History

Chapter 4

Year of Despair and Hope, June 1777 to June1778

During the 1777-78 campaign season, the crucial victory over the British at Saratoga in October 1777 brought action in the North to an end for the season and, for all practical purposes, for the war. In the Middle Department, however, repeated military setbacks as Washington unsuccessfully attempted to defend Philadelphia and the grim winter at Valley Forge which followed placed demands upon the Hospital Department in the New Jersey-Pennsylvania area which it could not meet.

THE MIDDLE DEPARTMENT

As Washington retreated before the British in Pennsylvania, the Hospital Department was forced to move seriously wounded and ill patients from place to place in all kinds of weather in open and springless wagons. Villagers who lived along the evacuation routes long remembered hearing "the wounded cry as they passed over the stones."¹ The shortage of both housing and clothing led to the overcrowding of poorly clad patients in inadequate facilities and the rapid spread of what was then called putrid fever, making a shambles of whatever hopes may have arisen as a result of the reorganization of April 1777 under the leadership of the new Director General, William Shippen, Jr.

Troops in the New Jersey-Pennsylvania area saw no major action until September of the new season since during the early summer the maneuvers of the British general, William Howe, in an attempt to force the Continental Army to give battle in the vicinity of Brunswick and Amboy, New Jersey, were in vain. In July he embarked 15,000 men, about two-thirds of his army, in the waiting ships of the British Navy and disappeared over the horizon. During the following six weeks, several sightings of the enemy fleet led to varying predictions of General Howe`s ultimate intentions, and General Washington, trying to anticipate the enemy`s next move, led his forces north to the Hudson River and then south again to New Jersey and Pennsylvania.²

General Washington`s troops were far from healthy during this time. Of an army of roughly 18,000, more than 3,500 were sick, according to a Medical Committee report of 5 August 1777.³ The general blamed the high rate of sickness upon the excessive use of "animal food, untempered by Vegitables, or Vinegar, or by any kind of Drink, but Water and eating indifferent Bread" and continued his efforts to improve not only the diet and camp sanitation affecting his troops but also the conduct of his regimental surgeons and the management of the hospitals caring for his men. He ordered that a list of the sick in each regiment be made every day and turned in to the regimental surgeon. He required that these doctors neither go on leave nor hospitalize a patient without permission from Dr. John Cochran, Physician and Surgeon General of the Army, or his deputy.⁴

By July, however, the situation had not improved and Cochran`s problems were multiplying. Although his letters do not reveal

MAP 4

precisely what it was that Cochran had done to offend, Cochran was under fire from Maj. Gen. John Sullivan, who regarded this physician`s attitude as insulting. Furthermore, General Washington`s very recently issued orders that regimental surgeons report twice weekly to Cochran on the patients in their care were apparently all too frequently ignored. On 9 July, he announced that surgeons continuing to disobey him in this matter were to be arrested.⁵

When the general turned his attention to the facilities caring for his men, he discovered that interference from his officers was undermining the authority of hospital physicians. Commenting that doctors should bein complete control of these units, he ordered that no officer visit such a facility except to check on the treatment of its patients or to help maintain order and discipline. In September, he also ordered that officers not remove patients from hospitals without the written permission of the physician in charge.⁶

The situation as far as hospitals were concerned seems to have been satisfactory in August 1777, however, Dr. Benjamin Rush claiming at that time that "great order, cleanliness, and the most perfect contentment prevail in our hospitals." By the end of that month, his army`s march slowed by the presence of unfit soldiers still under the care of regimental surgeons, General Washington had decided to turn all the sick over to the hospitals rather than attempt to take them with him on further moves about the countryside.⁷

In September, the British landed at the head of the Chesapeake Bay and Continental units saw their first real action of the season when General Washington attempted to stop the enemy at Chadd`s Ford on the Brandywine Creek in Pennsylvania on 11 September 1777. (Map 4) Contemporary estimates of the losses suffered here by General Washington`s army vary widely, but a modern authority estimates 200 killed and 500 wounded. Failing to stop the British at the Brandywine, the Continental Army moved northeast to the Schuylkill River and then retreated northwest along that river. After using a surprise bayonet attack to defeat Brig. Gen. Anthony Way neat Paoli on 21 September, on the 26th the enemy occupied Philadelphia unopposed. The Continental Army lost an estimated 100 wounded at Paoli and another 500 in wounded on 4 October through the defeat of General Washington`s army at Germantown. By 24 November 1777, wounds and disease had crowded Middle Department hospitals with approximately three thousand men, a figure which did not include those under the care of regimental surgeons.⁸(Table 6)

The walking wounded from the Brandywine defeat appear to have been directed toward the Hospital Department`s facilities in Philadelphia, and the more seriously injured were taken in open wagons, escorted by physicians, to such New Jersey hospitals as those at Trenton and Princeton. Dr. John Augustus Otto, one of the sons of the Dr. Bodo Otto who was director of the barracks hospital at Trenton, accompanied one group of wounded to his father`s unit. Here he stayed until the fall of Philadelphia necessitated the abandonment of that hospital. Another group of the wounded, escorted by Dr. James Tilton, went in slow stages to Princeton, stopping on the way in Philadelphia and Bristol, Pennsylvania, and Trenton. Tilton later claimed that the quarters these men were assigned at Otto`s hospital had not been cleaned and that his patients contracted putrid fever there. The commissary of the Trenton hospital, Otto, and a second son, Frederick, who also worked with his father, however, maintained that the rooms had been cleaned before Tilton`s arrival and that there had been no putrid fever in their hospital for three weeks before that date. It was true, at any rate, that Tilton and many of the Brandywine

wounded with him did develop "languor and listlessness of the whole body, and a peculiar sensation of the head, as if it were tightened or compressed" shortly after their arrival in Princeton. After some days, other symptoms appeared, and "the pulse began to sink, a dry tongue, delirium" developed. Tilton noted that "If I ever saw the petechiae, so much dwelt upon by Pringle and Monroe, I have forgotten all about them. This I am sure of, they were not regarded as essential to the disease."⁹

TABLE 6-MIDDLE DEPARTMENT HOSPITALPATIENTS, 24 NOVEMBER 1777

Location	Sick	Wounded	Convalescent	Total
New Jersey
Burlington	80	10	11	101
Trenton	112	0	102	214
Princeton	139	130	10	279
Pennsylvania
Buckingham	239	10	10	259
North Wales	100	0	59	159
Skippack (Shippack)	90	0	20	110
Easton	253	40	107	400
Bethlehem	161	80	142	383
Allentown	81	9	100	190
Reading	..	..	..	290
Lancaster	..	..	..	300
Manheim^a	17	5	40	62
Maryland
Baltimore	..	..	..	37

NOTE: Excluding regimental and brigade hospitals; as reported by William Shippen.
^aMistakenly listed as Mendham in Duncan, Medical Men, p. 239.

