nevertheless, the department`s physicians soon acquired an enviable reputation among those most familiar with their work. In 1827, for example, the inspector general of the Army, George Croghan, commented that "The army is truly fortunate in having such a medical corps ... More than once I have questioned myself, how it could be that the government were enabled to employ such professional worth and talents at so paltry a price."8

Some question exists as to exactly when Lovell modified his regulations to include the requirement that all candidates for appointment to the department or for promotion within it pass an examination by an Army medical board. This requirement was first activated in 1832, at a time when states were beginning to eliminate licensing exams for private physicians and exams were not required for other Army officers. From that time onward, no one joining the Medical Department was spared these tests. Even former Army surgeons desiring to return to the department were required to take them. The examining board, com-

7Ltrs, Calhoun to Johnson (21 Dec 1818), in Calhoun Papers 3:413; Lovell to Sec War (8 Nov 1828) and to Thomas H. Benton (18 Dec 1828), both in American State Papers: Military Affairs 4:32, 64-66, respectively.
8Quotes from Ltr, Lovell to Calhoun (18 Jun 1818), in Calhoun Papers 2:344, "Regulations of the Medical Department, September 1818," in Brown, Medical Department, p. 120, and George Croghan, Army Life on the Western Frontier: Selections From Official Reports Made Between 1826 and 1845, ed. Francis Paul Prucha (Norman: University of Oklahoma Press, 1958), p. 70; Ltr, Francis LeBaron to Lovell (21 Sep 1818), RG 112, entry 12.

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posed of three surgeons or assistant surgeons, was prepared to travel from post to post and city to city, if necessary, to administer the three-day examination. Physicians appointed to the department between the time when the new regulation was issued and that of the first examination a year later received conditional appointments and either took the tests when offered or left the Army. Assistant surgeons who had served five years in the department were required to take the promotion test in order to remain in the Army. They were not required to take a promotion should they pass; since assignments were based on seniority within grade, and transition from senior assistant surgeon to junior full surgeon might bring with it an undesirable change of post, refusal of promotion was not unusual. Those who failed might try the exam again after two years, but a third attempt was not permitted. To retain eligibility, any candidate who passed the examination but did not receive an appointment within two years had to repeat the process.9

Lovell`s campaign to upgrade the department still faced serious obstacles. The relatively low salaries and the specter of months of constant exposure to disease in desolate surroundings undoubtedly discouraged many able young doctors. One department physician pointed out, "The Surgeon is more confined, than any of the other officers, and Without the prospect of promotion, rank, or military Honors; performs the most important, Laborious, and Dangerous duties; for a consideration less than a Wagon Master. "Another wrote Lovell of the deaths of two of his children, the illness of his wife, and the destroyed health of his remaining child, adding that his "mind was too much fatigued, to attempt the drudgery of making out returns" and that the only deaths at his post were those of his own children. Nevertheless, Lovell could offer intangible rewards to the ambitious. He encouraged his surgeons to send geological, zoological, and botanical specimens back to interested scientific institutions. His open and unselfish support of Army surgeon William Beaumont`s pioneering work in the field of human digestion suggested that, despite the hardships, the Army Medical Department could offer opportunities to men of talent.10

Lovell`s concern for the welfare of the department`s surgeons also led him to attempt to consider the preferences of individual physicians when making assignments. The alternatives for full surgeons were few; in mid-1826, for example, Fortress Monroe, Virginia, and West Point were the only posts open to them, and the remainder were assigned to regiments. The choices available to assistant surgeons were more numerous and some medical officers remained at one post for as long as twenty years, but both surgeons and assistant surgeons, as a rule, were quick to request transfers if their assignments were not entirely to their liking. In 1825 the department initiated a requirement that Army physicians remain at least two years at their

9The two preceding paragraphs dealing with Medical Department examinations are based upon Rodney Glisan, Journal of Army Life (San Francisco: A. L. Bancroft & Co., 1874; Washington, Library of Congress [LC], microfilm 35155), pp. 3-4; Fayette Robinson, An Account of the Organization of the Army of the United States,2 vols. (Philadelphia: E. H. Butler & Co., 1848), 1:42-43; Ltrs, Lovell to various recipients (1831-36), RG 112, entry 2, vols. 5-7; Records of the Adjutant General`s Office, 1780s- 1917, RG 94, Letters Sent by the Office of the Adjutant General, 1800-1890, microfilm publication M565,roll 8, 10:343, 395, NA; Ltr, Lovell to Samuel Beekman (24 Mar 1828), RG112, entry 2, 4:226-27.
10First quote, Ltr, Lea to Lovell (2 Oct 1820), and second, Ltr, T. J. C. Monroe to Lovell (12 Nov 1829), both in RG 112, entry 12.

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posts before requesting transfers. But the problem was still not entirely solved, and Lovell was irritated to learn that some medical officers, including Thomas Lawson, who would be his successor as surgeon general, were rushing to request changes of assignment as soon as the two-year period had passed.11

Lovell`s attempts to please everyone actually led to discontent among some members of the department. Lawson, who responded to Lovell`s suggestion that he was too "pugnacious" with a fourteen page letter of 16 October 1825 reciting his superior`s failings, accused the surgeon general of, among other things, favoritism in the granting of appointments. "Some of the Surgeons," Lawson wrote, were "about to apply for a Reorganization of the Medical Staff" and unless prevented from doing so by difficulty in agreeing about how to proceed, they would formally try to "effect a new organization, or to produce a change in the present system of government under the existing organization of the Medical Staff." In 1830 the secretary of war assumed the final responsibility for assignments, but some relaxation in this rule was allowed in 1834, when those with three years or more of service within grade were granted their choice of vacantposts.12

THOMAS LAWSON (Courtesy of National Library of Medicine.)

Despite their many duties, some surgeons, particularly those assigned to small posts, had free time. With salaries less than generous, the temptation to take on private patients must have been strong. Although for many years the department`s regulations categorically forbade private practice, exceptions to the rule, while not always granted, were frequent. Early in October 1818, for example, Lovell wrote Calhoun that a surgeon at Norfolk, Virginia, was being permitted to continue treating patients who had no connection with the Army. In 1820 Beaumont mentioned seeking permission to care for sick and injured civilians at Mackinac Island, where no other physician was available for 300 miles; fortunately for American medicine, his request was granted. In 1834, although the prohibition against private practice had been reiterated, the adjutant general ruled that several military surgeons who had raised the question had permission to treat civilians as long as their doing so did not interfere with the performance of their assigned duties. This ruling appears to have

11Ltrs, Lovell to Calhoun (26 Nov 1818), in Calhoun Papers 3:301; Lovell to Thomas J. Jesup (1Sep 1818) and to Lawson (28 Apr 1827), both in RG 112, entry 2, 2:7 and 4:144, respectively; see also other Ltrs (1818-1822, 1826-1829), RG 112, entry 2. vols. 2 and4.
12Ltr, Lawson to Lovell (16 Oct 1825), RG 112, Lawson Letters, entry 226.

