History

Chapter 3

From Siege to Retreat, 1775 to May 1777

The months between 27 July 1775, when the Hospital Department was established, and the late spring of 1777, when General Washington`s army left its winter camp at Morristown, New Jersey, to begin another campaign, saw the scope of Continental Army operations broaden from a largely inactive siege of Boston to action on two fronts, along the Canadian border and in the general vicinity of New York City and northern New Jersey. It was a time of limited successes for the new army and of increasing strain upon the Hospital Department.

THE BOSTON AREA, 1775 TO 1776

The 17,000-man New England army, composed for the most part of Massachusetts units, which was positioned outside of British-occupied Boston in July 1775, was both disorganized and undisciplined. Enlisted men generally ignored both camp and personal hygiene and regarded attempts to discipline them as tyranny, but when General Washington assumed command, only 9.5 to 12.5 percent of them were

MAP 1

unfit for duty. Except for makeshift regimental facilities, the only hospitals available were those managed by Massachusetts at Cambridge, Roxbury, and Watertown. (Map 1) These hospitals seem to have made no attempt to segregate those with contagious diseases from the wounded, visitors were allowed unlimited access to patients, and the most elementary rules of hospital discipline were ignored.¹

During his short time as Director General, however, Benjamin Church managed to instill some order into the medical service of Washington`s army. By the late summer he had divided the Hospital Department`s patients among six buildings, 200 in houses named after Generals Washington, Lee, and Putnam and served by surgeons Isaac Foster, John Warren, Samuel Adams, Jr., and Charles McKnight in Cambridge, and 170 in three others serving the Roxbury

JOHN WARREN. (Courtesy of National Library of Medicine.)

CHARLES MCKNIGHT. (Courtesy of National Library of Medicine.)

camp but actually located, according to Church, in Brookline. The care of Roxbury patients was supervised by William Aspinwall, Lemuel Hayward, and Elisha Perkins, all three in the pay of individual colonies rather than that of the Hospital Department. Church, however, urged that three more surgeons be appointed to serve with the department.² In December, John Morgan referred to Aspinwall and Hayward as "additional surgeons," so apparently they were by then members of the department staff. However, no records exist giving exact information on this point. Church also planned in August to acquire more beds so that he could expand the Cambridge hospital to a 240-bed capacity.³

Church had noted that his patients were returning to duty before fully regaining their strength and that, as a result, as many as four of five relapsed and had to return to the hospital. He urged the creation of a unit specifically for convalescents where,

TABLE 2- HOSPITAL DEPARTMENTUNITS IN THE BOSTON AREA WITH THE STATUS OF PATIENTS
DURING WEEK PRECEDING 2 DECEMBER 1775

Hospital	Admitted Since Last Return	Dismissed Fit for Service	Discharged From the Army	To Convalescent Hospital	Absent With Permission	Absent Without Permission	Dead	Remaining
Total	128	95	5	51	1	6	13	^a377
At Cambridge:
Washington House	25	8	0	15	0	1	2	69
Lee House	13	10	0	0	0	1	2	65
Putnam House	12	5	0	12	0	0	2	47
Convalescent House	26	30	2	0	0	4	0	80
At Roxbury
Ward House	18	0	1	19	0	0	5	39
Thomas House	14	17	0	5	0	0	2	50
Spencer House (convalescents)	20	25	2	0	1	0	0	37

SOURCE: John Morgan, Return of the Sick & Woundedin the General Hospital at Cambridge & Roxbury, 25 Nov 1775-2 Dec 1775,RG 93, M246 roll 135, folder 3-1, item 15.
^aMorgan`s addition.

if a Hospital Department physician were to check on them each day, such patients would otherwise need merely the care of one or two mates. By the end of October 1775, a convalescent hospital was in operation in Cambridge, and by late November, it was apparently caring for as many as seventy to eighty patients at a time.⁴

On Church`s recommendation, General Washington took action designed to improve hospital discipline. On 21 August, he assigned a guard consisting of a sergeant, a corporal, and nine men to one of the hospital buildings. The following day, commenting that Church had informed him that patients were suffering as a result of "having improper things carried to them to eat" and that many of the illnesses afflicting them might have been brought in by visitors, the general ordered that no enlisted man or noncommissioned officer be allowed to enter a hospital without written permission from either his commanding officer or a surgeon. A week later, the general decided to organize the separate guards being set up at individual hospitals into one guard, to consist of "one Sub three Sergeants one fife Three Corporals & Thirty men," taking their Orders from Church.⁵

Despite Church`s efforts, when John Morgan became Director General, much was yet to be accomplished if the Hospital Department were to care for the sick and wounded of General Washington`s army efficiently. Since his first inspection revealed that no one could tell him the number of patients for whom the department was responsible, Morgan ordered that weekly reports, or returns, be made to him by each hospital unit. It is from these that we learn the details of the structure of the department as it existed under Morgan in the Boston area.

Four hospital units were in Cambridge as of 2 December 1775, when the first return was made, the three named during Church`s administration after the three generals plus the newer Convalescent House. The return from Washington House was signed by surgeon John Warren. Doctors Samuel Adams, Jr., and James McHenry, the latter apparently a regimental surgeon at this time, signed the return from Lee House, where five wards were named after patriots Henry, Franklin, Gadsden, Rodney, and Gates. Charles McKnight signed the report from Putnam House, where six wards were named after famous physicians, Pringle, Monro, Black, Shippen, Cullen, and Hunter. Surgeon`s mate Daniel Scott signed the return from the Convalescent House. Cambridge patients ranged in age from 16 to 60 and the most frequent diagnosis was "fever." There were also three

TABLE 3- HOSPITAL DEPARTMENTUNITS IN THE BOSTON AREA WITH THE STATUS OF PATIENTS
DURING WEEK PRECEDING 16 DECEMBER 1775

Hospital	Admitted Since Last Return	Dismissed Fit for Service	Discharged From the Army	To Convalescent Hospital	Absent With Permission	Absent Without Permission	Dead	Remaining
Total	^a155	117	5	29	1	4	11	341
At Cambridge:
Washington House	23	11	1	7	0	0	0	73
Lee House	22	0	0	10	0	0	3	62
Putnam House	21	8	2	6	0	2	3	52
Convalescent House	29	25	2	0	1	2	0	67
At Roxbury:
Ward House	11	29	0	2	0	0	2	15
Thomas House	16	19	0	4	0	0	3	49
Spencer House (convalescents)	23	25	0	0	0	0	0	23

Source: John Morgan, Return of the Sick & Wounded in the General Hospital at Cambridge & Roxbury, 9-16 Dec 1775, RG 93,M246, roll 135, folder 3-1, item 16.
^aMorgan`s addition.

units at Roxbury, Thomas and Ward Houses and the convalescent hospital, Spencer House. Since the Roxbury returns were not signed, the surgeons or mates in charge there remain anonymous.⁶

The Director General`s report to General Washington of this same date was typical in its form and its casual arithmetic of the many which Morgan was to submit from the Boston area in the following months. (Table 2)His patients during these first weeks did not total the 676 he claimed, although this figure has been uncritically repeated by subsequent historians.⁷In reaching his overall total in this instance, Morgan apparently added together the totals from all of the individual columns, thus counting both convalescents and newly admitted patients twice. A more accurate figure would appear to be 497. In his report of 16 December 1775, as an example of his arithmetic, Morgan not only incorrectly totaled the number of admissions to Hospital Department units (ten too many) but also concluded that the department cared for 512 patients, a figure at which it is difficult to arrive using Morgan`s figures. (Table 3) It is interesting to note that, while these early returns were entirely handwritten, beginning with that of 2 March 1776, Morgan used preprinted forms into which the appropriate entries were made.⁸

The health of the army besieging Boston when Morgan became Director General was considered by contemporaries to have been unusually good, although the number of men unfit for duty after General Washington took command apparently ran from less than 14 percent to approximately 17 percent per month, if one can trust monthly strength reports. The number of patients actually in Hospital Department units varied from 320 to 550 in the period 16 December 1776 to 30 March 1777 and the death rate from 1.4 percent of these patients to 4 percent.⁹ (Table 4) The most greatly feared threat to the health of the army came from within the city of Boston, where for months smallpox raged.