The most seriously injured from Brandywine received emergency care in buildings near the battlefield and were then collected by the victorious British and removed to the Wilmington area. General Howe told General Washington shortly after the battle that Continental physicians would be permitted to visit and treat wounded Americans held by the British. The Continental general responded by sending Rush, whose subsequent experience with the British system left a lastingly favorable impression, four other doctors, a hospital mate, and several other attendants through the lines.¹⁰

The fall of Philadelphia forced the evacuation of facilities within the city and rendered nearby hospitals vulnerable to surprise raids by the British. It also made necessary the establishment of new units at more distant locations. After the Brandywine defeat, Shippen had written a Moravian leader at Bethlehem, Pennsylvania, to ask the aid of his order in locating permanent

accommodations in that area for an estimated two thousand patients; and in late November and December, many of the patients from New Jersey facilities at Mount Holly, Bordentown, Burlington, and Trenton were moved to Princeton. General Washington feared for the safety of the Princeton unit and urged unsuccessfully that it, too, be moved. Other patients, including those from such Pennsylvania hospitals as the units at Bristol, Pottsgrove, and Buckingham, were evacuated to the west and northwest deeper into Pennsylvania, where new hospitals were established at Lancaster, Lititz, Ephrata, Reading, Easton, Allentown, Warwick, Reamstown (Rheimstown), and Northampton. The closing of so many hospitals, however, and the distance to the new facilities made it necessary to open temporary hospitals at Evansburg, Trappe, Pennypacker Mills, Faulkner Swamp, and Skippack, Pennsylvania. These units handled the 421 wounded from Germantown before they were moved even farther west within the state.¹¹

Those patients in General Washington`s army who had accumulated under the care of regimental surgeons since the army had first seen action in the fall of 1777 were removed to units of the general hospital when the army went into winter camp at Valley Forge. Reports to the Adjutant General concerning the number and location of patients still with the army were required in anticipation of this move. Dr. Charles McKnight and a colonel were told to provide wagons, but only for those patients unable to walk even when relieved of their packs. Three days` provisions were to be sent with these men and one officer from each brigade was to accompany them to ensure their receiving proper care. Dr. Jonathan Potts, again on leave from the Northern Department, had volunteered his help in this massive evacuation, and Shippen wrote him to point out that patients being taken to hospitals on the west side of the Schuylkill River would eventually pass through Potts`s hometown of Reading. Shippen asked his colleague to supervise these men during their stay in Reading and to do what he could to obtain for them comfortable transportation to their final destinations.¹²

The evacuation of so many hospitals, the overall increase in the patient load, and outbreaks of disease added to the burden of the Hospital Department even in hospitals which were not relocated. Nevertheless, in early December, although Tilton maintained that the Princeton facility`s patients at this time were vermin-infested and filthy, Rush did not seem unduly alarmed. When he wrote Shippen from Princeton, he limited himself to explaining his need for cooking utensils, straw for bedding, and similar items and mentioning plans to take over the local Quaker meetinghouse and the home of a Tory to expand to 1,000 the capacity of his unit, which was already using the college`s Nassau Hall and a church. Rush`s letter of the same day to Maj. Gen. Nathaniel Greene also gave no indication that the doctor was particularly upset by conditions at Princeton, although he did note that since many of the patients in his hospitals were only slightly ill and tended to spend their time stirring up trouble, he needed two or three officers to enforce discipline. In mid-December, however, Rush pronounced the situation at Princeton frightful. One building, which was large enough for only 150 men, now held 400, he said, and in one three-day period, twelve soldiers had died of putrid fever. Since the past spring, he added, six surgeons had died of fevers contracted at the Princeton hospital and there were still no guards present to enforce discipline.¹³

The necessity for reopening the hospital at Bethlehem had apparently distressed Shippen, who wrote the Reverend John Ettwein of his regret that he was "obliged by Order of Congress to send my sick and

wounded to your peaceable village . . . I am truly concerned for your Society and wish sincerely this stroke could be averted." By the end of September, both civilians and soldiers were pouring into the village. Less than three weeks after the defeat at Germantown, there were reportedly more than 400 men in the Single Brethren`s House, where physicians considered 360 to be an absolute maximum. The wounded coming in after the Germantown engagement were frequently sent on to Easton, but those too seriously injured to be moved farther were placed in tents at Bethlehem. Despite the crowded condition of the Bethlehem hospital, in October, Rush, as Physician General, ordered that 100 more be taken in.¹⁴

Because of such severe overcrowding in the Single Brethren`s House, steps had to be taken to add to the available accommodations. Early in November, seventy patients were sent to a nearby farm. Rooms not previously used for patients, such as the kitchen, also were taken over. A separate hospital was set up nearby at the Fulling Mill, where woolen cloth was made. The suggestion that one or more of the women`s buildings be used, however, caused so much dismay among the Moravians that the idea was abandoned. Sixteen members of the Continental Congress, including Richard Henry Lee, John Hancock, and both Samuel and John Adams, signed a message at this time recognizing the Moravians` "humane and diligent attention to the sick and wounded" and calling for the protection of their "persons or property."¹⁵

The situation in the middle states as General Washington`s army prepared to take up winter quarters at Valley Forge did not inspire optimism. Shortages of all kinds, especially of housing, made it impossible to provide care compatible with the standards of the time. Severe overcrowding alone was considered by one physician to have been responsible for at least half of the large number of deaths which occurred in the early winter, although precise recordkeeping was often impossible where the turnover was so great.¹⁶