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represented the official attitude toward private practice.13

In the course of his private practice, the Army surgeon also often cared for civilian workers and military families on the base. The extent to which he was officially responsible for civilians in these categories, however, was not always clear, even to members of the department. By the time of Lovell`s death, it was apparently understood that the surgeon was not required to care for anyone who was not in the Army, although it appears that he was permitted, as a rule, to supply medicines for the families of the soldiers at their posts and to provide hospital stores for civilian workers. In unusual circumstances, surgeons could also supply medicines to anyone in desperate need who was unable to pay for his own.14

Lovell`s ambitions for his surgeons extended beyond the provision of the best possible medical care for the Army`s soldiers. His appreciation of the new department`s unique opportunity for significant contributions to medical science led to a requirement that department physicians participate in attempts to establish the relationship of meteorological factors to health, a step he had urged before he became surgeon general and one proposed during the War of 1812 by James Tilton, then head of the U.S. Army`s medical services. Early in the course of his service as surgeon general, therefore, Lovell ruled that the surgeons under him must submit reports on the diseases they treated and on the weather and climate, as well as on landscape features, such as elevation, drainage, and vegetation, that might affect the health of the men. Lovell did not initially receive the cooperation he wished from his surgeons, who appear to have retained the nonchalant attitude toward reports that characterized their predecessors. Within two years, however, he was able to comment that his orders were being obeyed.15

With the aid of these detailed reports, it is possible to achieve some understanding of the sick rate with which the Medical Department had to contend more than 150 years ago. One author has determined that the rate of hospital admissions, largely as a result of fevers, digestive ills, and respiratory diseases, was on the average five times higher from 1819 to 1829 than, for example, it was in 1949 and that the mortality rate was fifteen times higher. Since no separate reporting category listed the number of men suffering from alcoholism and the effects of intemperance, even Lovell himself could only assume that this problem played an important role in much illness and death attributed to other causes. Although these morbidity and mortality rates seem shocking in the late twentieth century, they did not seem so to Lovell, who commented in 1822 that the death rate in the Army was less than that among young men in civilian life.16

Lovell`s interest in the way in which his surgeons performed their duties did not blind him to the important role that non-professionals, such as nurses, cooks, ward masters, and stewards, played in the care of the sick and wounded. In the earliest

13Ltrs, Lovell to Calhoun (2 Oct 1818), in Calhoun Papers 3:185; Adjutant General (AG) to J. Manney (17 Jul1834), RG 94, M565, roll 8, 11:49; Henry Stevenson to Lovell (19 Mar 1835),RG 112, entry 12.
14Ltr, Benjamin King to J. M. Foltz (17 Nov 1836), RG 112, entry 2, 8:112-13.
15Ltrs, Lovell to Calhoun (I Nov 1818 and I Aug 1819) and Calhoun to Jackson (10 Aug 1819), all in Calhoun Papers 3:248 and 4:224-25,respectively.
16Ltrs, Lovell to Calhoun (3 Oct and I Nov 1818), both in Calhoun Papers 3:186, 249, respectively; Edwin Sheffield Marsh II, "The United States Army and Its Health, 1819-1829," Military Surgeon 108(1951):505.

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years, civilians could be hired to fill these positions, but in 1822 the adjutant general decided, despite criticisms of the poor work performed by soldiers in hospitals, that only enlisted men selected by the surgeons for whom they would work should be assigned these responsibilities. Although the permission of the enlisted man`s commanding officer was necessary for his assignment to hospital duty, once the appointment had been made, the attendant was subject only to the command of the surgeon, except in cases of great emergency. This system did not work as well as the adjutant general had assumed it would. In 1833 the secretary of war gave doctors in charge of Army hospitals permission, when absolutely necessary to obtain suitable attendants, to enlist into the Army directly from civilian life men who appeared particularly well qualified.17

Guidelines concerning the size of staffs required by Army surgeons to man their hospitals were set forth in the department regulations. Initially, these regulations stated that a general hospital would need a steward and a wardmaster, one nurse to every ten patients, one matron to every twenty, and a cook for every thirty. A regimental hospital staff might consist of a noncommissioned officer who served as both steward and wardmaster, two matrons, a cook, and four nurses, chosen from among the privates in the regiment. A hospital for a post garrisoned by a single company would probably have a private serving as wardmaster and steward and either two nurses or a nurse and a matron. A post of more than one company was assigned an extra nurse for every added company.

The pay of civilians working in Army hospitals varied from $10 to $16 a month for hospital attendants to $5 for matrons, while enlisted received only their regular pay for hospital work. Whether the matron at this time was still a supervisor of nurses as she was in the Continental Army is not clear, but she apparently was responsible for cooking, nursing, washing, and cleaning. The worth of an intelligent and dedicated steward or attendant was well recognized, but shortages of funds and the absence of a legislative or regulatory provision permitting an additional allowance often frustrated attempts to give enlisted men and noncommissioned officers extra pay. Nevertheless, despite the low pay, at least one steward in the Army in 1835 was himself a highly respected physician.18

The administrative staff assisting Lovell in his Washington office consisted of a single clerk, also a physician. He was paid $1,150 a year, and his responsibilities apparently included a small but growing collection of books and journals started by Lovell and continued by his successors, the first volumes in what would eventually become a vast medical library. The initial intention was that each post or regiment have texts on, among other things, anatomy, surgery, and medical practice, and it appears that whenever a book was sent out to sur-

17Ltrs, Lovell to King (11 Oct 1821), RG 112,entry 2, 2:241; John H. Eaton to Lovell (4 Feb 1822), RG 112, entry 12;Lovell to Calhoun (18 Jan 1822), in Calhoun Papers 6:627; Surgeon at Ft. Gadsden, Fla., to Lovell (n.d.), in Ayars, "Notes: Medical Service," p. 511.
18Ltrs, Lovell to Benjamin Harney (3 Jun 1824 and 15 Nov 1828)and Henry Heiskell to A. Cox, Jr. (30 Sep 1830), all in RG 112, entry 2,3:147, 4:305, and 5:210, respectively; Thomas Mower to Lovell (2 Jun and 1 Nov 1818, and 2 Sep 1822), Swift to Lovell (5 Jan 1822), James Mann to Lovell (3 Feb 1822), Samuel Smith to Lovell (5 May and 29 Nov 1822), Edward Purcell to Lovell (6 Aug 1822), W. V. Wheaton to Lovell (24 Jan 1835),and Philip Maxwell to Lovell (8 Oct 1835), all in RG 112, entry 12.

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geons in the field, a copy was retained for the Surgeon General`s Office.19

Although Lovell`s accomplishments while he was surgeon general were many, he appears to have regarded as most significant his success in the management of the department`s finances. He believed that his close supervision of the work of his surgeons and, in particular, his insistence upon regular and systematic reports concerning their use of all forms of department property were responsible for important savings. In the autumn of 1822 he commented that he had succeeded in creating "a perfect system of responsibility for all public property from the period of its purchase to that of its expenditure" and that there was no longer any "possibility of fraud, extravagance or undue expenditure." The figures he cited to prove his point appear not to have included the salaries of either regular or contract surgeons but to have been limited strictly to supply and housing costs. They showed that from 1816 to 1818, $7 was paid out per man per year for medical care, but that by 1820 the figure had dropped to $3. It reached a low of $1.72 in 1824 before starting to rise again to $4.60 in both 1827 and 1828; it then dropped again to below $3.20

The overall annual expenses of the department during the 1820s apparently ran between $23,000 and $30,000, including the costs of hiring private physicians. (Exact figures are not easily obtained because Lovell often reported in the fall only for the preceding eight months of the calendar year, adding an estimate for the remaining four months.) As Army units were sent ever further west and the need for more surgeons grew, the department`s annual expenses grew also, approaching $34,000 in 1834. Of these sums, a large proportion went to pay private physicians, an expense the surgeon general had not included in his figure for the average cost per man. In the first eight months of 1824, for example, $5,152.30 was paid out to civilian doctors, while by 30 September 1829, the figure averaged more than $1,500 a month.21

Until 1821 the Apothecary General`s Office managed actual purchasing for the Medical Department. After the abolition of that office, supply responsibilities were given to a few surgeons and assistant surgeons. Items such as cooking utensils, hospital furnishings, and the food used for a regular diet were obtained through the commissary of purchases, the military storekeeper, or the Quartermaster`s Department, as appropriate. But medicines, instruments, and special diet items were, as a rule, obtained by medical purveyors directly from merchants. In 1820 Calhoun required that the Medical Department be guided in its ordering of medicines by the "General Pharmacopoeia" then being prepared by a medical convention.22