TABLE 4- MORTALITY, 16 DECEMBER1775-30 MARCH 1776

Date	Total Patients	Dead
16-24 Dec 1775	439	8
23-30 Dec	465	9
30 Dec-6 Jan 1776	442	18
13-20 Jan	419	7
26 Jan-3 Feb	504	12
3-10 Feb	497	13
17-24 Feb	520	16
24 Feb-2 Mar	550	11
2-9 Mar	485	7
11-17 Mar	404	6
23-30 Mar	320	6

SOURCE: Returns of the Sick & Wounded in the General Hospital at Cambridge & Roxbury, 16 Dec 1775-30 Mar 1776, RG 93, M246,roll 135, folder 3-1, items 17-27.

RETURN SIGNED BY CHARLES MCKNIGHT.(Courtesy of National Archives.) [page 1]

RETURN SIGNED BY CHARLESMCKNIGHT. (Courtesy of National Archives.) [page 2]

In the fall and winter of 1775-76, rumors abounded that the British were deliberately attempting to infect their enemies by sending diseased or recently inoculated civilians out of the city. The records on the hospitalizing of the Army`s smallpox victims during this entire period are incomplete, but a smallpox hospital had been in operation, under the supervision of Dr. Isaac Rand, since 27 June 1775. Rand was among those caring for patients in the Cambridge hospital under Church, but at some time thereafter the threat posed by smallpox waned and General Washington decided to close the hospital. In December 1775, however, Morgan noting that smallpox had appeared "several times in the army," requested that the care of its victims once again be assigned exclusively to Rand and his mate.¹⁰The first mention of a smallpox hospital as reestablished under Morgan appears in the Director General`s report of 20 January 1776. At this time, five patients were listed as "remaining" in the Cambridge institution, implying that it had gone into operation before that date. From the returns that followed through the end of March 1776, it would seem not only that smallpox was a minor problem for Washington`s army at this time but also that mass inoculation of soldiers was not being undertaken, since the greatest number listed as "remaining" at any one time was twelve and the weekly admission never exceeded six. James Thacher, a regimental surgeon at this time, recorded that the most prevalent diseases were actually autumnal fevers and dysentery like conditions.¹¹

Nevertheless, the threat of smallpox continued to hang over the Boston area in the early months of 1776, and a Boston publisher even reissued Baron Dimsdale`s pamphlet on inoculation, for which Morgan wrote a preface. It has been argued that the presence of smallpox in the city of Boston was actually to some degree responsible for Washington`s reliance upon siege rather than attack on the British during the fall and winter. When the enemy evacuated Boston on 17 March 1776, Washington, still wary, initially forbade any of his men to enter the city except for 1,000 men who had already had the disease, under the command of General Putnam. Both hospital and regimental surgeons were ordered to keep a sharp watch for smallpox victims and to send them at once to the isolation hospital. Apparently the contagion was still feared weeks after the British evacuation, for Thacher noted in May that he had believed it wise to undergo inoculation himself and in July that all soldiers in Boston were to be inoculated.¹²

During the siege, Morgan met the supply shortage affecting the hospitals in the Boston area by buying what he could himself and also by launching a vigorous campaign to have both individual citizens and states donate needed items. In Morgan`s behalf, Washington appealed to the governments of Massachusetts, New Hampshire, Connecticut, and Rhode Island, and within a month blankets and materials for bandages were arriving at Cambridge. Morgan then set everyone, including surgeons, to work making bandages.

One of Morgan`s first tasks after the British evacuation of Boston was to locate drugs and supplies for the new hospital in New York. In Boston he found that medicines were often held by Tories who hid what they had or by owners who, in fear of inflation, insisted on cash payments. In time, a good source of medicines also proved to be prize ships, taken from the British. The drugs left behind by the British in Boston, however, were the source of much controversy because of reports that they had been poisoned. Dr. John Warren testified that on 29 March 1776, when he entered the workhouse which the British had used as a hospital, he found the medicines in great disorder with small amounts of

yellow and white arsenic mixed in with them. After learning that another physician had already removed twelve to fourteen pounds of this poison from among the drugs, Warren recommended that no attempt be made to use them. On Washington`s orders and after offering to pay for what he took, Morgan did confiscate the drug supplies of two Tory physicians in Boston, one of whom was reputed to have the largest pharmaceutical business in the city.¹³

By June, having taken over a large quantity of abandoned British property and using every other means available to him, Morgan had acquired a large collection of bedding, medicines, furniture, and other supplies which, with the exception of the materials needed for medicine chests for five regiments left to defend Boston, he then had moved to Connecticut, as ordered by Washington. He was quite optimistic about the adequacy of his stock for the coming year, believing that he could easily obtain the little he still needed in Philadelphia. His optimism, however, was not entirely justified, since as early as April one of his principal suppliers was running low in items needed for regimental chests and by May was out of bark, ipecac, and cream of tartar, among other popular items.¹⁴

In anticipation of the active campaign against Boston, which the formation of new army units in March had made possible, Morgan also prepared a barracks at Prospect Hill which could care for at least 100 wounded. The fortification of Dorchester Heights by the Americans made the British position untenable, however, and they evacuated Boston. American losses in action, therefore, were slight, and Morgan`s planning remained essentially untested.¹⁵

Almost immediately after the British left Boston, the Continental Army moved south to the defense of New York City, leaving Morgan with the dual problems of caring for the approximately three hundred patients left behind in the Boston area and of preparing to establish a new hospital system. Maj. Gen. Charles Lee, sent in January 1776 to prepare the defense of New York, had written Washington as early as 9 February to request the establishment of a hospital there, but it was not until 3 April that Morgan received official orders to do so. He was at that time told to leave behind in Boston only those surgeons and attendants necessary for the care of soldiers too ill to move with the army. Morgan placed Isaac Foster in charge of these patients, who did so well that the death rate among them was very low and by 22 April only eighty remained in department hands. Within six weeks of receiving orders to move the department`s main operations from Boston, he discharged the last man and settled all his accounts for the Bostonhospitals.¹⁶

