Books and Documents > The Army Medical Department 1818-1865
Chapter 6
The War With Mexico: Scott`s Campaign
The campaigns in Mexico`s northern provinces, though successful, failed to bring that nation to her knees. As a result, in the autumn of 1846, Maj. Gen. Winfield Scott began planning a campaign to take Mexico City itself. Among his most important considerations at this time was the danger of yellow fever which, he was convinced, would make serious inroads into his force if April 1847 and the following months were to find him still in the mosquito-ridden coastal areas.
Joining General Scott in New Orleans at the end of 1846 was his good friend Surgeon General Thomas Lawson, who, after several months of sniping from the sidelines at the way Taylor and his medical director were handling the assignment of surgeons, had arranged to visit that city. The purpose of Lawson`s trip was ostensibly to supervise the establishment of a medical supply depot, but he quickly accepted Scott`s invitation to accompany him on his march to Mexico. The surgeon general remained with the invading force from December 1846 through early 1848, but he insisted that he was present in an advisory capacity only.1
The question of why Lawson did not officially take over the duties of the medical director for Scott`s army has no obvious answer. He rarely usurped the prerogatives of his subordinate, who was obviously in no position to protest encroachment. Lawson had, of course, found the management of medical officers and their work from Washington during wartime a frustrating business at best. His refusal to assume overall responsibility for the medical care of Scott`s army while in the field suggests that he would have been happiest merely serving as a senior surgeon on the battlefield, where the excitement was great and the responsibilities relatively uncomplicated. Available evidence indicates that Lawson`s somewhat ambiguous position in Mexico, far from being helpful to his surgeons, actually caused confusion. His absence from his desk in Washington moreover, meant that, at this crucial time, one of his subordinates, surgeon Henry Heiskell, was acting surgeon general, making the important decisions about supply and the apportionment of the Medical Department`s limited number of surgeons. Fortunately, Heiskell was thoroughly competent, and the department does not ap-
1Ltrs, Lawson to Walker (29 Aug 1846) and to Alexander Suter (1 Nov 1846), both in RG 112, entry 2, 16:473 and 17:53, respectively; see also the collection "Lawson Papers" for documents that suggest a close friendship between Scott and Lawson.
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pear to have suffered unduly from Lawson`s absence from Washington, despite his lack of interest in his Washington office while he was in thefield.2
Preparing for Invasion Even before they set foot on Mexican soil, Scott`s men were plagued by an assortment of diseases. The medical pur-
2Ltr, Adam N. McLaren to Med Dir (3 Jan 1848), RG 94, entry 634; Lawson to G. M. Brooke (7 Dec 1846) and Heiskell to Drake(8 Apr 1847), to John C. Glen (18 Jun 1847), and to AG (7 Jul 1847), all in RG 112, entry 2, 17:93, 411, 506, and 545, respectively.
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veyor at New Orleans had to work "night and day" to aid the men boarding transports there- "The dark cloud of disease hovered over us," a volunteer surgeon wrote in describing his sea voyage to Mexico. Illness continued to strike as the troops landed at Tampico, a town taken from the Mexicans in the fall of 1846 by the U.S. Navy, and at Lobos Island, off the coast. (Map 4) On the island, Surgeon Richard S. Satterlee was running short of quinine in December 1846, and an outbreak of smallpox detained three companies of Pennsylvania volunteers when their comrades departed for the assault on Vera Cruz. Mississippi volunteers, the "most lawless set of men" the surgeon general had ever seen, ran up bills with private physicians without authorization.3
When two divisions from Taylor`s force arrived to join Scott`s command at Tampico in the summer of 1847, surgeons found it necessary to establish a general hospital to care for the sick. Like so many of the general hospitals established in Mexico, the Tampico facility apparently remained in operation at least through the spring of 1848, at which time more than a thousand volunteers and a tenth as many regulars were stationed in that town. Yel-
RICHARD S. SATTERLEE. (Courtesy of National Library of Medicine.)
low fever struck in the fall of 1847, causing fifty-four deaths, but dysentery, diarrhea, and malaria were such common diseases that each soldier averaged almost two hospitalizations a quarter in the so-called sickly season, the late summer and early fall, of that year.4
Establishing a Base: Vera Cruz
Despite his best efforts, Scott was a month behind his timetable when his 6,000 regulars and 8,000 volunteers left Tampico and Lobos Island and landed near Vera Cruz in early March 1847. They brought with them tents where the approximately
3Thomas N. Love, "Remarks on Some of the Diseases Which Prevailed in the 2d Reg. Mississippi Rifles, for the First Six Months of Its Service," New Orleans Medical and Surgical Journal 5 (1848-49):4-6, first and second quotes, 5-6; third quote, Ltr, Lawson to Heiskell (11 Feb 1847), RG 112, entry 12; Porter, "Notes" 26:301; Ltr, Scott to Butler (3 Jan 1847), in U.S. War Department, Correspondence Between the Secretary of `War and Generals Scott and Taylor, and Between General Scott and Mr. Trist, presented to the 30th Cong., 1st sess.,House of Representatives, as Ex. Doc. 56, p. 41; Ltrs, Scott to Marcy (28 Feb 1847 and 24 Feb 1848) and to Butler (3 Jan 1847), all in U.S. War Department, Letters of General Winfield Scott and Secretary Marcy Relating to the Mexican War (1848) (n.p., n.d.), pp. 1-2, 41, and 86, 88, respectively; Oswandel, Notes, pp. 61-62; Ltr, Satterlee to Lawson (27 Dec 1846), RG 112, entry 12.