The role of the Quartermaster`s Department in supplying the Medical Department varied. In 1819, for example, Lovell urged that supplies be obtained through the quartermaster only when absolutely necessary, but surgeons continued to ignore this in-

19Ltrs, Lovell to Calhoun (24 Jan 1821) and to Sec War (9 Oct 1833), both in RG 112, entry 2, 2:111 and 6:252, respectively; Dorothy M. Schullian and Frank B. Rogers, "The National Library of Medicine," Library Quarterly 28 (1958):2, 5; Hume, Victories, pp. 12, 46.
20Quote from Ltr, Lovell to Calhoun (28 Nov 1822), in Calhoun Papers 7:358; Reasoner, "Medical Supply Service," p. 14.
21American State Papers: Military Affairs 2:125, 711;4:32, 201-02; and 5:445.
22Quote from Ltr, Lovell to Calhoun (12 Jan 1820), in Calhoun Papers 4:568; Ltrs, Lovell to Lawson (14 Feb 1823) and to O. Tiffany(16 Apr 1831), both in RG 112, entry 2, 3:17 and 5:212-13, respectively; Lovell to Calhoun (13 Jan 1820), in Calhoun Papers 4:569.

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struction, even during the short period when the Office of the Apothecary General existed to handle such purchases. With the abolition of the Apothecary Department, surgeons were told specifically to turn to the quartermaster for emergency or casual needs. Regardless of how supplies were obtained, however, shortages could result from problems created by distance, shipwrecks, and confusion over troop movements. Items were damaged in shipment, and delays of as much as a year between requisition and delivery occurred. Because of such difficulties, surgeons were occasionally permitted to buy what they needed directly.23

Lovell proved to be a talented administrator, skilled in the management of both men and supplies; one of his surgeons wrote of the surgeon general`s "undeviating kindness" toward his subordinates and their problems. Nevertheless, since Lovell could exert but little control over the situations his subordinates faced in the field, the Army`s physicians were to a large degree on their own in handling the varying difficulties that they encountered at their posts or while accompanying detachments on the move .24

Surgeons in the Field

The life of the Army surgeon and the problems he encountered varied considerably according to his assignment. In the East, a relatively civilized life was possible, but in the West, isolation and an unfamiliar environment often gave rise to situations for which the eastern-raised and trained young physician was not prepared. In the Northeast, many of the disease she was called upon to treat were the familiar ones of the respiratory system, but in the West, he often encountered malaria and, in the winter and early spring, scurvy as well. In the deep South he fought not only malaria but also diarrhea-like diseases and quite possibly yellow fever. Moreover, the garrison of the fort to which he had been sent might have its own peculiar problems, those that resulted, for example, from bad water, lead poisoning, or alcoholism, all factors that might be included among the "morbific agents ... which it falls to the lot of [the military doctor] to encounter."25

Wherever he was stationed, east or west, the Army surgeon, unlike his civilian counterpart, had to deal with men living closely together, among whom disease could spread rapidly. Once enlisted men fell ill, they would be gathered together in one place and, being subject to military discipline, were easier to treat than civilians, each in his own home. On the other hand, in the military hospital, and especially in wartime, soldiers would be exposed to cross infection, a problem that was essentially non existent in private homes.

Unfortunately, the facilities available for the accommodation of the Army`s sick often left much to be desired, even by the standards of the time. In one instance, a "small, but convenient [sic] Hospital ...comfortably arranged and very well sup-

23Ltrs, Lovell to Richard Weightman (28 Apr 1819), to all surgeons and mates (27 Mar 1820), to Lea (27 Aug 1828), to James H. Sargent and to Mann (both 11 Feb 1823), to Sec War (3 Feb 1831),and to Jesup (3 Sep 1833), all in RG 112, entry 2, 2:59, 191, and 237,3:12 and 13, 5:185-87, and 6:223, respectively; Alfred Elwes to T. M. Glassell(15 Jul 1827), John Thurston to Lovell (I Jul 1829), and S. Shannon toH. Stanton (copy, 18 Feb 1833), all in RG 112, entry 12.
24Ltr, W. L. Wharton to Lovell (22 Dec 1829), RG 112, entry12.
25Quote from SGO, Statistical Report on the Sickness and Mortality in the Army of the United States From January 1819 to January1839 (Washington: Jacob Gideon, Jr., 1840), p. 62 (hereafter cited as Statistical Report, 1819-39).

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plied" and managed by "a competent, intelligent and faithful Steward" lacked an attending surgeon. In many more instances, the reverse was true; the surgeon was present at the post, but no hospital facilities awaited his patients. The housing that sheltered the sick and injured at such posts was often so damp, poorly ventilated, and crowded as to further threaten their health. In late 1835, of the thirty-one posts in states along the East and Gulf coasts and in the District of Columbia from which surgeons reported, twelve had no hospitals, and those at three more were rated as poor.26

One of the eastern posts without hospital facilities was Fort Hamilton in New York Harbor. Here the sick were housed in casemates that lacked adequate ventilation and heat. Even in moderate weather the rooms might become unbearably hot. In cold weather, the wind often drove the smoke back down the chimney; the surgeon there reported that on such occasions sulfurous clouds filled the air and only the opening of doors, which let in cold, damp drafts, could dissipate them. The dampness contributed to rheumatism and related conditions. The need for a hospital at Fort Hamilton was recognized, but none was built while Lovell was surgeon general.27

The hospital at Fort McHenry in Maryland, on the other hand, was described as "passable." This was fortunate, since the elderly surgeon assigned to this post in 1818, William Stewart, had to contend with a disease rate that was the highest in the entire Northern Division. Initially, Stewart blamed the most common ailment, "an constipation of the intestines" accompanied by fever, on the water, which tasted strongly of iron, but he later suggested that the cause was rather a steady diet of salt pork. A surgeon sent to inspect the post disagreed, stating that he believed the constipation to be "merely symptomatic, produced by a peculiar state of the bile, and of course referable to all those causes which affect the bilious secretion. At Fort McHenry these natural causes," he added, were "aided by habits of inveterate drunkenness; for I never, among the same number of men, heard of so many addicted to intemperance."28

The disease afflicting the men at Fort McHenry and nearby Fort Severn apparently grew worse with time, and by 1819 its victims were being stricken by "frequent attacks of inflammation of the brain, ending in delirium, apoplexy, and death." In the year from March 1819 to March 1820, thirty-nine men at Fort McHenry were afflicted in this manner, and sixteen died from convulsions. The number of cases dropped when a unit camped at some distance from the fort (and possibly also at some distance from the suppliers of hard liquor), and speculation arose that the cause of the illness lay in the atmosphere at Fort McHenry. The problem continued throughout the early1820s, causing one or two deaths each year in the fifty-man gar-

26Quote from Ltr, William Beaumont to Lovell(30 Sep 1835), RG 112, entry 12; Ltr, Lovell to Sec War (28 Dec, 1835), RG112, entry 2,7:339-41. Unless otherwise indicated, statistics concerning morbidity and mortality rates at the posts discussed in this chapter are based on Statistical Report 1819-39.
27Ltrs, Elwes to Lovell (28 Nov and 10 Dec 1832) and Eaton to Heiskell (7 Jul 1842), all in RG 112, entry 12; Lovell to Elwes (29 Dec 1832) and to Lawson (13 Dec 1833), both in RG 112, entry 2, 6:35 and 238, respectively; Surgeon`s Quarterly Rpt, Ft. Hamilton (30 Jun 1833),and Rpt, Elwes to Lovell (6 Nov 1835), both in RG 94, Reports of Sick and Wounded, 1820-1860, entry 634.
28Harold Wellington Jones, ed., "A Hospital Inspector`s Diary," Bulletin of the History of Medicine 7 (1939):231-33,quotes from pp. 231-32; Surgeon`s Quarterly Rpts, Ft. McHenry (31 Dec 1818and 31 Mar 1819), both in RG 94, entry 634; Ltr, Stewart to Lovell (16Sep 1819), RG 112, entry 12.