THE NORTHERN DEPARTMENT

In the Northern Department in the late summer and early fall of 1775,preparations were under way for an attack on Canada under the command of Maj. Gen. Philip Schuyler. (Map 2) These preparations left much to be desired. No department physicians were assigned to the expedition and some units even failed to bring regimental surgeons. Furthermore, General Schuyler still had no hospital supplies by the first week of August, when100 of his 500 men were ill. On 6 August, he reported this situation to the Continental Congress, stating that he had already given up his own personal wine supply for the sick of his regiments and that he must have medical supplies even if he had to pay for them himself. He added that he had hired a surgeon from Albany on his own authority and that he would also meet this expense personally if Congress failed to act.¹⁷

Samuel Stringer, the physician appointed by General Schuyler, was requested to

MAP 2

bring with him as many of the supplies he believed to be needed for Schuyler`s army as time permitted him to gather. By 14 September, however, when Congress officially approved both Stringer`s appointment and his reimbursement for the medicines he brought with him, General Schuyler had become too ill to continue in command and had been replaced by Brig. Gen. RichardMontgomery.¹⁸

Stringer`s headquarters and that of Montgomery`s 2,000-man army appear to have been at Fort George, at the southern end of Lake George. Stringer`s only assistance here seems to have come from regimental surgeons and mates, but on 25 October, he requested the assignment of Hospital Department surgeons to serve under him. Stringer apparently accompanied the army only to Fort George, but General Montgomery continued to Montreal, taking the city on 12 November. By this date, however, disease, desertions, and expiring enlistments had reduced his army to 500 men. When he marched from Montreal to Quebec in December, 300 of the Montreal army went with him and they carried with them the seeds of a devastating epidemic of smallpox.

While General Montgomery`s army moved on Montreal, Col. Benedict Arnold led approximately eleven hundred men on a second operation against Canada, aimed at the city of Quebec. The only medical attendants to accompany him on the grueling march through thick New England forests and swamps were the 22-year-old regimental surgeon Isaac Senter and his assistants. Senter organized the hospital used for the Continental troops before Quebec, but although this institution was called the "General Hospital," it received its name from the fact that the building housing it already bore that designation. While most of the Northern Army was at Quebec, the smallpox epidemic first struck. It continued through the spring and summer of 1776 and eventually involved not only the regimental surgeons and mates but also Stringer and the Hospital Department.¹⁹

By the spring of 1776, Brig. Gen. David Wooster was in overall command of the troops in Canada, General Montgomery having been killed in action in January, and almost half of the approximately 1,900 men before Quebec were sick. An abortive attempt was made to start an official inoculation program, since many officers and men were secretly inoculating themselves and were thus intensifying the epidemic. When British reinforcements arrived at Quebec and the colonial army fell back on Sorel, many smallpox victims left their beds to join the flight. The epidemic worsened at Sorel and the men in the Montreal area were in no better condition, 1,200 of the approximately 3,200 there in early May being unfit for duty, according to General Arnold, most of them sick with smallpox.²⁰

The Hospital Department was by no means prepared to deal with the rapidly growing epidemic. Stringer wrote from St. Johns, where the army from Quebec retreated when it left Sorel, that he had neither medicines nor instruments and no way of obtaining either. It was in late May, however, that he finally received permission to hire a larger staff.²¹

A committee of the Continental Congress urged in early May, when new units were arriving and the total number of men in Canada was approaching 8,000, that Dr. Jonathan Potts be hired by the Hospital Department for assignment to either Canada or Fort George. By the end of May 1776, the situation of patients in the Northern Department was "almost Sufficient to excite the pity of Brutes, Large barns [being] filled with men at the very heighth [sic] of smallpox and not the least things, to make them comfortable"²² "and medicines being needed at both Fort George and Ticonderoga."²³

By 6 June, as estimated by the recently created Brigadier General Arnold, who was now in command at Montreal, only 5,000 of the men in Canada were fit for duty. Smallpox threatened the destruction of the entire army. On 15 June, General Arnold evacuated Montreal and by the time he arrived at St. Johns, two days later, half of his army was sick and the condition of all his men so poor that to remain at St. Johns seemed unwise. Maj. Gen. John Thomas, who took command of the army at Quebec on 1 May, himself died of smallpox on 2 June. "The smallpox," mourned John Adams, "is ten times more terrible than Britons, Canadians and Indians, together."²⁴

The misery of the men who had so recently set off to conquer Canada was total. One hospital was described, for example, as a "dirty, stinking place" in a camp which "echoed with execrations upon the musketoes.""Language cannot describe nor imagination paint, the scenes of misery and distress the Soldiery endure," and the patients crowded into the barn which served as the hospital were in such condition that many "could not See, Speak, or walk. In one day two had large maggots, an inch long, Crawl out of their ears."²⁵

It was only in June, however, that the Continental Congress, while leaving Potts`s exact status unclear, officially ordered him to go as Physician and Surgeon to the North. Washington was at first undecided as to whether to send Potts or Stringer to aid Arnold`s men who were then still in Canada, but by 26 June, when Potts and a supply of medicines from the Hospital Department headed north with Brig. Gen. Horatio Gates, who was to assume command of the Northern Army in the field from Brig. Gen. John Sullivan, General Thomas`s successor, General Arnold had left Canada. When Potts arrived at Fort George, he found approximately one thousand patients suffering from smallpox, dysentery, and fevers, cared for by four surgeons and four mates. The number of patients there was still growing when the bulk of the Northern Army, which had been first reunited at Crown Point, fell back further in early July to Ticonderoga. Their seriously ill were rowed in small boats to the Hospital Department`s Fort George facilities.²⁶

By mid-July, an estimated three thousand of the men of the Northern Army were sick, for the most part with smallpox, three thousand well, and five thousand unaccounted for Stringer, now also at the Fort George hospital, was close to desperation. More units were being sent to join the Northern Army, yet except for those which Potts brought with him, there were no drugs and the hospital was "in the utmost distress for both assistants and medicines."²⁷ Stringer had even been reduced to suggesting to Potts that "hemlock tops" be used for bedding. His request to Washington of 10 May 1776 for help had not been granted, the number of patients for whom he was responsible was still rising, and men were dying for lack of aid. On 26 July, the hospital at Fort George, reporting for a two-week period, noted 1,497 admissions, 439 discharges, and 51 deaths,²⁸with the deaths in a five-week period estimated by one regimental surgeon at 300 or more. "In the name of God" Stringer asked Gates, "What shall we do with them all, my dear General?"²⁹

Morgan, meanwhile, noted in a letter to Samuel Adams that he was lacking instructions as to how he should help Potts. He had, nevertheless, appointed Dr. James McHenry to serve under Potts, instructing him to go first to Philadelphia to obtain medicines with which to resupply the hospitals of the Northern Department. He had also assigned Potts the assistance of an apothecary, Dr. Andrew Craigie. Morgan ordered Potts to supply medicines both to the department`s unit and to regimental surgeons and to require an accounting from regimental surgeons for whatever they used.

RETURN OF THE SICK OF THE HOSPITAL AT FORT GEORGE. (Courtesy of National Archives.)

JAMES MCHENRY. (Courtesy of National Library of Medicine.)