A large number of the higher officers of the Hospital Department came into Pennsylvania during the winter at Valley Forge. Among them were, in addition to the Director General, the leading members of the staff for the Middle Department, including the new Deputy Director and Purveyor, Dr. Jonathan Potts; the Surgeon General (soon to succeed Rush as Physician General), Dr. William Brown; and Cochran, the Physician and Surgeon General of the Army. Also serving in this area were two Assistant Directors, Dr. Thomas Bond, Jr., and Dr. James Craik; and two Apothecaries General, Dr. Andrew Craigie, who left the Northern Department at about the same time as Potts, and Dr. John Brown Cutting, who had apparently been asked in the summer of 1777 to take charge of the buying of drugs of the entire Hospital Department. Also present at Valley Forge was Baron von Steuben, whose Regulations for the Order and Discipline of the Troops of the United States enacted into law by Congress in March 1779, formalized those doctrines on hygiene long preached by British and Continental militaryphysicians.¹⁷

Food, clothing, bedding, drugs, instruments, bandaging, even wagons for moving supplies were all very difficult to obtain at this time. The spring of 1778, furthermore, brought an increase in the number of men sent to hospitals because of disease, enhancing the effects of these shortages and leading Craik to warn, "if I am not supplied with what I write for, it will be impossible for me to give satisfaction here."¹⁸

The scarcity of clothing affected not only patients being treated in hospitals but also those ready to return to duty. Those who entered more or less fully clothed often could not leave when recovered because the clothes they had turned over when they were admitted could not be found. Those

in the hospital, moreover, had so little to wear while in bed that an adequate supply of blankets assumed a crucial importance. General Washington ordered that the items of clothing a patient wore on entry into the hospital be carefully recorded before storage. Those belonging to patients who died in the hospital were to be saved for men returning to duty. The Continental Congress appealed to the clergy in the Middle Department for donations of linen and woolens for the sick and wounded, and in February, General Washington ordered the Clothier General to supply both sick and convalescent patients.¹⁹

General Washington also was distressed by the inadequacy of supplies of food and bedding for hospitals. In January 1778, he ordered the Quartermaster General to draw upon his supplies of straw to meet the requests of army doctors and to see that the huts used for the sick at Valley Forge be kept well supplied. In February, he also ordered the Commissary General, Ephraim Blaine, to keep the army`s sick supplied with rice, or, if it could not be found, at least with the ubiquitous cornmeal. Blaine and Potts, however, were in conflict for the purchase of many items and Blaine attributed some of the higher prices to the competition from Potts, so that wholehearted cooperation between the two men was unlikely. Furthermore, since Blaine was not always able to meet his regular commitments, it was not easy for him to aid Potts significantly. A more direct approach to the problem of buying food for the sick involved sending several men from each regiment out to scour the neighborhood for such food as could be obtained from local farmers and transferring supplies from the Northern Department where, after the victory at Saratoga, the demand had begun to drop. Because of these steps, combined with the efforts of the new Quartermaster General, Nathanael Greene, and the milder weather which facilitated transportation, by April, adequate amounts of flour, beef, and bread were available in the Middle Department. In May, however, when the army was preparing for the new campaign, many other items were still in short supply, among them sugar, tea, coffee, chocolate, salt, wine, and vinegar as well as bedding, paper, and pots. By June, difficulties obtaining food for the sick led General Washington to direct the Commissary General of the Army to be prepared at all times to supply the sick with fresh foods.²⁰

Medicines were difficult to obtain throughout the entire winter of 1777-78. General Washington`s January order that the Director General furnish medicines for regimental chests was not carried out until April because of the shortage of the required drugs. Department members traveled to neighboring colonies in their search for medicines and considerable ingenuity was shown in acquiring what was needed; the Department turned to the Commissary of Military Stores for sulfur and oil and to the Northern Department for other medicines.²¹

The shortage of instruments experienced in the early weeks of Dr. John Morgan`s administration also continued during the winter of 1777-78, when many regimental surgeons were still unable to obtain so much as a lancet. Lint and bandages were also hard to find in Pennsylvania. To alleviate this problem the department encouraged Moravian women at Bethlehem and Lititz to make lint and drew once more on the generous supplies of the Northern Department. Apothecary General Craigie also suggested that the shortage of bottles be relieved by reopening the glassworks at Manheim,Pennsylvania.²²

The shortages of medicines, bottles, instruments, and other items usually contained in the regimental surgeon`s medicine chest led inevitably to delays in the distribution of these chests. Cutting suggested that when

the new, smaller, and standardized chests were ready, the larger ones be called in for replacement. Concern over the need for these medicine chests was expressed by General Washington himself, who ordered that regiments without chests be reported to Cutting as Apothecary General of the Middle Department. In May, however, Cutting "went away before the regimental chests were finished" and there was "a great clamor about them, "since sufficient medicines to keep all regiments supplied were still lacking.²³

Such drugs as were available to the Hospital Department in Pennsylvania were apparently stored initially at Manheim, but in March 1778, Shippen ordered them moved to Yellow Springs. Craigie, however, under the assumption that there would be some consolidation of hospitals in the area in the future, wanted to locate the main depot at Carlisle, Pennsylvania, and to have medicines and chests prepared there. He noted, however, that he had not been able to induce the masons at Carlisle to complete the required construction for such a depot and commented in a letter to Potts that "The department is at present in chaos--no regularity--no system," even though needs were "great and many."²⁴

In addition to the shortage of supplies and medicines, many serious conditions afflicted the men at Valley Forge. Those most frequently experienced included a typhus-typhoid type of fever and smallpox, the latter for the most part apparently through inoculation. While neither of these conditions posed a serious problem in the camp until spring, frostbite injuries during the winter were at times so severe as to necessitate amputations. There was, moreover, at least one minor ailment which, without threatening life, tormented the men at Valley Forge. This was "the Itch," or scabies. Baron de Kalb wrote back to France that Continental soldiers were severely affected even before they camped at Valley Forge, and General Washington ordered regimental surgeons to obtain the necessary sulfur from Cochran and to see that men with this condition were "anointed for it, "as quickly as possible.²⁵