4Ltr, Hawkins to Lawson (5 Jul 1847) and Surgeon`s Quarterly Rpts, Tampico (30 Jun, 30 Sep, and 31 Dec 1847 and 31 Mar 1848), all in RG 94, entry 634.
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JOHN B. PORTER.(Courtesy of National Library of Medicine.)
twenty physicians with Scott could care for their patients during the siege of that town. When the Mexicans there surrendered, Army doctors setto work to locate more permanent quarters for both sick and healthy. They also began to deal with the various forms of filth that littered the city`s streets, which they found to be broad and easily cleaned. Surgeon John Porter took over an old Franciscan convent facing the sea to serve as a general hospital, attracted by its excellent ventilation and good water supply. (Church and monastery buildings would prove to be popular choices as Army hospitals in Mexico.) Porter was not able, however, to obtain competent hospital attendants, and moving the wounded to the new facility, often by means of a blanket carried by four men, irritated wounds and may have caused one death. To add to Porter`s troubles, many of his patients were afflicted with diarrhea, but the new hospital contained neither privies nor "chamber utensils."5
Because of its location, Vera Cruz became the site both of an important general hospital and of the principal medical supply depot for General Scott`s campaign. The medical purveyor there, Charles H. Laub, was apparently responsible for distributing supplies that arrived at his post to the purveyors at other bases in central Mexico, but the presence of the surgeon general in Mexico caused him some confusion. In the early summer of 1847, Laub was still submitting his reports on the receipt of shipments to Lawson, and since Lawson did not bother to forward these documents to Washington, the New York City supply officer assumed that supplies were going astray and continued to ship more. Laub, on the other hand, concluded that the arrival of goods he had not ordered meant that requisitions were no longer necessary. Not until August, when the true nature of the problem began to emerge, did Laub realize that he should be reporting directly to Washington both on the arrival of shipments and on his future needs.6
The supply situation in 1847 was also complicated by the fact that more men were being called up than the Medical Department had prepared for.In urging care in the use of hospital stores and medicines,
5Porter, "Notes" 26:302, 311, 322-23,quote from 332; Roger G. Miller, "Yellow Jack at Vera Cruz, "Prologue 10 (1978):48; J. F. H. Claiborne, Life and Correspondence of John A. Quitman.... , 2 vols. (New York: Harper & Bros., 1860),2:232; Ltrs, Lawson to Brooke (7 Dec 1846) and Heiskell to Finley (8 Jan1847), both in RG 112, entry 2, 17:93; Lawson to Heiskell (11 Feb 1847)and Porter to Heiskell (19 Aug and 3 Sep 1847), all in RG 112, entry 12.
6Ltrs, Laub to Lawson (20 May, 30 Jun, and 3 Aug 1 847), and Joseph J. B. Wright to Lawson (25 Oct 1847), all in RG 112, entry 12; Heiskell to Satterlee (6 Mar 1848), RG 112, entry 2, 18:467.
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acting surgeon general Henry Heiskell deplored in particular the extravagance of volunteer surgeons; another member of the department`s staff directed the same comment at volunteer nurses and hospital attendants as well. Occasional orders to supply medicines to teamsters and other employees of the Quartermaster`s Department made the attempts of the Surgeon General`s Office to predict need accurately all the more difficult. Unexpected calls for supplies apparently were not unusual at lower levels in the chain. Purveyor Laub, for example, was distressed to learn in the fall of 1847 that he would be responsible for supplying the units coming south from the Rio Grande area, where they had been serving under General Taylor, since they were apparently bringing little in the way of supplies with them.7
Two items that would in the future be considered vital were not among regular shipments through Vera Cruz. A visiting civilian physician brought ether and the apparatus to administer it to the hospitals and demonstrated its use, but it inspired no enthusiasm. Lawson himself determined that the volatility of ether and the fragility of the necessary equipment made anesthesia impractical in Mexico. Porter concluded that its continued use would only add to the toll at that hospital. He blamed ether for slow healing as well as for the excessive bleeding that had characterized a thigh amputation that he saw performed with its aid. It poisoned the blood, he maintained, and damaged muscle "contractility." He speculated also about the relationship between ether and an increase in hospital gangrene (which was probably a streptococcal infection) and stated (inaccurately) that hospital gangrene had never existed before the use of anesthesia.8
CHARLES H. LAUB. (Courtesy of National Library of Medicine.)
Lawson had also been investigating the possibility of obtaining ambulances, but even at the time of the landing near Vera Cruz, the Medical Department was still unable to provide its surgeons with any type of vehicle designed specifically to serve as an ambulance. One authority maintains that the department did not use this type
7Ltrs, Heiskell to Craig (6 Sep 1847), RG 112, entry 2, 18:51; Glen to Lawson (1 Dec 1846) and Laub to Lawson (29 Oct 1847), both in RG 112, entry 12.
8Quote from J. B. Porter, "Surgery and Surgical Pathology: On the Effects of Anesthetic Agents in Operations for Gunshot Wounds, "New York Journal of Medicine and the Collateral Sciences, n.s.,9 (1852):288-89; Ltr, Lawson to Morton (I Mar 1852), RG 112, entry 2, 22:276; Wangensteen and Wangensteen, Rise of Surgery, p. 26; George Winston Smith and Charles Judah, eds., Chronicles of the Gringos: The U.S. Army in the Mexican War, 1846-1848 (Albuquerque: University of New Mexico Press, 1968), pp. 349-50.