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rison. By 1826 it had become customary to send the troops from the fort to camp at Huntington, Maryland, in late June.29

Although meningitis could have caused some of the illness at Fort McHenry, it is entirely possible that chronic alcoholism was a basic part of the health problems there, accompanied, perhaps, by malaria during the summer and early fall months. Many symptoms could have resulted from lead in the cheap whiskey the men drank, since in 1829 the formation of a temperance society at the post was followed by an improvement in the health of the garrison.

After they began to drink coffee instead of whiskey, the men also seemed to live together more amicably and to work more efficiently. Reports on the accomplishments of the temperance society were so glowing that the secretary of war himself expressed an interest in this experiment in sobriety.30

Surgeons stationed at Baton Rouge found health problems more serious than those at Fort McHenry. Until 1825, this post, the most disease-ridden in the entire

29Quote from War Department, SGO, Annual Report (1 Aug 1819), 1819, p. 2; Surgeon`s Quarterly Rpts, Ft. McHenry(30 Jun, 30 Sep, and 31 Dec 1819, 31 Dec 1820, and 30 Sep 1822), all in RG 94, entry 634.
30Ltrs, Lovell to Robert French (3 Mar 1830), RG 112, entry2, 5:98; French to Lovell (31 Dec 1829 and 1 Apr 1830), both in RG 112, entry 12; George N. Thompson, ed., Alcoholism (Springfield, Ill.: Charles C Thomas, 1956), pp. 253, 413, 476; Aspects of Alcoholism 1(Philadelphia: J. B. Lippincott Co., 1963):14-15.

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nation, might record in the course of any given year over 20 percent of the total deaths in the Army. In the second quarter of 1822, for example, twenty-eight of the Army`s total of forty-one deaths took place there. Dysentery, diarrhea, and malaria, all complicated by intemperance, took a high toll at Baton Rouge, where, in 1819, 1822, 1827, and 1830, the threat of yellow fever also added to the sufferings of the garrison. Despite the post`s notorious reputation, its hospital facilities were entirely inadequate.31

The surgeons who struggled to deal with the problems at Baton Rouge blamed the poor health of the garrison on the lack of acclimatization of the recruits, the intemperance of the men, their long work in the hot sun, their poorly constructed barracks, and even, in June 1822, on the "entire absence of rain." Lovell, on the other hand, eventually concluded that the presence of ponds, old buildings, and a graveyard located south of the barracks was responsible for the high rate of disease, apparently because of the miasmas they engendered.32

The problem of inadequate housing for the men at Baton Rouge was solved in 1824 with the construction of a new barracks, and it appears that by 1825 the health of the men was improving. Whether the improvement resulted from the new barracks, a final acclimatization of the men, an easing of their workload in hot weather, or possibly a combination of these three factors is unknown. It would appear, however, that by the time the hospital was completed in 1839, the need for such a facility was no longer as great as it had been in the 1820s when Lovell first urged that it be built.33

In contrast to Baton Rouge and Fort McHenry, Fort Mackinac, on Mackinac Island in Lake Michigan, was representative of the healthiest posts in the nation. (Map 1) In a cool climate and cut off from the rest of the world from November through the winter, the fort shared the island with 500 French Canadians and half-breeds who lived in the village of Mackinac, one of a chain of trading posts that lay along the Mississippi River and the shores of Lakes Michigan, Superior, and Huron. From Mackinac each fall, voyageurs, among them at one time Beaumont`s famous patient, Alexis St. Martin, set out in boats laden with goods to trade with the Indians for furs, returning in June and July of each year. Indians also came to Mackinac to trade, and the population fluctuated by several thousand, according to the season.34

In 1821 Fort Mackinac consisted of three intersecting lines of blockhouses and a wall of ten-foot-high pickets, placed at the top of a steep hill. The earliest hospital at the fort, like the facilities at so many other

31John Duffy, ed., The Rudolph Matas History of Medicine in Louisiana, 2 vols. (Baton Rouge: Louisiana State University Press, 1958), 1:484; Surgeon`s Quarterly Rpts, Baton Rouge (1821-36), RG94, entry 634; Records of the Office of the Inspector General, RG 159,Report on Condition of Troops and Posts, 1823, M624, roll 1, p. 10.
32Quote from Surgeon`s Quarterly Rpt, Baton Rouge (30 Jun 1822),RG 94, entry 634; Rpt, Lovell to Calhoun (I Nov 1822), in Calhoun Papers7:325; Ltr, Lovell to Harney (12 Apr 1823), RG 112, entry 2, 3:42; SGO, Annual Reports (Aug 1821, Nov 1822, and Nov 1823), pp. 3, 1, and 1-2, respectively.
33Ltrs, Lovell to Calhoun and to Harney (both 11 Jul 1821),both in RG 112, entry 2, 2:229; SGO, Statistical Report on the Sickness and Mortality in the Army of the United States from January 1839 to January1855 (Washington: A. O. P. Nicholson, 1856), p. 254.
34Willard B. Robinson, American Forts, Architectural Form and Function (Urbana: University of Illinois Press, 1977), p. 61;Myer, Beaumont, pp. 94-95; John Reed Bailey, "Army Surgeon," Physician and Surgeon 22 (1900):574-75; Keith R. Widder, Reveille Till Taps ... (Mackinac Island, Mich.: Mackinac Island State Park Commission,1972), p. 69; Ltr, Beaumont to Mrs. Lucretia Beaumont (16 Jun 1836), Papers of Win. Beaumont, M.D., Ms. Collection, doc. 36, folder 2, microfilm reel1, Washington University, School of Medicine Library, St. Louis, Mo.

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Map 1. The Frontier, 1818-1835

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posts, left much to be desired. It was located in an old, one-story storehouse, divided into two wards and a small kitchen, where in the summer the roof leaked and in the winter the rooms filled with smoke. The surgeon lived in a stone house built into the side of the hill. The fort`s isolation made supply particularly difficult, the post medical officer occasionally having to provide medical services as long as eighteen months without receiving new stocks of medicine. Surgeons ensured a proper diet for their patients by establishing a hospital garden on part of the post`s open ground, growing vegetables as well as opium poppies.35

Its best known Army surgeon, William Beaumont, arrived at Fort Mackinac in 1820, shortly after he was commissioned in the Army for the second time. Because Fort Mackinac was a healthy post, much of Beaumont`s work involved maintaining the health of the 50- to 100-man garrison and treating the victims of various mishaps. These responsibilities were not overly demanding, and Beaumont, like his predecessor, was able to gain permission to conduct a private practice, since no other physician lived nearby.36

From the outset, Beaumont`s concern that the post should have a garden to ensure the continued health of the garrison antagonized both the Indian agency on the island and the fort`s commanding officer, who had given the agency permission to erect a building in the middle of the garden plot. But because Beaumont believed so strongly in the importance of the garden for the health of the men, he wrote the War Department to complain; his plea was apparently heeded, and the garden remained.37