Large orders for lime juice suggest that scurvy was present in General Washington`s army in the spring of 1778. Dysentery like conditions were also being encountered, but the greatest burden on the entire hospital system in the Middle Department during the period spent at Valley Forge seems to have resulted from the repetition of the previous winter`s smallpox immunization campaign. It was believed that not only the ever-present possibility of action but also the heat itself made the procedure inadvisable in the summer, so despite the fact that spring inoculation slowed the preparation of the army for a new season of campaigning, the step was again undertaken in the winter and early spring of 1778. Attempts to determine how many men would require immunization began late in 1777, and by January, the effort to inoculate all susceptible soldiers in General Washington`s army was under way. The progress was slowed, however, both by the tendency for some surgeons to slip away from camp and by the lack of straw to serve as bedding. By March, inoculation had progressed to the point where, along with the lack of proper clothing, it was rated as one of the principal factors which "certainly emaciate the effective column in our returns,"²⁶and the rate of sickness for General Washington`s army exceeded 48 percent.

Recruits for General Washington`s army who had to come through Virginia were for a time inoculated at Alexandria, Virginia, under the supervision of Dr. William Rickman, Director of the Continental hospitals in Virginia. In the fall of 1777, however, rumors began to circulate that the procedure was being mishandled there and that patients were dying with putrid fever. Rickman was temporarily recalled, but the committee

investigating his conduct determined that the high death rate was attributable to the poorly clothed and exhausted condition in which the men arrived at his hospital and that the doctor had done as well as could have been expected under the circumstances.²⁷

In March, it was decided that in the future troops coming in from the south should not be inoculated until they reached the Valley Forge area. Orders were issued to the effect that as they moved north, these troops should avoid all towns where smallpox might be present. In anticipation of the inoculation of these men and apparently believing it a necessary ingredient of the diet of the smallpox patient, Cochran urged that Potts send him "Molasses in abundance." By the end of April, approximately one thousand men were in various stages of inoculation at Valley Forge and 50 to 100 more were undergoing the procedure in a hospital near Wilmington, Delaware.²⁸

It is in the documents dating from the winter at Valley Forge that one first encounters with any frequency the use of the term "flying hospital" in connection with the Continental Army. Like so many other designations in this army, however, the phrase was casually and imprecisely employed. In this instance, the flying hospital was managed not in the British manner as part of the general hospital (see Chapter 1) but rather as a large and more formal version of the regimental hospital. The flying hospital at Valley Forge consisted of a series of brigade hospital huts whose man-

agement was the responsibility of Physician and Surgeon General of the Army Cochran. In these units were kept, as was the custom also with regimental hospitals, only those who would be ready in a short time to return to duty and those who would be moved to a general hospital as soon as their conditionspermitted.²⁹

General Washington issued the order which led to the establishment of the Valley Forge flying hospital early in January. He required his generals to have two huts built for each brigade at appropriate locations 100 to 300 yards to the rear as soon as men could be spared for the work from constructing shelters for the rest of the army. These hospital huts were to be 15 feet wide, 25 feet long, and at least 9 feet high. They were to be covered with board or shingles, the cracks were to be left unfilled in the interests of ventilation, and there were to be a chimney at one end and a window on each side.³⁰

General Washington wanted patients to be kept as close as possible to camp, which necessitated the opening of new units near Valley Forge, for which the Hospital Department at that time had "neither utensils nor necessities required to open new ones." Nearby buildings, therefore, including churches, barns, and even a schoolhouse, were pressed into service to house Valley Forge patients who could not be accommodated in brigade huts. The assignment of the individual patient to a hospital was always to be made by Cochran. General Washington pointed out that sending men to overcrowded hospitals or to units not prepared to receive them could have already caused some deaths.³¹

A lack of discipline among army doctors continued to plague the hospital system at Valley Forge. Although there were more than sixty surgeons and thirty-three mates serving with General Washington`s army shortly before it entered winter camp, it was difficult to estimate the exact number actually on duty at Valley Forge because so many were able to wangle furloughs t which they were not entitled. At one point, the general forbade all leave for doctors, and in April, he ruled that only passes signed by Cochran were to be honored. In an attempt to further ensure that the sick of his army receive as nearly adequate care as was possible under the circumstances, General Washington also ordered the commanding officer of each brigade to appoint a captain to make daily visits to the sick of his unit who were hospitalized in the vicinity of Valley Forge.³²

The casual attitude of so many Valley Forge physicians toward the irresponsibilities even thwarted General Washington`s attempts to estimate the strength of his army. The reports of hospital surgeons on the number of men being cared for in their facilities differed markedly from those of regimental surgeons who were, despite the general`s efforts, still careless, both in meeting the deadlines which had been set for their reports and in clearing hospitalizations with Cochran.³³

By spring it was necessary to prepare the flying hospital for the new campaign season. Although the army was "becoming more sickly, "the flying hospital itself was reported by Craik to be "in fine order." General Washington`s principal concern in this connection seems to have been the speed with which the staff of the flying hospital could move the wounded after a battle back to a general hospital, since he did not wish to be again encumbered with disabled soldiers while his army was on the march. He therefore ordered the physicians of that unit to investigate the most efficient ways to move the seriously ill or wounded to permanent facilities, and by the end of June, approximately 85 percent of those under the care of surgeons appear to have been transferred to general hospitals.³⁴

During the winter of 1777-78, patients from the camp too ill to remain in the flying hospital were cared for in the general hospitals nearest Valley Forge, while facilities at a greater distance sheltered the sick and wounded hospitalized during the fall`s campaigns. In the first group, the Yellow Springs facility was by far the largest and most important. It was built during the early winter on land owned by an army physician, Dr. Samuel Kennedy, in an area already well known for the healing properties of its mineral spring.³⁵

Unlike so many of the army`s hospitals during this period, the Yellow Springs unit was carefully planned from the outset. The main building, later called Washington Hall, was specifically designed for the purpose and could comfortably shelter 125 patients. It was three stories and an attic high, 106 by 36 feet in dimension. The first floor held the kitchen, dining room, and service rooms, the second two large wards, and the third many small rooms. Nine-foot porches extended around three sides of the first two stories. Dr. Bodo Otto, formerly in charge of the Trenton hospital, was called to take over here, where he was joined by at least two of his sons and by Kennedy himself.³⁶