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of conveyance for a decade after the war. A soldier who was in Mexico in December 1847, however, wrote of his trip in an "ambulance," which he described as a closed and very uncomfortable wagon with springs. It seems unlikely that the vehicles referred to as ambulances in such contemporary documents were built to serve exclusively as such. Lawson`s order for fifty wagons specifically designed to carry the wounded, apparently placed after the start of the war, was lost in the Quartermaster`s Department until too late for them to be used in Mexico and was thus apparently never filled.9
Like the supply depot, the general hospital established at Vera Cruz was vital to the campaign. It remained open for the remainder of the war, caring for an average of from 300 to 800 patients at a time, many of whom were probably destined for evacuation to New Orleans. Patients from units stationed nearby were sent to Vera Cruz when their camp had no attending surgeon or no accommodations for the sick. Not all of the hospital`s occupants were soldiers; a few were civilian laborers, often "Irishmen, and very dissipated." When Scott`s army prepared to advance beyond the coastal areas, the sick and wounded in regimental hospitals who were unable to march swelled the population of the general hospital; a total of more than 1,000 soldiers remained behind. By 17 April, when the last of the troops left Vera Cruz, the patient load was so great that physicians had to take over a Mexican military hospital, by then almost emptied of its Mexican patients. By July the disease rate was so high that some patients had to lie on blankets on the hospital floor. The number of attendants fluctuated from month to month, but at the end of April, 11 stewards, 2 cooks, 4 male nurses, 1 wardmaster, and 4 Mexican matrons were on duty at Vera Cruz. There, as elsewhere, the shortage of physicians also made itself felt, but supply problems, at least, were minor.10
Many diseases brought patients to the Vera Cruz hospital, but yellow fever was most feared. The physician in charge concluded that yellow fever was most dangerous in summer, although it was present throughout the year and posed a greater threat to newcomers than to the native population, most of whom were already immune. Malarial fevers were also common, and dysentery-like illnesses were a constant threat to soldiers in such a climate. Nevertheless, General Scott believed that it would be safe for troops to stay in Vera Cruz as long as they did not associate with the natives and remained in the waterfront area with its breezes from the sea. He was confident that men assigned to the castle of San Juan de Ulloa, on an island in the harbor, would escape yellow fever entirely. In this notion he was sadly mistaken. Troops going through Vera Cruz on their
9Quote from Charles F. Hinds, ed., "Mexican War Journal of Leander M. Cox," Kentucky Historical Society Register 55 (1957):219; Ltrs, Harney to Tompkins (6 Jun 1848), in Daniel D. Tompkins correspondence (1847-49), NLM; Lawson to Heiskell (11 Feb 1847), H. L. Thistle to Scott (26 Jun 1847), and Testimonial, Valentine Mott, Lawrence Proudfoot, and William H. Van Buren, all in RG 112, entry 12; Ltrs, Lawson to Mower (4 Dec 1846) and Heiskell to Edward Warren (3 May 1847), both in RG 112, entry 2, 17:86 and 434, respectively; Mower to Asher Robbins Eddy (18 Jan 1847), in U.S. Hospital Department Copy Book, NLM.
10Porter, "Notes" 26:311-12, quote from 312; Surgeon`s Quarterly Rpt, Vera Cruz (30 Jun 1848), and Surgeon`s Monthly Rpts, Camp Bergara (Apr-May 1848) and Camp Washington (Jun 1847 and May 1848), all in RG 94, entry 634; J. B. Porter, "Letters," New Orleans Medical and Surgical Journal 6 (1849-50):52; Irwin, "Notes," pp. 113-14; Miller, "Yellow Jack," p. 49; Ltrs, Heiskell to McCormick (22 Feb 1848), RG 112, entry 2, 18:450; Porter to McCormick (copy, 11 Jan 1847)and E. H. Barton to Porter (18 Jul 1847), both in RG 112, entry 12.