Partially as a result of his concern for the prevention of disease, many of Beaumont`s patients were the victims of mishap rather than illness. Among those he treated was an artillery private who had been clubbed in a brawl. Although the surgeon trephined the victim`s skull in an attempt to relieve the pressure on the brain and to remove bone fragments, he was unable to save this patient`s life. He was more successful with a would-be deserter who had survived a week wandering without food, drink, shelter, or a source of warmth at a time when the nighttime temperatures ranged from 20° to -14° F. A visitor who had experienced a relapse of what he reported as "lake fever" (presumably malaria) while traveling from Detroit to Mackinac was one of Beaumont`s few patients suffering from disease. Although he had initially appeared to be hopelessly ill, under Beaumont`s care the newcomer recovered.38

Although the demand placed on the hospital at Fort Mackinac did not equal that at such posts as Baton Rouge and Fort McHenry, Lovell, Beaumont, and Beaumont`s successor at Fort Mackinac in 1825, all urged the construction of a new hospital. Lovell pointed out that the old structure was not fit for the use of healthy men, much less for the sick, who, because of the leaky roof, occasionally had to abandon their beds during heavy storms. In 1827 a new hospital was finally erected, only to

35Ltr, Beaumont to Lovell (1 Nov 1820), RG112, entry 12; Surgeon`s Quarterly Rpt, Ft. Mackinac (30 Jun 1820), RG94, entry 634; Bailey, "Army Surgeon," p. 574. Unless otherwise indicated, material on Ft. Mackinac is based on Myer, Beaumont; Widder, Reveille; and Ella Hoes Neville, Sara Greene Martin, and Deborah Beaumont Martin, Historic Green Bay, 1634-1840 (Green Bay, Wis.: Privately printed, 1893).
36Surgeon`s Quarterly Rpts, Ft. Mackinac (1820-21), all in RG94, entry 634; Ltr, Richard Satterlee to Lovell (3 Sep 1835), RG 112, entry12.
37Ltr, Beaumont to Lovell (1 Nov 1820), RG 112, entry 12.
38Albert G. Ellis, "Fifty-Four Years` Recollections of Men and Events in Wisconsin," Wisconsin Historical Collections7 (1873-76):213.

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burn down shortly after its completion. When rebuilt on the same foundation, this facility was capable of sheltering up to fourteen patients and remained in use as a post hospital until 1859.39

The life of the surgeon whose assignment sent him to the farthest reaches of the western frontier could be particularly grim. Many posts were even more isolated than Fort Mackinac and yet they suffered disease rates that at one time or another rivaled those at Baton Rouge and Fort McHenry. Isolated garrisons might be spared the inroads of such diseases as cholera or typhoid fever but suffer terribly from scurvy during the winter and early spring, when fresh vegetables and fruits were unobtainable, and from malaria in the summer and early fall. Disease often decimated expeditions sent out from Western forts to explore unfamiliar territory, escort traders, or contact Indian tribes. Although some surgeons might regard an assignment to a frontier post as a challenge, at least one mourned the necessity of spending "his best years ... on a pestilential frontier, with no incentives to honorable ambition, & no society save that of drinking, swearing, tobacco chewing companions."40

Among the frontier posts established early in the period when Lovell was surgeon general was Fort Snelling, located in present-day Minnesota at the confluence of the Mississippi and Minnesota rivers. One of a chain of forts designed to guard against the inroads of both Indians and British fur traders, Fort Snelling occupied a site of great natural beauty and, initially, of great isolation. Isolation during the winter, however, could lead to disaster, and in the winter of 1819-1820, disease took a frightful toll at two new posts, Cantonment Missouri, soon to become Fort Atkinson, and Fort Snelling. Supplies intended for the men who were to build Fort Snelling were damaged in transit, and the fort itself had not yet been built when, despite the efforts of the Army surgeon who accompanied the men, disease struck the 228-man garrison. It appeared "in almost malignant form, and raged so violent that, for a few days, garrison duty was suspended, there being barely well men enough in the command to attend to the sick, and to the interment of the dead." Symptoms appeared so suddenly that a man who went to sleep apparently healthy might never awaken. The surgeon general, assuming the problem to be scurvy, blamed the absence of vegetables, but he considered hard work and sleeping in wet clothes to be additional factors contributing to the sickness that swept the camp. Others, however, blamed the lack of fresh food and bread covered with mold. From the suddenness with which the disease produced fatalities, something other than scurvy may have also been afflicting the garrison. Given the inadequate

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diet, it is possible that the sudden deaths were related to a thiamine deficiency. But surgeons of the period were too familiar with scurvy and its causes to have entirely misdiagnosed the problem, and sudden death can result from scurvy after any sudden and marked fall in blood pressure. Reports on the number of deaths vary, but it appears that as many as 40 or more out of the 100 men in the 5th Infantry died in the cold of 1819 to 1820, before the use of remedies such as "strong decoctions of hemlock boughs" and the arrival of supplies from the South brought the problem to an end.41

41First quote, H. H. Sibley, "Reminiscences, Historical and Personal," Minnesota Historical Collections1 (1872):473; second quote, James Duane Doty, "Official Journal, 1820,"Wisconsin Historical Collections 13 (1895):214; Norris, "`Scurvy Disposition: " pp. 325-26; Wintrobe et al., Harrison`s Principles, pp. 430-3 1; Ltr, Purcell to Lovell (29 Apr 1820), RG 1129 entry 12. Unless otherwise indicated, material on Ft. Snelling is based on Doty, Sibley, and John M. Armstrong, "An Introduction to the History of Medicine in Minnesota," Minnesota Medicine 21 (1938):41-43; Marcus L. Hansen, O1dFort Snelling, 1819-1858 (Iowa City: The State Historical Society of Iowa, 1918); and Evan Jones, Citadel in the Wilderness: The Story of Fort Snelling and the Old Northwest Frontier (New York: Coward-McCann, 1966). At Ft. Atkinson, 15 miles north of Omaha, Nebr., on the Missouri River, 160 men died of scurvy and many of the survivors were permanently mutilated in the winter of 1819-20: John Gale, The Missouri Expedition, 1818-1820: The Journal of Surgeon John Gale, With Related Documents, ed. Roger L. Nichols (Norman: University of Oklahoma Press, [1969]).

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With the arrival of warmer weather, the ten-foot walls of Fort Snelling finally began to rise. Six of the ten rooms in a stone barracks became the home of the hospital. The lesson of the preceding winter had not been forgotten, however, and the soldiers took time off from the construction work to plant ninety acres to corn, potatoes, wheat, peas, and other crops. The availability of fresh vegetables no doubt played a role in the fact that the annual death rate from 1822 through 1825 was 1 to 4 in a garrison of 250 to 300 men, and that most of these deaths resulted from respiratory diseases rather than dietary deficiencies.42

The physicians assigned to Fort Snelling during the 1820s and 1830s included several who gained distinction for reasons not directly related to their professional talents. The first officer to die while on duty at Fort Snelling, for example, was the post surgeon, Assistant Surgeon Edward Purcell, who fell victim to an unspecified illness in 1825. A second surgeon, Robert C. Wood, gained a small amount of fame by marrying a daughter of the future president of the United States, Zachary Taylor, the colonel commanding Fort Snelling in 1828. In so doing, Wood also became for a brief time brother-in-law to the future president of the Confederate States, Jefferson Davis, whose first wife was also a daughter of Zachary Taylor. Another doctor, John Emerson, assigned to Fort Snelling in the late 1830s,brought with him from an earlier assignment in slave territory a slave, Dred Scott, who later claimed before the Supreme Court that his sojourn at Fort Snelling had made him a free man.