Although Otto`s patients began to arrive before the new building was ready for use and thus had to be sheltered in three nearby barns, the Yellow Springs unit quickly acquired a reputation for being "very neat, and the sick comfortably provided" for.³⁷ General Washington himself visited the hospital in May, speaking "to every person in their bunks, which exceedingly pleased the sick," and was apparently favorably impressed by the facility.³⁸

Nevertheless, the Yellow Springs unit was not without its problems. Putrid fever raged

there as elsewhere, and Kennedy, among others, died from it. The staff found that a shortage of the wine so esteemed for its medicinal properties triggered problems with rowdy officers who "crowd in upon us and from the reputation of our
hospitals, . . . call for wine and threaten excision if they do not get it." Furthermore, the number of patients was so great that other nearby buildings were pressed into service, the three barns were retained in use even after the main building was opened, and a convalescent unit was opened about two miles distant from Washington Hall.³⁹

Among the units caring for battle casualties was the hospital reopened in Bethlehem, Pennsylvania, in September. At the end of November, Shippen recorded only 383 patients at this facility, but patients continued to arrive in the village throughout December. (See Table 6.) The total number of the sick and wounded in the Bethlehem Single Brethren`s House alone by the end of December, after the arrival of fifty wagons laden with men from New Jersey on the 27th, was reported to be over 700. Many of these patients arrived after exhausting journeys through snow and rain clad "in rags swarming with vermin" and despite the Moravians` efforts to collect blankets, bandaging, and clothing on their behalf, continued even in the hospital to be poorly clothed and filthy. In this environment, of course, wounds quickly became infected and putrid fever appeared. It spread rapidly not only among patients but also among attendants, many of whom were Moravians,⁴⁰and afflicted most heavily those on the upper floor, where "the stench and filth were bad indeed." The Reverend John Ettwein wrote in his account of the 1777-78 winter that among the Moravians, "several died(among them my best & dearest Son 20 Years old)."⁴¹

Preparation to close the Bethlehem hospital began in the spring of 1778,and in

mid-April, a large number of the patients, about 100 of whom were classified as convalescents, were removed to the facilities at Lititz, Pennsylvania. A few still remained in Bethlehem in early May, however, and it was not until late June that the Moravian men were able to reoccupy their home. The staff of this hospital was moved to the Yellow Springs area to serve patients left behind at Valley Forge.⁴²

The village of Lititz, to which so many Bethlehem patients were taken in April 1778, was a Moravian community about half the size of Bethlehem. Since here, too, the order possessed large buildings appropriate for hospital use, when hospitals near Philadelphia were being evacuated, a unit was established in the stone Brethren`s House, which was three stories high,60 feet long, and 37 feet wide. Dr. Samuel Kennedy was in charge of the Lititz unit from the time of the unit`s opening until he moved to Yellow Springs, when he was succeeded by Dr. Henry Latimer. Dr. William Brown, best known as the probable author of the first American pharmacopoeia, made Lititz his headquarters after his selection as Physician General in February 1778.⁴³

The hospital at Lititz, apparently overcrowded soon after its opening, was also swept by disease during the winter of

BROTHERS` HOUSE AT EPHRATA.(From Duncan, Medical Men.)

1777-78. Although the first eighty patients arrived in fifteen wagons on the evening of 19 December, only two days later the unit had becomes o crowded that its staff had to turn away 100 patients. Inevitably, in a very short time, putrid fever was raging. The hospital quickly ran out of medicine and members of the staff began to fall ill. In a ten-day period ending 1 January 1778, seven patients died. From 12 to 22 January 1778, there were 12 deaths and 25 cases of putrid fever among the 173 patients. In the course of the winter, both of the physicians serving the hospital contracted the disease at the same time, and civilian doctors had to be called in to care temporarily for military patients. Five Moravian nursing volunteers and the congregation`s pastor died. The Sisters` House Diary of Lititz records in an entry at the end of December, "The misery of the lazaretto cannot be described; neither can it, without being seen, be imagined."⁴⁴

The town of Ephrata, where a Hospital Department unit opened about the time of the Brandywine engagement, was another unusual religious community, not of Moravians, however, but of "Dunkards," after whom Ephrata was also called Dunkerstown. The Dunkards of Ephrata were actually a splinter from the original Dunkards, lived celibate and almost monastic lives, and observed the seventh day of the week as the Sabbath. At Ephrata, three surgeons and two mates apparently formed the staff which, during the course of the winter and spring, cared for about 500 patients. Although the buildings they used were relatively large, the Dunkards of Ephrata had made their rooms small and the doorways low, in an attempt to keep the occupants humble.⁴⁵

The community kept the hospital well

supplied with veal and milk, and Shippen sent in all the required medicines, while the physicians in charge reportedly maintained a high level of discipline; but the death rate was still high. Putrid fever soon invaded this unit, too, and killed patients, staff, and Dunkards who had volunteered to serve as nurses. As many as 200 were rumored to have died and been buried on a hill in a plot belonging to the community, but Brig. Gen. Lachlan McIntosh reported that from 18 December 1777 to 26 April 1778, only 57 either died or deserted and 168 were discharged, with 34 remaining in the hospital as of that date.⁴⁶

Ephrata was considered at the time to be "An inconvenient place for an Hospital," but an unknown number of the patients from the facility at Reamstown, Pennsylvania, were moved there, nevertheless, on 17 March1778, when the Reamstown unit was closed. By June 1778, however, the Ephrata hospital, too, had been closed.⁴⁷

Another important Pennsylvania hospital during this period was at Reading, often for patients whose ultimate destination lay further to the west. Beginning in September 1777, the courthouse, a potter`s shop, several churches, a Quaker meetinghouse, and other buildings in Reading were used to shelter patients. Soldiers` wives were among the patients here and as many as eight of the nurses were women. These buildings quickly filled up and as early as mid-December men were being sent on to other hospitals, including that at Ephrata. On 30 March, 149 patients were reported to be at the Reading facilities, but by mid-April, only 32 remained. General McIntosh recorded a total of 132 as dead or deserted in the seven months of the hospital`s operations to that date, 367 sent on to Lancaster County hospitals, 22 furloughed, and 513 more returned to camp.⁴⁸