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way to or from the front often came down with yellow fever, as did those who, like the hospital staff or the men at the castle, remained in or near that city. Both volunteer and regular surgeons contracted yellow fever, and at least two died of it.11
Physicians at Vera Cruz treated yellow fever with 15 to 25 grains of quinine to reduce the fever and baths and mustard plasters to equalize" temperature and the circulation" and subdue "gastric irritation." Mercurials promoted "early and free evacuation of the bowels; ...five or six passages in as short a time as practicable" being considered desirable to alleviate stomach irritation and nausea. Cupping was favored over bleeding by means of either venesection or leeches.12
Despite the efforts of surgeons at Vera Cruz, legends grew up about disease and death there. At least one veteran of the Mexican War believed that "a great many deaths occurred, chiefly among that class of people who neither have the means nor care to take pains about health- such as Qr. Mr.s men & soldiers- they have died by the hundreds of yellow fever, dysentery and bad wounds. Occasionally an officer is stricken down, but al tho` all nearly have been sick, few have died, because they had had good attendance & good treatment."13
Part of the reason for the high death rate at the Vera Cruz hospital lay in the fact that many patients did not come into the facility until they were already near death; some soldiers, like their predecessors in the Continental Army almost seventy-five years earlier, apparently believed that death awaited those who entered a general hospital. The death rate at this facility from all causes among Army and nonmilitary patients from1 April 1847 to 21 March 1848 was 12 percent (775 of 6,466 patients died).Appalling though it may appear, this rate compared favorably with the 15 to 20 percent mortality experienced by British forces during the Crimean War and the 25 to 30 percent of the French in the same conflict, as estimated by Louis Duncan, and the 15 percent at the New Orleans Charity Hospital at this time.14
Compared to other causes of death at Vera Cruz, yellow fever did not prove to be as dangerous as had been feared. From April through September1847, the yellow fever season, 3,874 patients, both military and civilian, entered the Vera Cruz hospital, but only 402 of them had yellow fever, of whom 109 died. In contrast, almost a third of all those hospitalized were patients with diarrhea or dysentery, of whom 199 died. In August, a frightening 67 percent of the victims of yellow fever died, but the average overall death rate from that disease during the spring and summer of 1847did not exceed 28 percent.15
11Ltrs, Scott to Marcy (5 Apr 1847), in War Department, Correspondence, p. 100; Porter to Heiskell (19 Sep and 8 Oct 1847), both in RG 112, entry 12; Porter, "Letters" 6:52; Surgeon`s Quarterly Rpts, Vera Cruz (31 Aug 1847), San Juan de Ulloa (30 Sep 1847 and 31 Mar and 30 Jun 1848), and Surgeon`s Monthly Rpt, San Juan de Ulloa(31 Aug 1847), all in RG 94, entry 634.
12Porter, "Notes" 26:312-13, 326-28, and 35:352, quotes from 26:312-13.
13Lit, Josiah Gorgas to his mother (6 Aug 1847), in Frank E. Vandiver, "The Mexican War Experience of Josiah Gorgas," Journal of Southern History 13 (1947):382.
14Porter, "Notes" 26:301, 311, 331, 332-33; Ltrs, Scott to Marcy (13 Feb 1847), in War Department, Correspondence, p. 93; Duncan, "Scott`s Campaign" 47:445; ibid. 47:459; Miller, "Yellow Jack," p. 51. Estimates concerning Crimean casualty and mortality rates vary widely. In his History of the Army Medical Department, vol. 2. (Edinburgh: Churchill Livingstone, 1974), p. 185, Neil Cantlie suggests that only 11 percent of British troops hospitalized in the Crimea died.
15Porter, "Notes" 26:326-28 and 35:352; Porter, "Letters"6:57-58; Ltrs, Porter to McCormick (11 Jun 1847) and Laub to Heiskell (5Jul 1847), both in RG 112, entry 12; Charles McCormick, "Editorial: Sickness in the U.S. Army in Mexico," New Orleans Medical and Surgical Journal 4 (1847-48):141; Ltr, Heiskell to the editor of the Baltimore Sun (18 Oct 1847), RG 112, entry 2, 18:236-37; Statistical Report,1839-55, p. 230.
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By the spring and summer of 1847, the strain on Army surgeons was taking its toll, both at Vera Cruz and elsewhere in Mexico. The civilian physicians hired to make up for the shortage of military doctors provided only limited relief, since they proved all too often to be incompetent adventurers. Although he continued at his post, Porter`s health was seriously undermined by the demands placed upon him. Benjamin Harney, the elderly surgeon who was Scott`s medical director, fell ill even before the landings at Vera Cruz. He was still so weak in April that one observer believed he was "breaking down" and predicted that his departure from Mexico was imminent. Harney found the strength to continue, however, until he was slightly wounded by a ball that struck his leg just above the ankle, causing him to relinquish his responsibilities of medical director in favor of less arduous duties, although he remained in Mexico.16
The Drive on Mexico City
The strain on Scott`s surgeons was unrelenting. Although the men who marched inland from Vera Cruz in April 1847 left yellow fever behind them, intestinal disorders followed. Many were soon "weak and exhausted from the effects of bad water and diarrhea." Some were left by the roadside, easy prey for guerrillas. Even before his 18 April victory at Cerro Gordo, Scott found it necessary to order the opening of a temporary general hospital at Plan del Rio, not far from the Cerro Gordo pass.17
The battle for the control of the Cerro Gordo pass left sixty-four U.S. soldiers dead. Surgeons worked twenty-four hours and more in the open air, caring for the 353 wounded on
a great plateau of table land with giant precipices here and towering ledges of rock there, standing askew as if nature, when the earth was cooling from a molten mass, had wrenched the earth asunder, grasping and tearing out a huge proportion and carrying it away to leave a shelf where man might get a foothold and build his habitation.
Scott ordered that as soon as the U.S. victory seemed assured, one wagon per regiment and another for the cavalry gather up the wounded and take them to the appropriate hospitals. The decision as to which facility should be used for each case was made not by the medical director, but by the surgeon general himself. The wagon allotment must have been inadequate, for some patients were moved by litter, but when darkness fell, none of the wounded remained on the field.18
Because the Mexicans had used old muskets firing round balls, wounds were not serious except for injuries caused by artillery fire. As a result, only 10 percent of the wounded from Cerro Gordo died. Supply wagons returning to Vera Cruz carried the less seriously hurt back with them. Although the temporary hospital at Plan del Rio lacked both hospital furniture and bedding, and the supply of drugs, instruments, and dressings was small, most patients remained at this facility for at least a short time. To make matters worse, two days
16Eba Anderson Lawton, ed., An Artillery Officer in the Mexican War 1846-7: Letters of Robert Anderson, Captain 3rd Artillery, U.S.A. (New York: G. P. Putnam`s Sons, 1911), pp. 37-38,40, 256, quote from p. 123.