The surgeon was often the best-educated man at a post; hence it is not surprising that one of the finest accounts of life at Fort Snelling came from the pen of yet another medical officer there, Nathan Jarvis. Jarvis was also reputed to be a gifted caricaturist as well as an artist with pencil and sketch pad. To his responsibilities as post surgeon he added those of teacher of the fort`s children and librarian for a garrison library of over 400 volumes, newspapers, and periodicals. He was also, it would seem, a musician; he once wrote his brother requesting that he be sent an accordion, "for amusement," which, Jarvis was confident, could be purchased for "$3 or 4."43

Jarvis` letters to his family suggest that, despite the fort`s isolation, life was not entirely unpleasant at Fort Snelling in the 1830s. One Christmas Eve, for example, a major entertained "with a splendid supper consisting among other delicacies of the season of venison, roast pig sausages, mince& pumpkin pies ... and many other kickshaws too numerous to mention. "On Christmas Day, after an "excellent dejeuner [a] la fourchette [substantial breakfast with eggs, meat, etc.] at 11 o`clock," the company went in sleighs to the nearby waterfalls. Upon their return, Jarvis and his fellow officers had a supper "which was superb," while "Music& Songs closed the amusement of the day." Also during the holiday season, Jarvis "for the first time rode in a dog train. It was drawn by 4 dogs harnessed ahead of each other the leader

42Ltr, Nathan Jarvis to Lovell (16 Jan 1836), RG 94, entry 634.
43Ltr, Jarvis to William Jarvis (2 Oct 1834), Papers of Nathan Jarvis, New York Academy of Medicine, New York, NY (hereafter cited as Jarvis Papers).

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having a string of small silver bells around his neck ... The body of the train is made of deer skin something in the shape of a shoe large enough to stretch yourself at length [sic]."44

NATHAN JARVIS.(Courtesy of National Library of Medicine.)

Almost a year later, in a cold November 1835, Jarvis, his sense of isolation heightened by the infrequency with which he heard from his family, was still able to write his brother a vivid description of a most beautiful display of the Aurora Borealis ... Broad sheets of light shot from the zenith directly overhead to the edge of the horizon in every direction like radii from a centre illuminating the heavens like noonday and affording one of the most beautiful displays I have ever witnessed. To increase the beauty of the spectacle the light of the Aurora wasting of a most beautiful orange color .45

Jarvis` record of his expenses throws some light on the finances of a post surgeon in this period. His pay may have been deficient in relation to his responsibilities, but at a time when a physician trying to establish a new civilian practice might contract with an entire family for a year`s care for $10, Jarvis reported that his total income from the Army, which presumably included both pay and allowances, was a relatively munificent $82 a month. In addition, he received $100 a year from the Indian agency for caring for Indian patients- his predecessor had also received 25 cents an Indian for vaccinating 500 against smallpox. Another medical officer estimated that $100 a year came from his private practice, giving him an income of approximately $1,200 a year. Of this total he paid out about $25 a month for food, his servant, laundry, the maintenance of a horse, and similar expenses. His income may appear modest, but when Purcell wrote his brother about his own assignment to Fort Snelling, he confessed that although "You may think it strange that I have consented to go with the Regiment out of the world, as you may call it, the fact is that I go, not because I like it, but because of thinking that I can make money."46

At Fort Snelling, as at other early posts established in the winter, scurvy was the principal health threat, and the greening of the vegetable garden spelled an end to

44Ltr, Jarvis to William Jarvis (31 Dec 1834),in Jarvis Papers.
45Ltr, Jarvis to William Jarvis (30 Nov 1835), in Jarvis Papers.
46Quote from Ltr, Purcell to his brother (20 Mar 1819), in John M. Armstrong, "Edward Purcell, First Physician of Minnesota, "Annals of Medical History 7 (1935):169; David S. Wiggins, Service in "Siberia" (St. Paul: Minnesota Historical Society, 1977),p. 4; N. S. Jarvis, "An Army Surgeon`s Notes on Frontier Service,1833-1848," Journal of Military Service Institute 39 (1906):132;Shryock, Modern Medicine, p. 258.

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bleeding gums, loosened teeth, and multiple bruises. Even cholera, striking in 1833, caused no deaths. For many other forts in the West, where malaria was endemic, the trial was unending, repeated every summer and fall. Such a post was Fort Leavenworth, established in 1827 to protect the Santa Fe Trail and to serve as a base in what is now Kansas for expeditions along both the Santa Fe and Oregon Trails. The Medical Department quickly established a hospital at the new fort, but, like many other post hospitals, it left something to be desired, since it was badly arranged and its chimneys smoked. A minimum of two surgeons was assigned to Fort Leavenworth at all times, a step made doubly necessary by the repeated illness of the surgeons themselves. So severe were the health problems, however, especially those caused by fevers, that the inspector general recommended the post`s abandonment. Although its garrison was at times drastically reduced to protect the health of the men, Fort Leavenworth remained in use. In an attempt to minimize the onslaught of disease, an "admirable police [was] maintained, [and much] attention paid to the health of the men," but heavy drinking complicated efforts to improve the command`s health.47

The men of Fort Smith, founded late in 1817 on the right bank of the Poteau River, near its union with the Arkansas, also suffered from a disease that apparently was malaria. Although the men were spared scurvy despite their relative isolation (probably because of their successful garden),fevers of one kind or another so severely afflicted them that, in a bad season, one to five in each company might die. In August 1822, malaria sent half of one company to the post hospital, and the year as a whole saw 47 of the 206-man garrison die. Many men, trusting neither the surgeon, Thomas Lawson, nor the post hospital, attempted to treat themselves; some of those who blamed the water for their problems undertook to purify it with rye whiskey. Colonel Matthew Arbuckle, commander of the post in the early 1820s, blamed the purifying agent for the health problem at Fort Smith. Calomel was used as a preventive during the sickly season, but medicines disappeared rapidly because of disease`s heavy onslaught and supply was a problem. In the period from 1831 to 1833 alone, eight privates and an assistant surgeon died at Fort Smith, and the survivors were weakened by repeated bouts of fever and possibly by heavy dosing with calomel as well. As a consequence, in 1834 the fort was abandoned, only to be reoccupied four years later.48

Surgeon Lawson appeared to have added considerably to the troubles at Fort Smith,

47Quote from Surgeon`s Quarterly Rpt (30 Jun1830), RG 94, entry 634; Surgeon`s Quarterly Rpts, Ft. Leavenworth (1827-36, esp. 30 Jun, 30 Sep, and 31 Dec 1830, 30 Sep 1831, and 30 Sep 1833), and Ltrs, Edward Macomb to Lovell (1 Dec 1835) and Gale to Lovell (1 Oct 1828),all in RG 94, entry 634; Ltrs, Lovell to P. G. Randolph (27 Dec 1827),to T. S. Bryant (9 Feb 1828), and to Macomb (29 Jul 1832), all in RG 112, entry 2, 4:198 and 211 and 7:527, respectively; David S. Wiggins, "Minnesota`s First Hospital .," Minnesota Medicine 59 (1976):871; Croghan, Army Life, p. 10; Robert W. Frazer, Forts of the West: Military Forts and Presidios and Posts Commonly Called Forts West of the Mississippi River to 1898 (Norman: University of Oklahoma Press, 1965), pp. 56-57; Francis Paul Prucha, The Sword of the Republic: The United States Army on the Frontier 1783-1846 (New York: Macmillan Co., 1969), pp. 179, 224, 236-37.
48Edwin C. Bearss and Arrell M. Gibson, Fort Smith: Little Gibraltar on the Arkansas (Norman: University of Oklahoma Press, 1969),pp. 28-29, 37, 83-84, 136, 160; Frazer, Forts of the West, pp. 16-18;Kent Ruth, Great Day in the West: Forts, Posts, and Rendezvous Beyond the Mississippi (Norman: University of Okla-homa Press, 1963), p. 14;Ltrs, D. Holt to Lovell (12 Oct 1833), Thomas O`Dwyer to Lovell (25 Jul1833), and C. B. Welch to Lovell (13 Feb 1834). all in RG 112, entry 12.