Other large general hospitals in Pennsylvania at this time included the units at Allentown and Easton. In November 1777, the Allentown facility held 190 men and that at Easton 400, but by March 1778, the two together held no more than 70 patients and were plagued by shortages, especially by a shortage of beef. Shippen, on visiting these hospitals in the spring, urged that both be closed and that any patients not ready to return to camp be sent to Bethlehem. The men at Easton were moved to Bethlehem on 27 March, but the unit at Allentown remained open through mid-April.⁴⁹

The idea that the military hospitals in the Middle Department should be consolidated was put forward in the spring of 1778 by both Shippen and General McIntosh, who made an inspection trip among these hospitals at this time at General Washington`s request. Both men envisioned a greater concentration of patients at the Lititz unit, to which General McIntosh recommended the removal of the Schaeffers town and Ephrata patients. He urged that all Pennsylvania hospitals except those in Lancaster County(which included the Lititz unit) be closed. Shippen, however, wished to go further and envisioned the expansion of the Lititz facility and the complete abandonment of the village by the Moravians. The Reverend Ettwein, however, wrote General Washington to emphasize that his people from Lititz would be rendered almost incapable of supporting themselves should this happen. Shippen finally abandoned his plan, but the Hospital Department continued to occupy the Brethren`s House there for five more months and patients continued to come into Lititz not only from Bethlehem but also from Easton, Allentown, and Reading, as the hospitals in these towns wereclosed.⁵⁰

In addition to the hospitals in Pennsylvania, at least two units east of Philadelphia remained open during the winter and early spring, one at Princeton and the other in Delaware. The latter facility averaged eighty patients, all from Brig. Gen. William Small-

wood`s brigade. Originally located at Newport, which General Washington considered to be too exposed, this hospital was moved to the Nottingham Meeting House near Wilmington some time shortly before 22 April 1778. The Princeton hospital, the only one outside of Lancaster County, Pennsylvania, which General McIntosh believed should remain open in the Middle Department, held only fifty-three patients as of 8 April. From 14 January to 8 April, 52 died or deserted from this hospital, while 135 were recorded as returned to duty.⁵¹

As spring approached, various proposals were put forth concerning the handling of the casualties which would be left behind when the army marched or would be sent to the general hospitals from the flying hospital with General Washington`s army. Craik at one time envisioned continuing to use the huts at Valley Forge as units of the general hospital after the army itself had left. He assumed that 1,500 to 1,700 patients would be left behind and urged that Shippen send surgeons and mates to Valley Forge t care for them since, of course, the regimental surgeons would leave with their units.⁵²

General Washington, however, was not happy with the use of these huts even for healthy men and had ordered some sickly regiments to vacate their huts as soon as tents could be obtained for them. The rate of illness continued to climb at this critical time, however, and there were not enough wagons available to move the ill to hospitals beyond Valley Forge. The general seemed to have at last resigned himself to the temporary use of huts for the sick, but he ordered that any mud used as plastering be removed and every effort be taken to improve ventilation.⁵³

The general also ordered that officers be appointed to stay behind with the ill at the rate of one officer for every 250 men. He told his regimental surgeons to report to Cochran on the number of men who could not march with the army and required that medical attendants from each brigade remain o care for these men until hospital surgeons could remove them. An attempt was also to be made to find women to serve as nurses for the patients remaining at Valley Forge. On 1 June, General Washington appointed a colonel to supervise the care of the sick and to send them back to the army as they recovered. Finally it was decided to put Otto in charge of the patients left behind and to move them when possible either to Yellow Springs or to a new hospital to be established for them elsewhere.⁵⁴

On 18 June, the British evacuated Philadelphia and General Washington led his army out of Valley Forge to reoccupy that city and then through Bucks County, Pennsylvania, across the Delaware River; on 28 June, the army was into the first action of the new season, at Monmouth, New Jersey.⁵⁵

THE NORTHERN DEPARTMENT

Although the men under Maj. Gen. Philip Schuyler, like General Washington`s men, continued to suffer from a lack of clothing, prospects for the new season of campaigning seemed reasonably bright as far as the army`s health was concerned. The smallpox problem was under control, and newly planted gardens promised a reliable supply of fresh vegetables. The total number who were sick of the 4,533 men who were at Ticonderoga and Mount Independence on 25 June, however, is difficult to estimate. (Map 5) Samuel Adams reported 342 to be "Sick in camp, and in barricks" as of thatdate,⁵⁶ and since General Schuyler complained of the hospital under construction there that "not one single room . . . is yet finished, nor will it soon be in condition to receive a considerable number of sick,"⁵⁷one might safely assume that there were few patients, if any, being cared for outside of "camp . . . and barricks," in this area. It is, therefore, surprising to note that

MAP 5

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

in the entire Northern Department in July and August the overall sick rate, if monthly report figures are used, was just under 24 percent and that more than half of these were "sick absent." General Schuyler was distressed by the condition of the hospital accommodations on Lake Champlain and at the end of June had all the patients not likely to be ready to return to duty in a very short time moved in covered boats to the Fort George facilities where, he believed, there would also be a better supply of vegetables.⁵⁸

The British, under Maj. Gen. John Burgoyne, had already begun their move south, and when, on 6 July, Continental forces abandoned Ticonderoga, the remaining patients, along with hospital and other supplies, were hastily loaded into 200 small boats. That night, escorted by five armed galleys and a guard of 600 men, these vessels slipped across thirty miles of water as still as glass to Skenesboro, at the southern tip of the lake. They were so closely pursued by the enemy, however, that they were unable to stop there and were forced to continue south along a small river to Fort Anne, in the process losing to the British several patients and most of their supplies. At Fort Anne, the sick were placed in tents where they remained until 25 July, when surgeon`s mate James Thacher was ordered to take them by boat to Albany. Thacher and his forty patients arrived there safely, having covered approximately fifty-five miles in three days.⁵⁹On 29 July, the British also took Fort George. If any of the patients who had been moved to Fort George from Ticonderoga were still there, presumably they also moved farther to the south before the British arrived.