17Oswandel, Notes, p. 108, quote from p. 110.
18Quote from Elderkin, Sketches, p. 63; Maria Clinton Collins, ed., "Journal of Francis Collins..., " Quarterly Publications of the Historical and Philosophical Society of Ohio 10 (1915):59.
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after the battle, the able-bodied left the area. Since medical officers were attached to units rather than hospitals, these men took their doctors with them, leaving only one physician, a Regular Army surgeon, to care for 200 wounded.
Scott`s force occupied Jalapa after the Cerro Gordo victory, and wagons moved many of the wounded there from Plan del Rio at the end of April. As they neared the town, these sufferers were enveloped by "air. .. filled with sweet fragrance of orange trees, making the entry of Jalapa more like the Garden of Eden." The approach appears to have been so dramatic that despite the jostling of the wagons and the agony of their wounds, the injured men could still be "amazed by the hills of the city." The discomfort caused the patient by being moved by litter is not known, but carrying one was apparently a depressing duty; a soldier who had been required to bear a litter finally vowed he would kill himself before he spent another day at such a task. He then leaned on the muzzle of his gun, pulled the trigger with his big toe, and brought his earthly sufferings to an end.19
The Jalapa hospital was apparently located in a church or buildings attached to a church. It evidently lacked even the most essential equipment, and its attendants, like those at Vera Cruz, were men unfit for anything but hospital duty. As many as 1,000 men went through this facility, and although one patient believed that "men are dying in this hospital almost constantly," the mortality was actually only 20 percent. In a castle at Perote, a short distance beyond Jalapa, was a second hospital, managed by a Pennsylvania volunteer surgeon responsible to the head of the Jalapa facility. The Perote unit remained open through the summer, but by August the deaths among the 300 patients sheltered there were mounting. The average death rate was about four a day but could be as high as twelve. A majority of the deaths were blamed on diseases contracted on the march, most often diarrhea and dysentery.20
When Scott ordered his men forward once more in May, he hesitated to leave the sick and wounded at Jalapa, where they would be unguarded should the enemy attempt to harass them. Moving them, however, would also expose them to enemy attack and, in addition, would further undermine the health of many. Scott appears to have finally decided to leave at Jalapa those too ill to withstand two days on the road, trusting the Mexicans to follow the tradition that "military hospitals are universally regarded, by civilized enemies, as sacred." The patients left at Jalapa remained safe until their evacuation at the end of June, and the facility appears to have reopened in the fall of 1847. Although "infernal fleas and other creeping things" were infesting the hospital, diarrhea-like ailments rather than insect-borne diseases caused the highest percentage of deaths, at least among the volunteers. By June 1848, venereal diseases were taking a high toll; forty-six patients were suffering from gonorrhea and thirty-three from primary syphilis.21
19Oswandel, Notes, p. 383, first quote, p. 140; second quote, Thomas D. Tennery, The Mexican War Diary of Thomas D. Tennery, ed. D. E. Livingston-Little (Norman: University of Oklahoma Press, 1970), p. 84; Surgeon`s Quarterly Rpts, Jalapa (21 Apr and 30 Jun 1847), both in RG 94, entry 634.
20Quote from Tennery, Diary, p. 84; Oswandel, Notes, pp. 195, 383; Surgeon`s Quarterly Rpts, Jalapa (21 Apr and 30 Jun 1847)and Ltrs, McLaren to Med Dir (3 Sep and 3 Dec 1847), all in RG 94, entry 634; Grady McWhinney and Sue McWhinney, eds., To Mexico With Taylor and Scott, 1845-1847 (Waltham, Mass.: Blaisdell Publishing Co., 1969), p. 158.
21First quote, Ltr, Scott to Col Childs (3 Jun 1847), in War Department, Correspondence, p. 187; second quote, Oswandel, Notes, p. 404; Surgeon`s Monthly Rpt, Jalapa (31 Dec 1847), Surgeon`s Quarterly Rpt, Jalapa (30 Jun 1848), and Ltrs, McLaren to Med Dir (3 Sep and 3 Dec1847), all in RG 94, entry 634; Ltr, McLaren to Heiskell (1847), RG 112,entry 12.
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Diarrhea "in its most fatal and destructive form" struck Scott`s men when they reached Puebla, a town about a hundred miles southwest of Jalapa and located on a high, dry site, with a temperate climate and clean streets. In one regiment men were soon dying at the rate of two a day. Over 1,000 there were on sick report as of 4 June 1847. Surgeons blamed the disease rate on bad food, the change in diet, poor cooking, the weather, and the weakened condition of the men. When the army left Puebla during the second week in August, 2,000 men who were sick or convalescent stayed behind. Still others fell ill along the way, requiring surgeons to establish hospitals at other sites through which Scott`s force passed on its way to Mexico City, while supply trains returning to Vera Cruz through these towns picked up invalids to carry them on the first leg of their trip home. Many who remained with the army were also suffering from diarrhea, and some carried their own supply of opium to treat themselves.22
On 18 August, Scott`s surgeons set up another general hospital at San Augustin, ten miles south of Mexico City. During the following two days, Mexican forces killed 137 U.S. soldiers and wounded another 877. Despite rain and cold, at least thirty wo surgeons, including Lawson, worked night and day to care for the injured. Although the wounded were soon disbursed among several regimental hospitals at various sites in the area, the general hospital remained open to care for men stationed there after the main body of the army moved on. A facility was also opened at San Antonio, principally to care for the Mexican wounded, who apparently preferred treatment from U.S. Army physicians.23
As he approached Mexico City, Scott ordered a general hospital established at Mixcoac, where he placed the surgeon serving as the medical purveyor for his army in charge, aided by ten assistants. This facility remained in operation until after the surrender of Mexico City. A second hospital was established in the archbishop`s palace west of Tacubaya, near Scott`s headquarters.