He was to report to Morgan monthly on the hospitals under him and theirexpenses.³⁰

McHenry had not arrived by the end of July and the drug shortage was so severe that Stringer received permission from General Gates to go to New York himself to obtain medicines. Unable to fill his requirements in New York, however, Stringer hurried to intercept McHenry, who was preparing to travel north with the few drugs he had been able to collect. Although he obviously and desperately needed a larger staff, Stringer attempted to show his own independence by dismissing McHenry as soon as he encountered him, in so doing apparently failing to take over the drugs McHenry had with him. In August, however, Potts was still in ignorance of this development and anxiously awaiting the arrival of his new assistant with his supply of medicines. His own dismissal of McHenry did not keep Stringer from eventually blaming Morgan for the shortage of supplies in the Northern Department, because the Director General had failed to forward the medicines which McHenry had obtained. "A tissue of misunderstanding and mistakes seem to be the fate of your district," McHenry commented to Potts.³¹

By the second week in August, although he still believed he should have been independent of Stringer, Potts had resigned himself to working as Stringer`s subordinate and acted as Director while Stringer was absent from his post, still ostensibly seeking drugs. There had been no enlargement of the staff caring for the patients at Fort George and the situation at the hospital had not otherwise improved since his arrival a month earlier. Patients were "without clothing, without bedding, or a shelter sufficient to screen them from the weather." There were no jalap, bark, salts, or opium available and the number of sick was, according to Stringer, stillincreasing.³²

Although the urgent need to improve the care given patients in the Northern Department was recognized by the Continental Congress by the late summer of 1776, there were occasional optimistic reports in mid-August and the smallpox threat was diminishing. Samuel Adams believed that the number of patients was no longer increasing at Fort George, Stringer maintained that he had located a supply of medicines and sent a portion of them to Potts, and, on 28 August, General Gates was able to write Washington that "the Smallpox is now perfectly removed from the Army." For the disappearance of this disease, Potts should receive some credit, since he apparently did go forward with the inoculation not long after his arrival, as ordered by Stringer, although exact figures are not available.³³

Nevertheless, despite these hopeful comments, the shortage of medicines was by no means relieved, self-inoculation by

newly arriving militia was threatening a renewed epidemic, and Stringer was still absent from his post. When he had not returned by 22 August, General Gates became angry that the Director of his department`s hospitals would go "preferment hunting . . . while the troops here are suffering inexpressible distress for want of Medicine." Begging that medicines be sent to Potts at Fort George, Gates added a request that General Washington be informed of Stringer`s behavior. He followed this letter by comments in his General Orders of 31 August which emphasized that, although Stringer had been ordered to obtain the needed drugs and return at once, he had now been absent from duty 33 days.³⁴

Smallpox did not reappear in Gates`s army, but other diseases also afflicted his men, among them dysentery at a time when the accepted remedies for this condition were scarce, bilious, remittent, and intermittent fevers, and scurvy; even worms apparently added to the miseries of the Northern Army. In September, one regimental surgeon at Ticonderoga reported that half of his regiment was unfit for duty because of dysentery, jaundice, and various fevers. Returns of late September suggest that in the Northern Army at this time, as many as 50 percent of all the enlisted men assigned to the camp may have been sick. Two to four times the number sick away from camp remained under the care of the regimental surgeons in their tents or, quite possibly, within regimental hospitals, a situation which may have resulted from the fact that the general hospital staff had not grown as rapidly as the size of the army in the North.³⁵

A committee of surgeons had drawn up a list of the minimum drug supplies required by a battalion, which included twenty pounds of bark, four pounds each of gum camphor and powdered jalap, three pounds of powdered ipecac and tartar emetic, two pounds of powdered rhubarb, and fifteen pounds of Epsom salts, along with quantities of more than a dozen other medicines. Several of these drugs might be used to treat any one collection of symptoms, tartar emetic, followed by a combination of nitre, camphor, and tartaremetic, for example, being one treatment for the "ague and chills; a violent pain in the head, back, and in every bone . . . with loss of appetite, Nausea, and considerable degree of weakness . . . succeeded with an inflammatory fever" which was seen in the fall of 1776 in the North.³⁶

Recognizing that the department`s inability to provide adequate care for its patients threatened future recruitment, Gov. Jonathan Trumbull of Connecticut wrote General Schuyler that, rather than waiting for a specific order from Congress, he would send on clothing and medicines whenever informed of the need.³⁷

The Continental Congress reacted to reports of the situation in the Northern Department by ordering that the necessary medicines be sent to the northern hospitals and by sending an investigating committee to Ticonderoga. In view of reported shortages of all kinds of food except bread and meat, the Congress also ordered that not only sheep but also cornmeal, rice, oatmeal, and molasses be sent at once to the Army`s patients in the Lake George and Ticonderoga area.³⁸

Early in October, apothecary Craigie commented that, although he had received a wagonload of herbs, half of it consisted of varieties he could not use, but Stringer, now in Albany, wrote General Gates only a few days later that he had been most successful in obtaining medicines. He wrote Potts, as he had on another occasion, that he was sending along a portion of his supply, this time enough to fill two barrels and a box, and added that he had more on

hand should it be needed later. The picture brightened further in November when a member of Congress noted with satisfaction that "Medicines are sent in sufficient Quantities for the Army at Ticonderoga," and Potts was able to begin distributing generous quantities of medicines to his regimental surgeons.³⁹

The alleviation of the drug shortage did not mean that the problems of the Northern Department were over. Items valued for the hospital diet were still in short supply, especially sugar, vegetables, and "spirits," money to pay the medical staff was almost nonexistent, and the Fort George hospital was badly overcrowded. Alarmed by the possibility of an enemy attack which could further burden this facility, Stringer attempted to reduce its population by urging that no more patients be sent to Fort George, by discharging some from the Army, and by sending still others to the Albany unit, recently set up in a building originally constructed as a military hospital during the French and Indian War. In November, when the anticipated attack seemed imminent, despite Arnold`s successful delaying action against British naval forces seeking to gain control of Lake Champlain, he sent 130 patients to Albany; housing for as many as 500 patients and an adequate supply of food were available there, but medical attention was inadequate. Because of his need for medical attendants, Stringer was unable to have a senior surgeon escort these men.⁴⁰

Complaints about the number of patients Stringer`s department was discharging from the Army, however, apparently began to appear in the summer of 1776,and in September, Potts was ordered to discontinue the practice. Stringer protested this order to General Gates, maintaining that the number for which he was required to care was growing daily and that he had but three surgeons and two mates at Fort George to handle them. He added that he believed that such discharges as had already been granted would have met with the general`s approval.⁴¹

The committee sent by Congress to investigate Northern Department hospitals reported in November that the Fort George General Hospital contained 400 patients who lacked only an adequate supply of vegetables, "good female nurses and comfortable bedding." Concluding that the Fort George unit was too far from Ticonderoga to serve the troops there, it also recommended that a building designed to serve as a general hospital be constructed on Mount Independence, a hill across a narrow stretch of Lake Champlain from Ticonderoga, where Potts was apparently already prepared to care for the wounded if any enemy attack should occur.⁴²

When no British attack had materialized by December 1776, the Fort George hospital was closed and all of its patients apparently were moved to Albany, while Potts was preparing to go home to Pennsylvania on leave late in 1776. Having now dismissed Stringer, the Continental Congress ordered Potts to return north at once in February 1777, however, and by the end of March he was again on duty in the Northern Department,⁴³ this time as its acting Director.

