Chapter 5
From Defeat to Victory, June 1778 to 1783
For three years after the battle of Monmouth in June 1778, the major operations of the Continental Army took place in the South, where the organization of the Hospital Department was either weak or nonexistent. The successful siege of British-held Yorktown, Virginia, by a combined French-Continental force in the early autumn of 1781, however, brought an end to all significant military activity in the American Revolution, while the signing of the Treaty of Paris in the early autumn of 1783 was followed by the disbanding of both the Continental Army and its Hospital Department.
NORTH OF THE POTOMAC: BEFORE THE VICTORY AT YORKTOWN
After evacuating Philadelphia in June 1778, the British forces withdrew to New York City, on their way defeating an attempt by the Americans to stop them at Monmouth, New Jersey. (Map 6) After the battle of Monmouth, General Washington also led his men north and established his headquarters at White Plains, New York. General Washington`s army saw little action in the North from this point onward,1 and the number of wounded was correspondingly small, but shortages of food, clothing, and supplies continued to have an unfavorable effect upon both the health of the army and the suffering of the patients in Continental hospitals.
The wounded from the battle at Monmouth were initially cared for in nearby buildings, including a courthouse and churches, where they lay upon straw on the floor. Many fell victim to the heat during the battle, and as the army continued northward, the number of those unable to keep up the pace without medical care increased, the temperatures being so high that a "vast number of our men fell down with the Heat . . . & Died." Early in July, General Washington, concerned lest the army`s mobility be impeded by attempts to carry the sick and wounded with it, ordered that they be sent to a barracks in the town of Brunswick, New Jersey, and that the director of the flying hospital inform him at once how many of these men were left behind. Many who became ill after early July appear to have been carried along for a short time in wagons but at the end of the month were sent back to hospitals at Trenton and Princeton, New Jersey. It appears that somewhere in the course of the march to White Plains, men were also hospitalized at Springfield, New Jersey, in accommodations General Washington considered inadequate. Only one Hospital Department physician could be spared for this facility, but a regimental surgeon was assigned to assist him. The number of patients here rose to 200 before these men could be moved to the hospital opened at Morristown, New Jersey.2
In returning to New York State, General Washington`s men crossed from the Middle into the Eastern Department, where Dr. Isaac Foster was the Deputy Director and Dr. William Burnet the Physician and Sur-
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geon General of the Army. Dr. John Cochran, however, was still attached to General Washington`s army as Physician and Surgeon General of the Army. The situation was further complicated by the fact that many surgeons from the Northern Department were still working in this area. Rather than grant either Cochran or Burnet supreme authority over flying and regimental hospitals there, General Washington ordered that they share the responsibility. Burnet apparently signed many, if not all, of the weekly returns submitted concerning these facilities,3 but there does not seem to have been any friction between the two men.
Reports of the late summer of 1778 signed by Burnet as Physician and Surgeon General of General Washington`s army suggest that the number of the sick within General Washington`s army was running at 1,200 to 1,450 men per week, but not all of the sick soldiers were retained in the hospitals within the camp and the monthly strength report for the period indicates that the rate may have been 17 to 20 percent. On 12 September, a group of patients was moved to the general hospital at Fishkill. Water transportation was frequently resorted to for such moves, many of the patients on this occasion going by land to Tarrytown and thence by water to Fishkill. Those able to walk went on foot to Peekskill, where they boarded boats for the same destination, while their packs were sent separately by the Tarrytownroute.4
Little detail is available on the management of medical support for the unsuccessful attempt by the Continental Army on Newport, Rhode Island, conducted from 29 July to 31 August 1778, but we know that the care of the 137 American wounded was assigned to Dr. Thomas Tillotson of the staff of the Northern Department and to an assistant, also drawn from the Northern Department staff. Tillotson reported to Foster, from whom he was ordered to obtain his medicine, instruments, and "such things as may be thought necessary in the formation of a military and flying hospital."5
When it was time in late 1778 to establish winter camp, several units remained behind at Peekskill, Fishkill, and West Point, New York, and three brigades wintered at Danbury, Connecticut, but the bulk of General Washington`s army marched south to winter camp at Middlebrook, New Jersey, in late November. A total of seven brigades spent the winter there, while an eighth camped at Paramus, New Jersey. Information on the precise nature of the hospital facilities serving troops in New Jersey during this winter is not plentiful, but it appears that some patients were housed in nearby churches, barns, and a courthouse, while others were sent to the hospital at Brunswick. There seem also to have been physicians caring for Middlebrook patients at Bound Brook.6
There was remarkably little sickness in the Continental Army north of Virginia in the years 1779 and 1780, perhaps as a combined result of inoculation for smallpox, a drop in the proportion of green to seasoned troops in the Army, and efforts to improve sanitation and discipline. Since the health of his army while it camped at Middlebrook did not demand all the time of the regimental surgeons there, General Washington was able to decide that it would be wise if they were to spend some of it improving their professional knowledge and skills. A series of lectures was planned, with the first to be conducted by Dr. William Brown, Physician General of the Middle Department, in February. The general observed that "All regimental surgeons are desired to attend."7
In May 1779, General Washington led his men out of winter camp toward West Point, New York, after ordering that the huts they had been using be left standing for the benefit of those too ill to keep up with their fellows. After the army reached West Point, the number hospitalized with-
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in the camp at any one time often ran higher than 300, with 20 to 30percent of this number classified as convalescent. A comparable number might be described as lame. Well over 10 percent of the total in the hospitals within the camp were suffering from intermittent fevers, but putrid fever does not seem to have been a serious threat at this time.8