On 8 September, U.S. troops met the Mexicans at Molino del Rey. Present were Lawson and eleven other Medical Department surgeons, two of whom were wounded. Litters and wagons took the casualties from the battle to Tacubaya. One of the injured physicians, who had been shot in the head while leading troops after their officers had fallen, died there of a brain abscess. A few days later, while viewing his men as they attacked the castle of Chapultepec, Scott realized that the Tacubaya hospital was within the range of enemy guns and ordered its occupants evacuated to Mixcoac. The Tacubaya facility reopened once the danger was past and some of the wounded from Chapultepec were moved there not long after the surrender of Mexico City on 14 September.24
22H. Judge Moore, Scott`s Campaign in Mexico... (Charleston, S.C.: J. B. Nixon, 1849), p. 120, quote from pp. 118-19; Oswandel, Notes, pp. 177, 239; Ltr, Scott to Marcy (4 Jan 1847), in War Department, Correspondence, p. 188; George Ballantine, "How Far Shall We Charge?" in McWhinney and McWhinney, To Mexico, p. 158.
23Ltr, McMillan to Lawson (6 Sep 1847), RG 112, entry 12; Edgar Erskine Hume, "Comment and Criticism: Medical Officers Who Marched With the Army Under General Scott Upon the City of Mexico in August, 1847,"Military Surgeon 54 (1924):99-101.
24Hume, "Medical Officers" 54:99-101; Hazard Stevens, The Life of Isaac Ingalls Stevens, 2 vols. (Boston: Houghton Mifflin Co., 1901), 1:218-19.
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The surrender of Mexico City was not the end of hostilities. Just a Scott`s troops were completing their victory at the nation`s capital, Mexican guerrillas were launching an attack on Puebla, with its garrison of 800. Santa Ana and several thousand men quickly reinforced the attackers. Although a typhoid epidemic reportedly struck during the siege and killed hundreds of the defenders in a short time, as many as 600 of the 1,800 patients at Puebla were well enough to aid in the city`s defense. On the evening of 28 September, "the Mexicans (cowardly dogs) attacked our hospital, and succeeded in setting fire to the main gate." Even though the siege was not lifted for two weeks, the hospital was able to continue in operation much as before, apparently closing only in the summer of 1848.25
After the Victory
Despite the action at Puebla, the active phase of the war was essentially over when U.S. forces took Mexico City. Scott`s medical director, wishing to close the facilities outside the city, quickly searched out buildings suitable for use as division hospitals within Mexico City. He often chose convents or official palaces, but even the best of these were still cold, damp, dark, badly ventilated and, in the opinion of U.S. surgeons, conducive to digestive problems and fevers. Floors were often brick or tile. Since there were no chimneys, presumably there was no artificial heat. Windows opened into a central courtyard, thereby limiting the ventilation. The real cause of health problems, however, lay in the character of Mexico City itself. The city in general was "exceedingly filthy" and the area in which one hospital was located was poorly drained, so that sewage remained near the surface. "The poor [had] no privies, and their excrement [was] at once deposited in the open street, [while] the lower order of people [was] almost universally affected with lice, and fleas [were] the inmates of the palace as well as the hovel." Not surprisingly, typhoid could appear year round, and many U.S. soldiers contracted it while in the city.26
In Mexico City the division hospitals were merely collections of regimental hospitals, functioning under the overall supervision of a surgeon at the division level. Although some of the funds of each regiment intended for its sick were sent to help finance the division hospital, Scott also levied a tax on the city, $20,000 of which went to meet hospital expenses. By December 1847 the number of patients in Mexico City hospitals had declined, permitting all to be moved into one general hospital, which was sheltered in several large buildings under the control of a single surgeon and four assistant surgeons.27
Nevertheless, disease continued to be a major problem for troops in Mexico. The volunteers who continued to come into Mexico even after the end of significant military action often fell ill, frequently with diarrhea. A Kentucky unit was devastated by one ailment after another, beginning with measles that afflicted the men even before they started out. Some had not entirely recovered from the measles when they boarded ship and subsequently became seasick. "The Sight was laughable.... A poor fellow would tumble over so sick that he could not move and vomit
25Oswandel, Notes, pp. 267, 341, 359-60, quote from p. 309; Surgeon`s Quarterly Rpt, Puebla (16 Jun 1848), RG 94, entry634; Moore, Scott`s Campaign in Mexico, pp. 212-14, 217-18.
26Robert Newton, "Medical Topography of the City of Mexico" New York Journal of Medicine and the Collateral Sciences, n.s.,1 (1848):298, quotes from 302-03; Irwin, "Notes," p. 114.
27Lawton, Anderson, p. 314.