By the time Potts arrived in the Northern Department, conditions were sufficiently stabilized for improvements to be scheduled and carried out in a coherent manner. General Schuyler suggested that Potts leave the Albany hospital to the care of others and concentrate on preparing the Fort George facility to house patients with contagious diseases, as suggested by the congressional committee the preceding November. It was planned to house newly inoculated patients there, but one wing of that hospital had never been finished. A general hospital was now being prepared on Mount Inde-

pendence, and General Schuyler wished patients from the Fort George garrison, presumably those not afflicted with diseases considered contagious, to share this hospital with those from Ticonderoga. Since the Congress wished in addition to have a vegetable garden planted on Mount Independence, Potts had the additional problem of obtaining an adequate supply of seeds.⁴⁴

The staff assumed by Potts when he succeeded Stringer in the Northern Department apparently consisted of three surgeons, an apothecary, nine mates, and a clerk. The new Director had the same difficulties as his predecessor in meeting the payroll and also began to receive complaints about the pay scale. Early in April, however, he wrote General Gates that he believed he had succeeded in persuading all but one of his subordinates to stay on even though the promised pay increase had not yet materialized.⁴⁵

The new appointments for the Hospital Department made in April (see Chapter 2) designated Potts Deputy Director for the Northern Department and assigned him as assistants, among others, Dr. Malachi Treat, reputed to be "clever," and another physician,⁴⁶ whose surgery the new Director General, William Shippen, Jr., described as "elegant." His new and enlarged staff at this time apparently consisted of an Assistant Director, a Physician General, a Surgeon General, a Physician and Surgeon General of the Army, an Apothecary General, six senior surgeons, seven mates, a Commissary General and his assistant, two clerks, and one steward.⁴⁷

By the end of May 1777, conditions in the Northern Department with its three general hospitals at Mount Independence, Fort George, and Albany were much improved. The general hospital at Mount Independence, for example, on 21 May reported no great incidence of any one disease among its patients but rather a variety, from asthma and measles to inflammation of the liver and "cough and hectic." Although Potts had appointed a private physician, one Dirk Van Ingen, to care for army patients near Schenectady, there is no evidence that this was done because of crowding in the nearby Albany hospital. Smallpox was under control, supplies were adequate, patients were, for the most part, housed in buildings specifically designed for their care, the staff was large in proportion to the number of patients, fresh vegetables were available from local gardens, and evidence even indicates that sheep and cattle were now being delivered on the hoof. By May 1777,therefore, the Hospital Department in the North was well prepared to handle the casualties of another hard campaign.⁴⁸

NEW YORK AND NEW JERSEY, 1776 TO 1777

For the estimated forty regiments defending New York City, hospitals were initially established not only within the city but also on Long Island, where one of the five divisions forming Washington`s army of about twenty thousand was stationed.⁴⁹ (Table 5)

On the island of Manhattan, hospital units were located in the City Hospital, newly rebuilt after a disastrous fire, in the City Barracks, and even in rows of private houses appropriated for the purpose by the New York Convention, in some instances outside the most populous areas, but the principal unit was at King`s College. Morgan later maintained that he had experienced considerable difficulty in using private homes. The state militia actually turned patients out of houses on the Bowery and one belonging to the Stuyvesants, where they had been placed by the state legislature. There were also instances where regimental surgeons took over buildings

TABLE 5-PATIENTS IN HOSPITALDEPARTMENT UNITS, NEW YORK CITY AREA, APRIL-JUNE 1776

Hospital	Admitted Since Last Return	Dismissed Fit for Service	Dead	Remaining
New York City
24 Apr-4 May^a	70	7	3	57
4-11 May	60	15	1	101
11-18 May	85	28	2	156
18-25 May^b	37	22	1	165
9-16 Jun^c	20	31	4	136
Long Island
4-11 May	7	2	0	5
11-18 May	19	6	0	18
18-25 May	27	18	2	25
Smallpox Hospital, Montresor`s Island^d
4-11 May	4	0	0	5
18-25 May	8	0	3	25
9-16 Jun	0	1	0	6

SOURCE: Return 24 Apr-25 May, 9-16 Jun 1776, signed by Isaac Foster, RG 93, M246, roll 135, folder 3-1, items 4-8.
^aThree absent without permission.
^bThree removed to the smallpox hospital, two absent without permission.
^cTwo discharged from the Army.
^dNo return submitted for 11-18 May.

assigned to the general hospital. Asked to collect herbs, however, the local populace also helped to supply other needs of army patients in the area, giving the hospitals 2,000 sheets, hundreds of shirts, and similarsupplies.⁵⁰

To Maj. Gen. Nathanael Greene`s division fell the assignment of holding Long Island, and it was at General Greene`s request that a branch of the general hospital was established to serve his troops. Morgan assigned this Long Island unit to Dr. John Warren when it began operations in the summer of 1776 and ordered him to take three hospital mates with him. Any further assistance Warren might need could come from among the surgeon`s mates of General Greene`s brigade. On the question of what medicines to bring with him, Morgan told Warren to consult with physicians Foster, Adams, and McKnight.⁵¹ Morgan gave Warren detailed instructions on how the Long Island hospital was to be managed. Careful records must be kept of its patients, the time of their entering and leaving the hospital, and their diseases. In this instance, they could also be allowed to remain under the care of their own regimental surgeons in whatever quarters General Greene might see fit to set aside for this purpose. These surgeons were even to be permitted to draw upon the Hospital Department`s stores, but when so doing, they were to consider themselves a part of the Long Island hospital and under Morgan`s authority. No supplies were to be issued to patients not reported to and considered as a part of the general hospital. Nurses must be hired and each nurse paid 50 cents a week. The regulations for the unit`s personnel and patients should be agreed upon by the surgeons, read to the occupants of each ward, and then posted, along with the rules for diet. Both sets of rules must be most strictly enforced.⁵²

The regimental surgeons were to be required to keep careful records of their patients and to submit weekly returns to Warren of those of their patients being cared for through the Long Island unit. Once each month a roll was to be made out for ration money and signed by the general. The rations for these men to their regiment were to be stopped while they were in the care of the Hospital Department. Morgan assigned a storekeeper to Warren`s staff and he was to apply, as appropriate, to either the Commissary General or the Quartermaster General for what he needed, keeping strict accounts of such transactions. Warren was instructed to obtain 100 blankets and 100 beds to take to Long Island, applying to the Quartermaster for straw, and he was to be sure to have the nurses and washerwomen clean these beds "from time to time." An "orderly Mate" was to be placed in charge of hospital furniture and

bedding and to keep careful records, which were to include notations on what equipment and clothing each patient brought with him to the hospital.⁵³

Warren`s hospital was not long established, however, before the British attack in late August 1776 drove the Long Island division, now under Maj. Gen. John Sullivan because of General Greene`s illness, from the island. American losses ran high, 970 officers and men killed or wounded. The patients from Warren`s hospital had to be moved in considerable haste to New York City and placed in the barracks there. A heavy rain was falling as the patients were landed at various wharves and many inevitably suffered as a result, but Morgan personally took part in caring for them and later maintained that he had not only attended all the operations of which he was aware but also dressed all the patients himself.⁵⁴