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both through his failure to gain the confidence of the men and through his quarrelsome disposition. Even before his arrival, he was involved ina wide-ranging feud with his colonel. Highlights of this feud included the trouncing of Lawson in a fist-fight by a lieutenant who supported Arbuckle, the bringing of charges against Arbuckle by Lawson and Lt. Col. Zachary Taylor, the placing of charges against Lawson by Arbuckle, and the filing of counter-charges against Arbuckle by Lawson. At least one modern authority on the subject believes that Lawson resented Arbuckle`s popularity with the women at the post. In the final analysis, all parties concerned survived the charges with their careers intact, including Taylor, who later became president, and Lawson, who succeeded Lovell as surgeon general .49

Men from Fort Smith were among those who established Fort Gibson, Oklahoma, in the 1820s. This post was yet another where health problems were frequent and severe, but it could not easily be abandoned. It was a base from which important expeditions set out and to which came many refugees, including Indian women and children seeking shelter from tribal warfare engendered by the federal government`s removal policy. From 1824 through 1835, 561 enlisted men and 9 officers died at Fort Gibson, described by one surgeon as "the charnel house of the Army." More than half of the deaths occurred in 1834 and 1835 alone, years when the more dangerous form of malaria, remittent fever, was more prevalent than usual, and tuberculosis was also causing deaths. Although cholera did appear at the fort, it was probably not a major factor in the mortality rate; most of the patients at the post hospital seem to have been the victims of malarial fevers. The surgeons also cared for the victims of respiratory diseases, drunkenness, and the harsh physical punishments meted out to enlisted men. So great was the rate of sickness and disability that in 1831 an addition was ordered for the log hospital that had been completed only four years earlier. The commanding officer, Colonel Arbuckle, apparently had little enthusiasm for the hospital addition, and its completion was long delayed.50

Disease and the remedies used to combat it also plagued the many expedition that set out from Fort Gibson. Among the most unfortunate of these undertakings was one led by Brig. Gen. Henry Leavenworth, who in the spring of 1834 joined dragoon units that had already arrived there from Jefferson Barracks. Assigned to the newly formed Regiment of Dragoons were a surgeon, Clement A. Finley, who later served briefly as surgeon general in the early months of the Civil War, and two assistant surgeons. The men under their care were already sickly, and at least one soldier blamed an unnamed medical attendant at the fort for their condition. It may have been this medical officer who had fallen into the habit of treating almost every complaint with calomel, his favorite mercurial remedy, with-

49Bearss and Gibson, Fort Smith, pp.55-56, 70, 74-75; Ltrs, AG to Lawson (27 Aug 1823), RG 94, M565, roll 6,6:374; Lawson to Lovell (31 Mar 182 1) and to Edmund R. Gaines (12 Oct1823), both in RG 112, entry 12.
50Quote from Leonard C. McPhail journal, Ms C88, National Library of Medicine (NLM), Bethesda, Md., p. 19; Philip St. George Cooke, Scenes and Adventures in the Army (Philadelphia: Lindsay & Blakiston,1857), p. 227; Ltrs, Lovell to Zina Pitcher (21 Oct 1831 and 2 Sep 1833),both in RG 112, entry 2, 5:261 and 6:22 1, respectively; AG to Mrs. Eliza Shaw (4`Dec 1834), RG 94, M565, roll 9, 11:157; Pitcher to Lovell (7 Jan1830 and 3 Sep 1831), both in RG 112, entry 12; Rpt, Samuel DeCamp (30 Sep 1835), RG 94, entry 634; Statistical Report 1839-55, p. 267.Unless otherwise indicated, material on Ft. Gibson is based on the journals of Hugh Evans and on books and articles by Frazer, Prucha, James Hildreth, and Louis Pelzer.

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out being careful of the dosage. Soldiers might come to him with a minor complaint, but, after repeated visits, the mercury would begin to take its toll. His patients would

gradually decline, their countenances merging from the rosy hue of healthfulness into the sallow and ghastly likeness of disease, their firm step giving way to the totter of decrepitude; their strong arms shaking with a nervous tremor; their bright eyes become sunken and dilated, and, in fact, through a cause of either willful neglect or gross malpractice, brought down within a short period of time from the health, and buoyancy, and joyousness of youth, to a premature grave.51

The dragoons were already six weeks behind schedule when they finally set out from Fort Gibson on 15 June to bring peace treaties ready for signing to the villages of the Pawnee and Comanche Indians near the headwaters of the Red River. Sickness caused 68 of the expedition`s 588 men to be left behind at Fort Gibson. As the dragoons left the post, temperatures were climbing toward 105° F. even in the shade. As an officer described it,

Nature would seem to have conspired with an imbecile military administration for the destruction of the regiment. On, on they marched, over the parched plains whence all moisture had shrunk, as from the touch of fire; their martial pomp and show dwindled to a dusty speck in the midst of a boundless plain; disease and death struck them as they moved; with the false mirage ever in view, with glassy eyes, and parched tongues, they seemed upon a sea of fire. They marched on, leaving three-fourths of their number stretched by disease in many sick camps; then, not only destitute of every comfort, but exposed with burning fevers to the horrors of unnatural heat- it was the death of hope.

In the heat even the horses and mules fell sick and died. General Leavenworth himself was fatally injured when his horse fell during a buffalo hunt. Fewer than 200 men actually reached their goal at the Indian villages and one of the assistant surgeons left behind with patients at a sick camp was extremely ill himself by the time the returning troops reached him.52

In early August, as the dragoons began their return to Fort Gibson, the sick list continued to grow. One soldier wrote, "The sickness is now becoming very [sic] alarming as we have a great many deaths everyday." Four or five died daily, and the mortality rate averaged 21 percent. The cause of their sufferings, according to artist George Catlin, who accompanied the expedition, was fevers "of a bilious nature, and contracted by exposure to the sun, and the impurity of the water, "among which could have been hepatitis and typhoid fever as well as malaria.53

The dragoons were ordered out from Fort Gibson on another expedition shortly after their return, but from 140 to 150 men were still too sick to march; 3 to 4 died each day. It was hard to say which was worse, the fort or the road, since a high rate of disease characterized both. In the summer of 1835, Fort Gibson was described as "the worst and without doubt the hottest and most unhealthy in the U. States," where the families of the men were constantly sick and the quarters of the men themselves rotten, leaking, and crowded.

51James Hildreth, Dragoon Campaigns to the Rocky Mountains: Being a History of the Enlistment, Organization, and First Campaigns of the Regiment of United States Dragoons (Wiley & Long, 1836. Reprint. New York: Arno Press, 1973), pp. 115-16.
52Philip St. George Cooke, Scenes, p. 225.
53First quote, "The Journal of Hugh Evans, Covering the First and Second Campaigns of the United States Dragoon Regiment in 1834and 1835: Campaign of 1834," Chronicles of Oklahoma 3 (1925):215;second from "Letters of Geo Catlin, 13 June and Sept 1834," in Hildreth, Dragoon Campaigns, p. 187.

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The Black Hawk War

In 1832 men and surgeons from many Army posts joined the successful campaign to prevent the return of members of the Sac and Fox tribes led by Black Hawk to their former lands east of the Mississippi. To meet this threat, the secretary of war ordered 200 men from Jefferson Barracks, near St. Louis, Missouri, to move north, and 1,000 men stationed in the east to move west via the Great Lakes under Maj. Gen. Winfield Scott Still more men came in from Fort Leavenworth and were joined by others from Forts Winnebago and Crawford in modern Wisconsin.