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upon himself... The hold was full of sick men & the whole boat presented the most sickening scene." The seasickness eased in a day or two, but then, not long after the unit landed on 16 November 1847, diarrhea took over. Soldiers too ill to march were left behind at the ship or at the nearest hospital. The sick tried many remedies to cure their diarrhea, including bathing their feet in warm water and drinking "some cayenne pepper tea," evidently placing little faith in professional medical advice until amateur remedies had failed. By early December one man was so ill with diarrhea that he had to be hospitalized at Jalapa. As the unit continued to move inland, wagons picked up those too sick to march, and more were hospitalized, twenty being left at the Puebla facility.28
Incoming volunteer units were not the only ones afflicted with diarrhea. Three companies out of ten ordered to leave Mexico City for Vera Cruz and, presumably, to return to the United States in March 1848, for example, were detained because of what was called "the diarrhea blues." Furthermore, measles and mumps apparently occasionally appeared among volunteers already in Mexico, and erysipelas, in addition to malaria, was reported to be "common among all the corps." In January, almost 4,000 of the 15,000 men in Mexico were sick. Thus, even though hostilities were over, as long as U.S. soldiers remained in Mexico, hospitals would be needed to shelter their sick, not only at Mexico City but also at ` Vera Cruz, Jalapa, and other sites where troops were stationed or through which any great number of them might pass.29
Surgeons ordered the evacuation of those who were faced with a lengthy illness or convalescence and those with serious wounds. As a result, to their sufferings were added the torture of sixteen or more days in a wagon ,tossed about from Mexico City and Puebla to Vera Cruz, where they boarded ships bound for New Orleans. Physicians accompanied them on each leg of this trip, but the stress of the journey upon men already in a weakened state increased their chances of falling ill. Many, having survived their wounds, died of disease. Once on board ship, they too often lay upon the deck without cover, presenting, according to Assistant Surgeon Charles McCormick, "a spectacle of the most heart rending distress, &extreme suffering," their situation made yet more depressing by the fact that the sick were scattered among the dead and dying and surrounded by dirt and filth.30
The sufferings of the invalids returning to the United States did not end with their arrival at New Orleans. In one instance, a volunteer surgeon accompanying 128 patients neglected them on board ship and abandoned them entirely as soon as they got to shore. His failure to turn them over to anyone else allowed them to scatter throughout the city, so that eight were never found. On another occasion, a department assistant surgeon accompanying
28Hinds, "Cox" 55 (1957):35, 39,41, 46, 47, 49, 213, 214, 217, 218, 220, 226, 227-28, 232, quotes from pp. 39 and 214, respectively.
29First quote, Oswandel, Notes, p. 509; second quote, Ltr, Scott to Sec War (2 Feb 1848), in War Department, Correspondence, p. 272; Ltr, Thomas Marshall to Scott (3 Jan 1848), in War Department, Correspondence, p. 258; Porter, "Notes" 26:329-30; Rpt, Scott to Sec War (6 Jan 1848), in Winfield Scott, Memoirs of Lieut-General Scott, LL.D., 2 vols. (New York: Sheldon & Co., 1864), 2:562-63;Israel Moses, "Cases of Erysipelas, Which Occurred at Soluca, Mexico, "New York Journal of Medicine and the Collateral Sciences, n.s.,2 (1849):162-63.
30Quote from Ltr, McCormick to Heiskell (30 Oct 1847), in RG112, entry 12; Collins, "Journal," p. 89; Karl Jack Bauer, The Mexican War (New York: Macmillan Publishing Co., 1974), p. 32; Stevens, Stevens 2:225.
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invalids developed delirium tremens when the ship arrived at New Orleans. Moreover, the hospital in that city was becoming overcrowded. A nearby barracks and the buildings of a private institution were taken over to shelter the casualties, but an outbreak of yellow fever in the summer of 1847 further congested the New Orleans facilities, which until the spring of 1848 could shelter an absolute maximum of 300 men.31
In 1847 the acting surgeon general in Washington urged that some patients at New Orleans be moved upriver to Baton Rouge, where the barracks hospital was empty; if the barracks itself was also used, 100 or more patients could be accommodated. Medical and hospital supplies were plentiful, and a good private physician was available nearby. This hospital, however, was not ready for patients until September 1847, when the preparation of 30 spaces was complete, and 100 more were almost ready for occupancy. This number, however, was insufficient to give the New Orleans facilities much relief, and when Lawson himself returned from Mexico to New Orleans, he found the situation there as bad as ever.32
CHARLES MCCORMICK.(Courtesy of National Library of Medicine)
Such a large number of invalids continued to come in to New Orleans that by 1848 the situation was critical. The department attempted to send as many patients as possible out of the New Orleans-Baton Rouge area to such posts as Jefferson Barracks near St. Louis. Lawson urged that Congress take greater heed of the problem Mexican War invalids posed; a new hospital should be built in New Orleans and specially equipped hospital ships sent to return men from Vera Cruz to New Orleans. Lawson`s suggestions about hospital ships were evidently ignored, but by June 1848 the Army had taken over new facilities under construction at New Orleans that had originally been planned as a hospital for merchant seamen. While this project remained incomplete, a general hospital apparently capable of taking at least 300 patients was opened on Greenwood Island, near Pascagoula, Mississippi, to care for the sick from Mexico. Unfortunately, the four buildings used there were "mere
31Porter, "Notes" 35:351-52; Ltrs, Heiskell to McCormick (9 Nov 1847), to James McFarlane (12 Nov 1847), to Wright (5 May 1848), and to Satterlee (17 May 1848), all in RG 112, entry2, 18:219 and 226 and 19:43-44 and 58, respectively; McCormick to the editor(22 Jun 1847), in "Editorial," New Orleans Medical and Surgical Journal 4 (1847-48):140; Lawson to Heiskell (11 Feb 1847), McCormick to Heiskell (30 Oct 1847), and Wood to Heiskell (18 Jul 1847), all in RG112, entry 12.