When operations in the New York City area were just in the planning stage, it had been assumed that the city itself could not be successfully retained unless, by holding Long Island, the Continental Army could make the city also untenable for the British. It was, therefore, obvious that if the British were to take Long Island, New York City was doomed, patients in the New York hospitals would have to be evacuated, and hospital supplies and medicines would have to be quickly moved to a safer place for storage.(Map 3)

On General Washington`s order, Morgan went to Newark several days before the evacuation from New York was scheduled to take place to set up a hospital for the approximately one thousand patients from Long Island. Here he established Foster and Dr. William Burnet plus seven or eight mates to assist them. Morgan had sent Dr. Barnabas Binney to Philadelphia in July to round up additional hospital stores and in August had located some himself. Although Binney could find no instruments, the supplies arrived at Newark just before the patients themselves were expected and were deposited at the new hospital under the care of Assistant Apothecary John B. Cutting.⁵⁵

Despite Morgan`s efforts, however, the move of patients from New York City to Newark led to a "dreadful scene of confusion and disorder. "Some mates had been taken prisoner and many nurses and other attendants had fled. The militia had impressed a considerable number of wagons in the course of their flight, complicating the moving of seriously ill and wounded patients to boats. The boats themselves were late in arriving. Furthermore, the neighbors of the new hospital were not pleased to have an institution assumed to be a source of fatal infections established near them. It was also becoming difficult to obtain nurses to care for the growing numbers of sick because, Washington believed, they were not being paid enough. Men from the regiments, therefore, were used even though their services were of questionable value to the sick.⁵⁶ On 18 September, Washington was forced to authorize regimental surgeons to care for their own patients "until the General Hospital can be established on a properfooting."⁵⁷

The situation at Newark was made more difficult by the Morgan-Shippen feud over control of department hospitals in the New Jersey area. Shortly after Morgan`s departure from Newark, he received a visit from Foster, whom he had left in charge of the hospital there. Foster reported that Shippen had attempted, albeit unsuccessfully, to assume control over both the hospital and the stores left in Newark. Washington, in response to Morgan`s complaint about this situation, wrote Shippen that he wished Foster to remain in charge at Newark.⁵⁸

In addition to the Newark hospital, Morgan also set up other hospitals in New

MAP 3

Jersey for the sick and wounded of General Washington`s army. He supervised the establishment of a 300-bed facility at Hackensack, New Jersey, where hospital supplies had also been stored, a few days after he opened the Newark hospital. By 18 October, Morgan was able to move "several hundreds "of patients to Hackensack despite the fact that he had only three mates and a surgeon to help him, that he had been forbidden the use of army workmen, that several days` more work was needed, and that he had no guards to help him because the fifty assigned managed within a short period of time and on various pretexts to disappear. Morgan was particularly anxious to have his hospital in Hackensack running smoothly so that he could leave it in Warren`s hands and join General Washington at White Plains, New York, where action was momentarily expected.⁵⁹

While Morgan attempted to care for the men of Washington`s army, Shippen was with the men of the militia`s flying camp at Amboy. Chosen chief physician for the camp on 15 July 1776, at a time when fewer than 3,700 men had come in, he was quite confident of success in spite of his lack of military experience and the greenness of the new recruits which predisposed them to illness. He at once placed appeals in local papers asking the citizens of Philadelphia and nearby areas of Pennsylvania as well as those of New Jersey to send old sheets and linens to him for his hospitals and he also began to collect a staff.⁶⁰

By mid-September, however, Shippen found himself hard pressed and in great need of surgeons, especially, he stated, in view of the fact that seven or eight battalions in the flying camp had neither regimental surgeons nor mates of their own. He was forced to act personally as both director and surgeon at the Amboy unit as well as apothecary for nine battalions. By the end of September, however, he had added to his staff at least two former regimental surgeons, Bodo Otto, a native German who had served with Pennsylvania troops in the Battle of Long Island, and William Brown, who had been recommended by both General Washington and the flying camp`s Brig. Gen. Hugh Mercer. It is interesting to note that even before the 9 October resolve which placed him in command of all army hospitals in New Jersey, the Continental Congress apparently considered Shippen chief physician for the entire New Jersey area. Thus, in appointing Brown as Shippen`s assistant, the Congress named him assistant for the "flying camp and troops in New Jersey."⁶¹

As General Washington`s army retreated south through New Jersey before the British in the fall of 1776, the sick and wounded, often numbering one-fourth to one-third of the total, were sent ahead and placed in temporary hospitals at Amboy, Elizabeth, Brunswick, Trenton, Fort Lee, Newark, and Morristown. On 1 November, Shippen submitted an optimistic report to Congress on the hospitals in five of these towns, saying that his two units at Amboy contained 90 sick and 7 wounded, that at Brunswick 10 sick, and that at Trenton 56 sick. At Elizabeth he recorded 54 sick, 3 wounded, and 25 "sick from Canada" and at Fort Lee, 75 sick, 9 wounded, and 19 "distressed New England Troops." It should be noted that even at a time of action, the sick outnumbered the wounded sixteen to one. Shippen predicted that four-fifths of his patients would recover but noted that 2,000 more patients who were not yet under his control were scattered in barns around the countryside. By late November, in spite of Shippen`s optimism, patients from the flying camp, unattended by physicians, were pouring into Philadelphia, arriving in wagons and threatening to spread putrid or camp fever among the citizens of the city. Although he must have been aware of the sickliness of green troops, Benjamin Rush later tried to

claim that Shippen was to blame for the flying camp`s high death rat eat this time. In November 1776, however, he wrote Shippen that everyone was praising the work he was doing. Washington personally ordered the sick from Trenton moved to Philadelphia so that his troops might use the barracks which had formerly sheltered Shippen`s patients and gave Shippen permission to use supplies in New Jersey which Morgan had been moving about withoutusing.⁶²

Hospital units in Philadelphia were under Morgan`s direct control, but such a great number of the Army`s sick was coming into the city that the Council of Safety asked the vacationing Jonathan Potts early in December to take charge of them, apparently under Morgan. Bodo Otto took over the city`s Bettering House, and several stores and private houses were also pressed into service as hospitals. Philadelphians were asked to help to obtain the supplies the Hospital Department needed and many citizens served as volunteer nurses. Morgan, with a possible British occupation of Philadelphia in mind, asked faculty members of his own medical school to stand by to care for patients too ill to be moved. Soon, however, so many disabled soldiers were quartered on local citizens that Morgan ordered Potts to send flying camp patients belonging to Maryland units back to Maryland, adding that Potts was to be sure that these men received the best care, including warm housing and blankets. A hospital was, therefore, established in Baltimore under Dr. Samuel MacKenzie and a mate. Morgan urged that others be accommodated in towns outside Philadelphia. Despite the care and attention devoted to the patients remaining in the city, however, the death rate was very high. On 16 February 1777, a total of 4,745 of the 17,449-manarmy was reported to be ill or unfit and some claimed that as many as 2,000 military patients were buried in the Philadelphia potter`s field.⁶³