Although the hospitals in the Lake Champlain-Lake George area were abandoned in the summer of 1777, a new unit was established at roughly the same time in the vicinity of Bennington, Vermont, to serve the militia units gathering there. American patients were cared for by regimental surgeons in whatever shelters could be found for them scattered about the countryside, but after the British were severely defeated in their raid on Bennington, Dr. Francis Hagan reported to Potts that a meetinghouse had been taken over for wounded prisoners and two German surgeons had been placed in charge of them. Stores were badly needed; this shortage was to continue throughout the summer and fall, causing unnecessary suffering for the unit`s patients. Hagan could not find nurses for the wounded, and the local population was of no assistance to him, but his patients were in no condition to be moved. The situation here seems to have only deteriorated as the season progressed, for as late as 21 September, Hagan was writing Potts of his fear of the effects of cold weather upon his patients, of the poor condition of the prisoners, and of the additional problem posed by the fact that

the British and Hessian patients were mutually antagonistic.⁶⁰

Not all was gloomy at Bennington, however. Another physician there, Dr. Samuel MacKenzie, wrote Potts on 27 August 1777, "I want Doctr Treat here very much to prescribe leeks for the Doctrs as they seem very fond of bundling and the Tory girls seem to have no objection to that kind of amusement."⁶¹

The flying hospital for the Continental Army in the Northern Department, under the direction of Physician and Surgeon General of the Army John Bartlett, was also beset by many problems. Its location as the army prepared to meet General Burgoyne at Saratoga was considered unhealthy, and at times the sick entering and being discharged were too numerous to count, although on 18 August, Bartlett fixed the number of patients at 335, under the care of thirty-two nurses. Regimental surgeons contributed to the situation by complaining that Bartlett was refusing to supply them with medicines, lint, and bandages, a charge he vigorously denied. His staff was too small, he added, and he needed three more regimental surgeons and three more mates. By the end of the month, when he still had 192 patients in his hospital, such regimental surgeons as were available were refusing to help him, saying that Maj. Gen. Horatio Gates, who replaced General Schuyler on 19 August, had forbidden them to do so.⁶²

Despite the good beginning, as the summer progressed, sickness increased in the Northern Army. The men were often in retreat, at times without shelter, and almost always short of every sort of supplies except food, and the quality of that food was open to criticism. Nevertheless, on 20 July 1777, of 6,023 officers and men, only 459 were reported to be in the general hospital, a figure which apparently represented about half of the total list of those sick and presented a marked contrast to the situation in the North the previous year. The staff of the department included fifteen surgeons and seven mates and the much feared putrid fever was not a great threat. Furthermore, during the period 1 March to 29 August 1777, only fifty-three of the men cared for by these doctors were reported to havedied.⁶³

General Gates`s force grew rapidly in October 1777. He had approximately 8,000 officers and men on 4 October, 885 of whom were sick in the general hospital and another 4,000 men joined him in the course of the following three days. In contrast to the situation which developed in the North in the spring of 1776, however, the staff of the Hospital Department in the Saratoga area, responsible for both American patients and wounded prisoners, also grew rapidly until it was almost double its original size. From the end of August to mid-November 1777, however, another 150 men were reported to have died and the British complained that their wounded held by the Continental Army were not being well treated. In September, British Brig. Gen. Simon Fraser himself inquired with concern about sick and wounded prisoners in American hands after the British raid on Bennington and suggested that he could forward both medicines and surgeons to aid in their care, but General Gates appeared initially to have rejected this offer. The American informed his counterpart that his wounded prisoners were well supplied with "Surgeons, medicines, and attendance, with every comfort imaginable. "After their Saratoga defeat in October, however, when the British were forced to abandon an entire hospital, including approximately 250 patients, five medical attendants remained with their patients in captivity.⁶⁴

At some time in the fall, the British wounded were moved from the Saratoga area to the Albany facilities, where more than 300 American patients were being cared for, but their chief physician continued to complain of the treatment they re-

ceived and of supply shortages. Among the enemy patients here who had the least cause for complaint, however, was one Maj. John Dyke Ackland(Acland), who was shot through both legs. His wife, who had accompanied him through the entire campaign, sailed down the Hudson River, accompanied only by a maid, a valet, and a chaplain, to join her husband at Albany and to nurse him back to health at the hospital. She apparently was treated with true gallantry by General Gates.⁶⁵

Most of the American patients at the Albany hospital suffered from disease rather than from physical injuries; numbers of patients reported in mid-August were as follows:

Dysentery	81	Rupture	2
Intermittent fever	79	Scorbutic	4
Diarrhea	61	Pleurisy	3
Rheumatism	22	Hemorrhoid	1
Cough	25	Hemoptysis	2
Convalescent	17	Nephritis	3
Debility	17	Asthma	1
Leus venerea	14	Paralysis	2
Fever	13	Cholera	1
Whooping cough	10	Hypochondria	1
Head itch	9	Scrofula	3
Measles	8	Ophthalmia	1
Putrid fever	6	Total	396
Bilious fever	4	Total	396
Dropsy	4	Surgical	53
Jaundice	2	Surgical	53

SOURCE: A Return of the Present State of the General Hospital at Abany [sic] 20 Aug 1777, Potts Papers, 2: 283. This return, however, gives an incorrect total of 296.