32Ltrs, Heiskell to AG (2 Jul 1847) and to Porter (25 Apr 1847)and Lawson to See War (13 Mar 1848), all in RG 112, entry 2, 17:534-35and 18: 100 and 485, respectively; Ltr, Wood to Heiskell (18 Jul 1847)and Statement, Lawson (26 Jan 1848), both in RG 112, entry 12.
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shells, leaking in rainy weather," according to Porter, who was in charge of this facility. Proper food for the sick was hard to find, and the men were in very poor condition, suffering from diseases such as chronic dysentery, diarrhea, and even scurvy. When the Greenwood hospital closed in November 1848, Porter accompanied those still needing hospitalization back to New Orleans, despite the fact that the new hospital there was not actually completed until a month later.33
For some troops, New Orleans was but a way station. Many eventually went on to other posts along the coast, and especially to Fort Monroe, or returned to their homes. Some arrived at the Virginia post in fine health, but of the 250 on one ship, 100 came down with yellow fever after leaving New Orleans. A company of artillerymen that had been at Vera Cruz also arrived at Fort Monroe with many still sick. The post surgeon reported that 25 of these men had fevers during the trip and that 9 died, "one with black vomit" (i.e., yellow fever). He hospitalized 7 with diarrhea and placed 14 convalescing from fevers in hospital tents set up about a mile from the post at a healthy site. As he went home by steamer, one veteran wrote, "my mouth is so sore that the least effort to masticate my food is very painful, and I cannot eat.... and even if I could, it would be improper for me to do so, on account of a long continued diarrhea and pain in my breast and side."34
Conclusion
Of the more than 100,000 soldiers who had left the United States to fight in Mexico, over 1,500 had been killed in action, but more than 10,000 had died of disease. The proportion of sick to killed was better than that of the Revolution; in the Civil War, however, only two would die of disease for every one killed in battle or dead from wounds. These figures include either those who died at home as a result of disease contracted in Mexican or those family members of returned soldiers who contracted dysentery or typhoid from them. Many a man undoubtedly suffered from impaired health long after the end of the war, starting the campaign "full of health," and returning home "a sick soldier- a mere skeleton of a man, worn down by the prolonged fatigue of travelling, watching and toil."35
As it was in so many wars, disease was the great enemy in the Mexican War- the rate of death from disease among the U.S. soldiers in Mexico was ten times that of civilians at home. The surgeons of the Medical Department, too few to meet the demands made upon them, working with inexperienced volunteer and contract surgeons and assisted by attendants who were, for the most part, the dregs of the Army, were helpless before the in roads of dysentery and other digestive ills. They were not as helpless as they had been, however. By means of vaccination they were able to stop outbreaks of smallpox before they became epidemic, and with large doses of quinine
33Quote from Ltr, Porter to Bliss (1 Nov 1848), RG 112, entry 12; Porter, "Notes" 35:247-48; Ltrs, Lawson to Sec War (13 Mar 1848) and to Taylor (18 Aug 1848), both in RG 112, entry2, 18:485 and 19:172, respectively; Chase to Lawson (23 Jun 1848) and Porter to Lawson (20 Jul, 29 Nov, and 3 Dec 1848), all in RG 112, entry 12; McCormick to Lawson (10 Mar 1848), copy in RG 112, entry 12.
34 First quote, Ltr, Thomas Henderson to Heiskell (13 Jul 1848),RG 112, entry 12; second quote, Richardson, Journal, p. 86; see also Ltr, Henderson to Heiskell (24 July 1848), RG 112, entry 12; Collins, "Journal," pp. 106-08.
35Quotes from Richardson, Journal, p. 86; I rey, "Soldiers," pp. 285, 298; William Jay, Review of the Causes and Consequences of the Mexican War (1849. Reprint. New York: Arno Press & The New York Times, 1969), p. 221; Bayne-Jones, Preventive Medicine, pp.55, 86.
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they were able to cut short the paroxysms of malarial fevers. Unfortunately, for practical reasons as well as because of prejudice and fear of the unfamiliar, they failed to use anesthesia on a large scale, and thus passed up their only real chance during the Mexican War to make a significant contribution to the progress of medical science.36
Although Army surgeons would continue to be helpless against many scourges until progress in the state of the art of medicine gave them better weapons against disease, the war with Mexico emphasized the need for many changes that were within the realm of possibility. As a result, although Lawson`s suggestion about hospital ships appears to have been dropped, efforts to develop an ambulance and to make the position of hospital steward permanent continued. The Mexican War did not, however, lead Lawson to conclude that the Medical Department should anticipate in peacetime the complex demands of war. As a result of his lack of insight, a lack many others shared, he failed to develop plans that might minimize the adverse effects of the necessary wartime influx of large numbers of inexperienced surgeons, allow for the need to staff both general and regimental hospitals, and meet in other ways the requirements of an army at war. A stubborn and unimaginative surgeon general had overlooked the most important and perhaps even the most obvious lesson of the Mexican War.
36Edward Jarvis, "The Sanitary Condition of the Army," Atlantic Monthly 10 (1862):472-73.