Washington was concerned with the threat of contagion posed by the large numbers of the Army`s patients housed in Philadelphia and wished from the beginning to see hospitals established at a safe distance from that city. Shippen moved his family to join him at Bethlehem in early December and, with the cooperation of the Council of Safety of Pennsylvania, established hospitals at Bethlehem, Allentown, and Easton, Pennsylvania. In a letter urging that he be sent the funds he was totally lacking for the care of his patients, he reported to his brother-in-law, Richard Henry Lee, that as of 17 December his patients were much reduced in number and doing well.⁶⁴

The main hospital in Shippen`s system occupied the former Single Brethren`s House of the Moravian Order in Bethlehem. This 83- by 50-foot building dated from 1748 and contained eight rooms on the first floor of the main section. There were also refectories, a chapel, and superintendent`s rooms on the second floor and dormitories plus several smaller rooms on the third. More recently built east and west wings housed further accommodations, including workshops. Completing the complex was a 40-foot belvedere or summer-house open to the outside air. Shippen filled the cellars of the former church storehouse with hospital supplies and medicines and assigned officer patients the upper rooms. The hospital guard, surgeons, and convalescents were housed in shops and other buildings on the western side of town. A Moravian minister, the Reverend John Ettwein, visited all the patients at Bethlehem, the single brethren aided patients, the women made lint bandages, and Moravian carpenters made the coffins and dug the graves for 110 patients before the survivors were transferred to Philadelphia late in March 1777.⁶⁵

BRETHREN`S HOUSE AT BETHLEHEM.(From Duncan, Medical Men.)

Patients began arriving in Bethlehem early in December 1776 in all sorts of transport and were initially so short of food that the Moravians fed them for three days until the Army`s supplies arrived. Shippen was touched by the cooperation of the townspeople and decided to house as many of the former Morristown patients as possible at Easton and Allentown. These units also were closed in March 1777 and patients too sick to be discharged as convalescents were sent to Philadelphia. The men who had been serving as nurses or orderlies returned to their regiments, while the department began efforts to find women to replace them.⁶⁶

The last action before the Army went into winter camp at Morristown involved Washington`s surprise Christmas attack upon Hessian units at Trenton and his early January success against the British at Princeton. The wounded from these operations and the sick from the camp at Morristown required the opening of new hospitals and the reopening of some old ones in New Jersey.

Christmas celebrations at Bethlehem were interrupted by General Washington`s call to Shippen and his principal surgeons to join him as he moved against Trenton. It would appear, however, that Shippen did not reach the general in time to take immediate charge of the wounded, as on 29 December the general ordered that the wounded from the initial Trenton engagement betaken to Newtown, Pennsylvania, just across the Delaware River from Trenton, until Shippen and John Cochran could have them moved farther.⁶⁷Fortunately, few Americans were injured in this

engagement, but seventy-eight wounded Germans surrendered. Since the Americans wished to encourage such mercenaries to desert the British cause, they paroled these men and provided them with hospital facilities and the care of their own surgeons. An attempt was even made to give the German surgeons instruments, but it was reported that at least some of the amputating instruments so supplied were unusable.

Benjamin Rush had offered his services to General Washington`s army after the Continental Congress adjourned on 12 December, and he and Cochran assumed responsibility for the Continental Army`s wounded at Trenton just before the general began his withdrawal toward Princeton. It would appear that General Washington not only took no physicians with him on this march but also failed to inform Rush and Cochran that he was leaving. Cochran discovered the Army`s departure on 3 January 1777 only when he rode out in search of it. Rush and Cochran were at the time caring for about twenty American wounded who were in danger of being captured by the British. The surgeons hastily obtained wagons and horses and removed their patients to Bordentown, southeast of Trenton, apparently assuming that this would be Washington`s destination. Three days later they moved their unit to Princeton, where on 7 January 1777 Rush wrote Richard Henry Lee of the serious (and soon to prove fatal) wounds of General Mercer. Since many other Americans were also wounded in the Princeton engagement, a hospital was set up in the College`s Nassau Hall. Here Rush and the other surgeons, possibly including Potts, with the aid of a surgeon and five privates left behind for the purpose by the British, cared for both American and enemy wounded until the end of the month when Rush, considering his patients to be out of danger, left to rejoin the Continental Congress.⁶⁸

HOSPITALS IN NEW YORK STATE AND NEW ENGLAND AFTER THE EVACUATIONOF NEW YORK CITY

Some of the wounded from action in the vicinity of New York City were cared for in hospitals in New York State and in New England. (See Map3.) After opening the hospital at Hackensack, New Jersey, in October 1776, Morgan had hurried toward White Plains, New York, where action was momentarily expected. When he arrived at his destination, he found that the department`s surgeons had already decided upon a church at North Castle as the site for a general hospital. The supply situation, however, had not been solved, since, despite orders to the contrary, the regimental surgeons of Maryland units had arrived at White Plains expecting Morgan to let them have what they needed. Many regimental surgeons were not even present, despite both orders to the contrary and the fact that the sick and wounded were numerous.⁶⁹

As soon as action was joined, on 28 October, Morgan and his surgeons set out for White Plains from North Castle, while mates followed them with wagons carrying instruments and dressings. They established themselves near the front lines in houses along the road to North Castle and remained there, according to Morgan, about a week, until the enemy withdrew and Washington left to cross the river in an attempt to defend Fort Washington, on the northern end of Manhattan Island. During this engagement, Morgan was able to return to North Castle only briefly and at least one surgeon and three or four mates were also on duty at White Plains, awaiting possible further action. Morgan kept surgeons Samuel Adams, Jr., and Charles McKnight at North Castle, and sent some one thousand patients to Stamford and Norwalk, Connecticut, under the care of physicians Philip Turner and William Eustis.⁷⁰

While Morgan was at White Plains, the British took Fort Washington and also Fort Lee, opposite Fort Washington on the west bank of the Hudson River, and then began to drive General Washington south through northern New Jersey. After leaving instructions with his surgeons, therefore, Morgan moved to join General Washington, catching up with him not long after the army crossed the Delaware River.⁷¹

Among the hospitals Morgan left behind him was that at Stamford, in charge of Turner, whose unit cared for 1,200 to 1,300 patients from early November to February 1777, by which time only 25 remained. Eustis was in charge of the hospital at Norwalk, where approximately 700 patients were sheltered in the course of the late fall of 1776 to March 1777, when only 8 to 10 patients remained.⁷²

For help in supplying these two hospitals, Morgan was forced to turn to Gov. Jonathan Trumbull of Connecticut, who sent Turner a significant supply of necessary items. It was ironic that Morgan`s need in Connecticut was so great, for about eighteen tons of supplies from New York City had been moved by boat to Stamford just before the evacuation of that city and stored in a private home there. Not long after these supplies arrived in Stamford, they were moved, without either Morgan`s knowledge or General Washington`s approval, but their new location was only fifty miles from Stamford and Morgan could easily have reached them. Unfortunately, however, while Morgan`s most urgent need at this time was for medicines, the bulk of these supplies consisted of blankets, bedding, sheets, and new shirts.⁷³

Among the hospitals set up by the Hospital Department in New York State were units at Kingsbridge, on the east side of the Hudson opposite the northernmost tip of Manhattan Island, and at Fishkill, on the Hudson River not far from West Point, both of which served the men of Maj. Gen. William Heath`s army. The hospital at Kingsbridge cared for the sick and wounded of a still raw and undisciplined army in a filthy camp entirely devoid of sanitation. A form of diarrhea termed "putrid" resulted from the unhealthy conditions, and one surgeon commented that "Many died, melting as it were and running off by the bowels." Aid from the Quartermaster`s Department was almost impossible to obtain for this hospital, according to Morgan, and medicines were so short that the capture of a chest of medicine from the enemy was deemed a noteworthy event.⁷⁴

WILLIAM EUSTIS. (Courtesy of National Library of Medicine.)