In the fall of 1777 the patients with physical injuries included none other than Brig. Gen. Benedict Arnold (promoted to major general on 29November 1777), who was again wounded, this time by a musket ball which had broken his leg. Of Arnold the patient, Thacher said, "He is very peevish and impatient under his misfortunes." Hospitalized for a time with Arnold was a young lieutenant colonel, James Wilkinson, who was to lead a colorful life after the Revolution and to serve with less than complete success as a major general in the War of 1812. While on duty in the North, Colonel Wilkinson became so ill that he had to be evacuated by wagon first to Albany and then, on 20 October, accompanied by a hospital surgeon, further south, taking with him the details of the Saratoga victory.⁶⁶

By the end of October, the overflow from the main Albany unit had spilled over into private homes and a church. Enemy patients were being cared for by their own surgeons, but Thacher considered the Hessian doctors "uncouth and clumsy operators." The operations being performed consisted principally of amputations and trepanning, and some surgical patients for a time had to endure maggots which thrived in their wounds. Among the twenty patients Potts had assigned to Thacher was a particularly interesting one in the person of an American captain who had managed to survive a scalping at the hands of the Indians.⁶⁷

The increase in the number of patients at the Albany unit strained the supply system in the Northern Department. For a time, no fresh straw was available, and with the harsh northern winter rapidly approaching, wood was also badly needed. In an attempt to relieve the pressure on the hospital, seventy to eighty men were returned to their barracks and steps taken to furlough an even greater number. By mid-November, however, 218 patients,118 wounded and 100 sick, were still listed on the rolls at the Albany hospital, a figure which a month later had risen to a total of 297.⁶⁸

The number of patients under the care of Dr. Dirk Van Ingen in Schenectady had also increased in this period to the point where by late summer Van Ingen had found it necessary to hire two men and two women to care for them in the two rooms which had been allotted them in a barracks. By mid-August, he needed bedding, medicines, and more attendants for his forty-three patients. In November the Schenectady unit was treating 72 patients and a month later312,

more than were reported for that period by the Albany unit. The subsequent decrease in the patient load by February 1778 led to the transfer of remaining Schenectady patients to Albany, where on 16 February 1778 there were only 304 patients, 24 of whom were children being wormed. (The records do not indicate whether these patients were military dependents.)⁶⁹

Inoculation continued to be practiced in the Northern Department, although the evidence suggests that the procedure was undertaken earlier in the year in the North than it was in the Middle Department. Repeated references to the fact that inoculation was taking place can be found, but since the records remaining to us from this period rarely distinguish between smallpox deliberately and naturally acquired, we can only assume that most of the smallpox patients hospitalized in the Northern Department at this time had acquired the disease through deliberate immunization. Northern Department records list 68 smallpox patients at Albany and 260 at Schenectady in December 1777, but only 30 at Albany and 55 at Schenectady in January, and on 15 January, Dr. Robert Johnston noted that those patients who had been inoculated had done well and were almost ready to return to duty.⁷⁰

The total number of patients in the Northern Department at the end of November was estimated by Director General Shippen at 1,000. Potts had been forced by ill health to return to Pennsylvania at the end of the campaign season and Johnston was asked by both General Gates and Potts to function as Deputy Director General in the Northern Department, although it appears that he was never actually named to the position. By the end of the year, since the patient load was diminishing and all of the twenty patients assigned specifically to Thacher`s care had recovered, the young surgeon was permitted to go on a forty-day furlough.⁷¹

When Thacher returned in February 1778, although the hospital was in desperate need of money, the atmosphere was quite different from that prevailing in Middle Department hospitals at this time. "Several gentlemen belonging to the hospital being desirous of improving in the accomplishment of dancing, "Thacher and his friends actually hired a teacher and every afternoon worked with him to prepare themselves to "figure in a ballroom." In the spring of 1778, with the patient load still steadily decreasing, the decision was made to move most of the Albany staff and supplies down the Hudson to the West Point area, since it was expected that in the future major Continental operations would not take place in the Northern Department. On 5 June, therefore, the staff, except for three doctors who stayed behind to care for the remaining patients, and the facility`s stores were embarked on a sloop and taken down the Hudson. Two days after its departure, the unit stopped at Fishkill to replenish its food supply and on 10 June was ready to install itself on the east bank of the Hudson across from WestPoint. Large houses surrounded by extensive farms and gardens had been found for the hospital facilities to be established there; good pasture for horses and cows abounded, and a number of large orchards offered several kinds of fruit. The principal house used by the Hospital Department here was referred to as Robinson`s House, after the wealthy Tory Col. Beverly Robinson, from whom it was confiscated following his flight to New York City.⁷²

THE EASTERN DEPARTMENT

Despite several British raids in the area, there was no major action in the department east of the Hudson River in the period June 1777 to June 1778, and there were few patients for Eastern Department hospitals to treat, only 383 being reported there in late November 1777. Dr. Isaac Foster had been placed in charge of this department in April

1777 with physicians Ammi Ruhamah Cutter and Philip Turner as his Physician General and his Surgeon General, respectively, and Dr. William Burnet as his Physician and Surgeon General of the Army. Cutter apparently resigned his position in March 1778.⁷³

The hospitals within this department included units at Danbury, to which the Stamford hospital had been moved, Hartford and New London, Connecticut, Providence and Newport, Rhode Island, Boston, Massachusetts, and Fishkill and Peekskill, New York. The assignment of patients to appropriate hospitals was the responsibility of Burnet, who also received reports from regimental surgeons reputed to be often careless with their reporting. Turner apparently made his headquarters at Danbury, where a five-room building housed the hospital, and traveled a 400-mile circuit to visit lesser units.⁷⁴

The hospitals in his department, Foster maintained, were in excellent condition and "the sick soldiers are as anxious this year, to be admitted into them, as they were last, to avoid them." Rush believed Foster`s division to be so superabundantly supplied with linen, bedding, and similar items that he suggested that the Director General send someone to New England to bring back a portion of their plenty to the Middle Department.⁷⁵

The only real concern for the medical staff of the Eastern Department lay in the possibility of a smallpox epidemic among newly arrived troops during the active part of the campaign season, since, as noted in the section on health at Valley Forge, inoculation was not undertaken during the summer. As early as July 1777, therefore, Maj. Gen. Israel Putnam, commanding in the Peekskill, New York, area, ordered the immediate hospitalization and isolation of all who so much as seemed to be infected with the disease. Inoculation was undertaken in the late winter and early spring of 1778, however, and the existing records do not mention any type of epidemic in this department in the period June 1777 to June 1778. Foster was able to comment in March 1778 that "we do very little here."⁷⁶

The 1777-78 season was characterized by inactivity in the Eastern Department and the end of large-scale operations in the North, but the Hospital Department had no reason to expect that their work would be easier in the 1778-79 season. The Continental doctors and their patients from General Washington`s army had endured another year of agony, and the sickly condition of the men as they left Valley Forge gave little reason for optimism.