Surgeon General Lovell ordered one of his surgeons, Josiah Everett, to leave his post at Fort Monroe, Virginia, to serve as medical director for General Scott`s men and sent other Army physicians to join him from such posts as New Orleans, Baton Rouge, and Forts Niagara and Gratiot. Others were called back from furloughs to meet the need. Surgeon Thomas Mower, handling medical supply in New York City, was warned to be ready to supply the needs of surgeons ordered to the front and to prepare, in addition, "a full supply of medicines, Hospital Stores Dressings and Bedding for 1,000 men according to the supply table, with such addition to the essential medicines and to the dressings as you think advisable for active service." By 20 June sixteen Army surgeons had been ordered to the Northwest frontier, their specific assignments being left in the hands of the commanders in the field.55

The real enemy these surgeons soon faced, however, was not Black Hawk and his warriors, but cholera. In the two battles fought with the Indians, regular troops suffered only minor losses, but cholera, moving west, first with General Scott`s men and then with those who came into contact with them, overwhelmed the surgeons and decimated the forces they served.56

The first man reported to have contracted cholera in the Army appears to have been a passenger on the transport Henry Clay. After he became ill on 4 July when the ship was near Detroit, because of the disease on board, city authorities refused to permit the men on the Henry Clay to land. Two men from an eighty-man artillery unit that had landed a day earlier came briefly on board, however, and both men died three days later of cholera. By the evening of the same day, five more cases had appeared among the artillerymen.

The Henry Clay anchored two miles above the city, and Surgeon Everett, who had traveled with General Scott on the Sheldon Thompson, a vessel that had previously carried cholera-infected immi-

54Army and Navy Chronicle 1 (1835):279, 357,397, quote from 279.
55Quote from Ltr, Lovell to Thomas Mower (16 Jun 1832), RG 112,entry 2, 5:378; Ltrs, Lovell to Sec War (10 and 20 Jun 1832) and to J. Everett (22 Jun 1832), all in RG 112, entry 2, 5:375, 381, and 382, respectively.
56Unless otherwise indicated, material on the effects of cholera in the Black Hawk War is based on John Sharpe Chambers, The Conquest of Cholera ... (New York: Macmillan Co., 1938).

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grants from Montreal to Niagara, joined Robert Kerr, the assistant surgeon on the Henry Clay. The number of cases rapidly multiplied, and Everett warned that all on board might die if they were not landed. At last the men were put ashore near Fort Gratiot and tents and beds set up, and a large barn was taken over for use as a hospital. Some men fled the camp in total terror not long after landing, only to die in the nearby woods, where wolves waited to devour their bodies. Thirty-nine perished in camp, Everett among them. Despite Kerr`s unflagging efforts, by 10 July, be-tween disease and desertion, a detachment of 400 men had been reduced to 150. Although Scott`s men had not been taken into Fort Gratiot itself, cholera began to appear among the men of the garrison, and by 14 July, despite the best efforts of assistant surgeon Henry Steinecke, 21 inhabitants of the fort had died.57

On board the Sheldon Thompson, cholera did not appear until after a stop at Fort Gratiot, where some of her passengers were put ashore because of serious overcrowding on board. On 8 July she stopped at Fort Mackinac and left off four more who were sick. She then proceeded to Fort Dearborn, at Chicago, where three passengers died, their illness not immediately recognized as cholera. The day after the ship left Fort Mackinac, more passengers fell ill, and the diagnosis of cholera became unavoidable. By the time the ship reached Chicago on 10 July, seventy-seven cases of cholera had been identified. Fort Dearborn was quickly converted into a hospital and its garrison ordered to pitch camp several miles away. While his men were being cared for by two assistant surgeons, General Scott warned all comers away from the fort in order to prevent the spread of the disease to troops actually engaged in fighting. At the fort, however, 200 men had been taken into the hospital in the space of a week, and 58 died .58

An increasing number of men from the artillery unit that arrived at Detroit early in July were becoming ill, and the city authorities finally insisted that they, too, leave the immediate area. On 9 July these men were moved to a site about thirteen miles from Fort Gratiot. The vessel that had brought them picked up the men General Scott had left behind, all of whom still appeared healthy, and continued on toward Fort Mackinac. The artillerymen, meanwhile, were moved once again to a spot three miles from Detroit. By 12 July, 17 or 18 of them were dead, and before the epidemic abated, 21 had died and 4 deserted. In August 1832 a newspaper reported that of a total of 850 men who had left Buffalo to join the fight against Black Hawk, only 200 remained strong enough to participate in military operations.59

General Scott finally arrived at Fort Crawford, at Prairie du Chien in Wisconsin, five days after the last successful battle against BlackHawk, to assume command. The wounded from the campaign were left at Fort Crawford while, in late July, the rest of the army moved on to Fort Armstrong, at Rock Island in present-day Michigan, with cholera following in their footsteps. Within five days in late August, the dread

57 James M. Phalen, "The Cholera Epidemic During the Black Hawk War," Military Surgeon 83 (1938):454,456; Niles` Weekly Register 42 (1832):391; Ltrs., John Norvell to Robert Morris (12 Jul 1832), in Niles` Weekly Register 42 (28 Jul1832):390-91; A. Walker to R. C. Bristal (30 Oct 1860), in John Wentworth, Early Chicago: Fort Dearborn (Chicago: George H. Fergus, 1881),p. 72.
58Forry, Climate, pp. 321-22; Ltr, Robert McMillan to Lovell (24 Jul 1832), RG 112, entry 12.
59Ltr, Norvell to Morris (12 Jul 1832), in Niles` Weekly Register 42 (28 Jul 1832):390-91; see also Niles` Weekly Register42 (11 Aug 1832):423.

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disease struck; 146 of about 300 men at Fort Armstrong fell ill, and26 died. Among the dead was another Army doctor, but Surgeon Clement Finley and two assistant surgeons continued to care for those who fell ill.60

The entire fort at Rock Island soon resembled a hospital; deaths occurred so rapidly that no time was available to dig individual graves. Bodies were "thrown confusedly- just as they died, with or without the usual dress- into trenches, where a working party was in constant attendance; and it is a fact that an officer in charge of it, making inquiry as to some delay on one occasion, was answered that there was a man who was moving, and they were waiting for him to die."61

Sometimes with the unwitting aid of the veterans of the Black Hawk War, cholera then spread to other forts across the nation in 1832 and 1833. Baton Rouge was spared until 1833, when 8 died from this disease. In the third quarter of 1833 there were 150 cholera cases at Fort Gibson, with 16 deaths. The toll taken in the Army in 1832 alone, however, was 686 cases with 191 deaths; and there was a possibility that some cases had not been reported or were misdiagnosed.

The impact of cholera was far greater than that of the Black Hawk War that had helped to spread it. The best efforts of both Lovell and the Army`s surgeons were of no avail in the face of a devastating disease that the physicians of the period were powerless to prevent or cure and of the wide-spread panic it caused.

Conclusion

Nevertheless, Lovell`s unceasing effort to improve the number and caliber of the surgeons in his Department, to regulate the Department`s expenditures, and to guard the health of the nation`s soldiers had begun to show positive results. Although prevention and cure remained often impossible, better care brought a death rate among the nation`s soldiers that compared favorably with that among young men in the civilian population. The consequences of Lovell`s work became clearer when the Army was called upon to meet its first prolonged challenge since the War of 1812, the Second Seminole War of 1835-1842.

60Phalen, "Cholera Epidemic," p.455; Military and Naval Magazine 1:332.
61Cooke, Scenes, p. 193.

 

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