After the loss of the White Plains engagement, General Washington sent General Heath`s division north to Peekskill and West Point and stationed General Lee on the Croton River south of Peekskill. Both divisions thus remained on the east side of the Hudson River, where Morgan still directed the department`s hospitals. Before

leaving to join General Washington near Trenton, New Jersey, Morgan set up a hospital for General Heath`s division at Peekskill, in response to the complaint that the sick and wounded of this 5,000-man division were receiving inadequate care. Morgan initially suggested that General Heath find appropriate quarters to shelter 300 sick and that the Hospital Department, now free to expand its staff to match the Army`s growth, then staff the unit. The Director General added, however, that he believed Peekskill to be an unhealthy location for a hospital. Morgan put Adams and McKnight in charge of the new hospital, but they were unable to find a satisfactory site near the town and finally took over accommodations at Fishkill, twenty miles to the north, for their hospital. General Washington, however, orderedt hat convalescents be sent to Peekskill. On Morgan`s dismissal in January1777, General Washington requested that Dr. Isaac Foster, as the "eldest surgeon," take over the temporary supervision of these hospitals on the east side of the Hudson River.⁷⁵

Until mid-1776, official policy called for the prevention of smallpox epidemics through isolation only and rejected planned inoculation. When General Washington`s army moved south from Boston, a smallpox isolation hospital was established on Montresor`s Island (now Randalls Island) in the East River and a twenty-three-man guard of men who had already had the disease was assigned to it. Although there had been some inoculations at the Montresor`s Island hospital in the spring, in May, General Washington ordered that there were to be no more. All those already inoculated or exposed to the disease were to be sent there. (See Table 5.) The general warned that "any disobedience to this order will be most severely punished." The Continental Congress supported Washington`s stand and when a private physician in the State of New York was discovered to have been inoculating soldiers, he was jailed.⁷⁶

Despite these precautions, the fear of smallpox grew among the men of the Continental Army. Recruiting was threatened, and by late June, official attitudes toward inoculation began to show signs of change. The Maryland Council of Safety, noting the presence of smallpox among some of the Maryland troops, suggested that inoculation be tried and even offered to pay for such a step, but the Council of Massachusetts, learning that Maj. Gen. Artemas Ward was permitting the inoculation of some of the troops outside Boston, where this procedure was illegal, asked that the practice be stopped.⁷⁷

General Washington found that, despite all precautions, most units contained a few infected men who posed a threat to the entire regiment in which they served. And by August official attitudes were apparently changing in favor of inoculation in segregated camps. Orders again were issued specifically forbidding private and secret inoculation, but the prohibition brought protests, since it was believed that such a rule would hinder recruiting, especially for the Northern Army.⁷⁸

Since General Washington and the Hospital Department still feared the possibility of triggering an epidemic, careful precautions were planned to ensure the isolation of soldiers undergoing inoculation. The general suggested moving them out of Philadelphia and into nearby segregated hospitals. And when be sent John Cochran to Newtown, Pennsylvania, to oversee inoculation there, he suggested that houses in the remote countryside be used to shelter newly infected soldiers. General Washington urged that those already inoculated not be moved until entirely recovered and that when they left the hospital they be equipped with either new or "well washed, air`d and smoaked "clothing. By mid-February, he was also suggesting that the individual

states immunize their recruits before sending them to join the Army. Rush, as chairman of the Medical Committee of the Congress, wrote Washington that troops coming in from the South were terrified of contracting smallpox naturally and, since the disease was raging in Philadelphia, should be inoculated somewhere outside of that city.⁷⁹

It was in February 1777, while the bulk of Washington`s army was in winter camp at Morristown, that the official order to proceed with the inoculation of the entire army was given. The Continental Congress, then meeting in Baltimore, ordered specifically that the troops there be immunized and requested the Maryland Assembly to give MacKenzie the necessary medicines. On 5 February, the general, convinced that only inoculation would prevent the destruction of his army, decided that all soldiers, including recruits, at Morristown and in the Philadelphia area should undergo the procedure.⁸⁰

The Hospital Department, although now without a Director General and in a state of disorganization after the dismissal of Morgan, nevertheless immediately moved to carry out the wishes of Congress. Shippen ordered Dr. Bodo Otto to leave Philadelphia for Trenton, where he was to set up an inoculation hospital in an old barracks originally constructed for British troops in the French and Indian War. General Washington personally told Dr. Nathaniel Bond to prepare to inoculate troops in the Morristown area, emphasizing that he wanted the procedure administered secretly and as quickly as possible. Bond was to immunize not only the troops already in Pennsylvania and New Jersey but also all those coming into the area, upon arrival.

A few minor complications arose as the process of immunizing General Washington`s army began. The general was unhappy that so many troops were being marched all the way to Morristown before being inoculated, since the facilities were not as good there as elsewhere. Some confusion existed in the area supervised by Foster, and that doctor claimed that he had been told that the order to inoculate the troops in the Fishkill area had been countermanded. General Washington told Foster that he had never intended to cause any delay in the inoculation of these troops, since waiting so long to begin the procedure had already had harmful effects.⁸¹

Distressed that Virginia still did not permit inoculation, General Washington wrote Gov. Patrick Henry to support the repeal of such restrictions, adding that smallpox "is more destructive to an Army in the Natural way, than the Enemy`s Sword."⁸² These regulations were apparently changed shortly after General Washington`s request, since on 23 April, the Continental Congress ordered Dr. James Tilton to Dumfries, Virginia, "to take the charge of all continental soldiers that are or shall be inoculated" there and on 30 April decreed that troops from Carolina stop at Dumfries, Colchester, and Alexandria, all in Virginia, to undergo the procedure.⁸³

In having his entire army inoculated during the winter and early spring of 1777, General Washington took a great risk. The procedure would in a short time greatly strengthen his army, but it temporarily weakened his forces in the face of the enemy. Only four of every 500 of his men died as a result of inoculation, however, and the gamble was so successful that he repeated it in the Valley Forge winter of 1778.⁸⁴

By March, General Washington had sent a large proportion of his troops north to the Hudson River, and only 3,000 remained at Morristown, two-thirds of them militia whose terms of enlistment were about to run out. French arms and supplies were now arriving, however, and in a short time new units also began to come in. By May there were 8,000 men at Morristown, but

2,000 of them were soon sick. Furthermore, an epidemic of fever was raging in one of the Army`s facilities in Philadelphia, where Benjamin Rush reported that most of the staff had been ill at one time or another and several surgeons and mates had died.⁸⁵ Thus, despite his precautions, it was with an army weakened by sickness that General Washington opened the spring campaign in May 1777.