In the fall of 1779, Virginia and Carolina troops were sent south toward their own states, where enemy invasion was anticipated, and other units again camped for the winter along the Hudson River or in Connecticut, but the main body of the army left the Highlands of the Hudson in late November and arrived at the camp at Jockey Hollow, about three miles south of Morristown, early in December.9
These men were already in poor condition and without adequate food, clothing, or fuel, and now, since they were not using the site of the 1776-77 encampment, there were no huts available to house them when they arrived. With the snow lying two feet deep around them, they had to lie on the bare earth. For more than a week after their arrival at camp, there was no bread for them to eat.10
During the winter of 1779-80, rivers froze solid and temperatures reportedly dropped lower than they had been in decades. The four to six feet of snow which sometimes covered the ground interfered with the transportation and delivery of supplies and occasional thaws only turned roads into quagmires. Food had been hard to obtain even before the onset of winter because the drought of the previous summer had lowered both crop yields and the level of the water which powered flour mills. Now the frozen streams of winter again made milling impossible and, for a long period of time, adequate stocks of clothing were still unavailable. By spring, the army was near starvation and mutinies were beginning to break out.11
Surprisingly, however, in view of the conditions at the camp, there were relatively few patients in the hospitals serving Morristown in the winter of 1779-80. In February 1780, approximately 3.5 percent of the slightly more than 11,500 men at Morristown were reported seriously enough ill to be hospitalized and perhaps more than twice this number of the sick were cared for within their own quarters. Those men who did require prolonged hospitalization were sent to the nearby general hospitals at Basking Ridge(also spelled Baskin ridge or Basken ridge) or Pluckem in, but in the period 1 March to 1 April 1780, 670 men, or 60 percent of the total requiring hospitalization, did not leave the care of the regimental and flying hospital surgeons. Only eighty-six died from 17 December 1779 to 3 June 1780. These patients were housed in regular huts rather than in especially designed structures, and the huts assigned during the winter to the Pennsylvania Line were taken over in June 1780 to serve as a general hospital for the patients who had to be left behind when the army left its winter encampment. Dr. James Tilton has been traditionally credited with having designed the Morristown hospital huts, but recent research has shown that Tilton`s design was apparently used only once during this winter, not at Morristown but for an experimental general hospital building at Basking Ridge, near Morristown.12
The troops remaining along the Hudson during the 1779-80 winter apparently fared no better than those at Morristown. Severe snowstorms began late in November and alternated with freezing rain throughout December. The effects of the weather upon the men led Maj. Gen. William Heath to comment that among the men spending the winter there, the number who froze to death rivaled the number returning to the army after treatment at the New Windsorhospital.13
As far as the Hospital Department was
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HOSPITAL HUT DESIGNED BY DR.JAMES TILTON. (From Duncan, Medical Men.)
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ROBINSON`S HOUSE. From the number of patients reportedly cared for here, it might be assumed that other buildings in the same area were also used to house patients.(From Duncan, Medical Men.)
concerned, conditions did not improve markedly with the coming of summer. In August, Dr. James Craik commented that "There is a large army without stores, surgeons or any thing comfortable for the sick & wounded."14 The number of sick grew as the summer progressed, but there continued to be little for patients to eat. By early August, the hospital at Robinson`s House, across the Hudson from West Point, held 126 sick and hungry men. Discipline and organization, furthermore, were so poor that, although Cochran urgently needed surgeons, doctors who could have helped him were in Philadelphia and, the Medical Committee was informed, had "no visible employment."15
The main part of General Washington`s ragged army remained in New York for the winter of 1780-81. Conditions were so poor that mutinies began to break out once again in early January 1781. It was at this difficult time that Director General William Shippen resigned.16
Figures in the Hospital Department reports which have survived from this period do not agree with the corresponding Army monthly returns. Although at the end of March 1781, for example, the return of the new Director General, John Cochran, listed a total of 288 patients remaining in regimental and flying hospitals, the official monthly return submitted by General Washington listed only 251 "sick present." The
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following May, however, when Cochran reported a total of 398 men and 40 women and children being cared for by all of the Army`s hospitals, the official return recorded a total of 723 under the care of surgeons, 406 "sick present," and 208 "sick absent" among the rank and file and 109 in both categories among the commissioned and non-commissioned officers. The official monthly report for June listed 566 sick in all categories, but the figure given by Cochran for June is 408, with 218 of these in the flying hospital. The discrepancies in the reports of any one given month may, of course, reflect differing base dates for the reports, inaccurate reporting at one or more levels, the inadvertent omission of one or more units from one of the overall monthly returns, or shifts in unit assignments between the times of composition of the different returns. Of the 288 listed by Cochran as remaining in the regimental and flying hospitals of the Army for March 1781, 43 were termed "lame," 18 "rheumatic," and 14 "venereal." In May, 41 of the 142 in the flying hospital were suffering from "casual hurts," 19 were convalescent, 16suffering from intermittent and remittent fevers, and 6 from smallpox.17
In June 1781, while preparing for operations against New York City, General Washington ordered his regimental surgeons to send to the hospital at Robinson`s House all patients unable to move with the army, except for those with smallpox, who were to be isolated in the huts used during the previous winter by New Hampshire troops.18 It might be noted that this order for all practical purposes converted Robinson`s House into a general hospital.
In July 1781, when the rate of sickness appears to have dropped below 11 percent, two flying hospitals were listed in Director General Cochran`s records, without any description or commentary to distinguish between the two, one having forty-one patients remaining at the end of the month and the other twenty-one. In the August report, Cochran listed a flying hospital with 102 remaining at the end of that month and another 207 patients remaining with the "Army east" of the Hudson. Since General Washington, discouraged about operations against New York City, received word in August that he could have the support of the French force under Rear Admiral deGrasse for an attack on the British in eastern Virginia, by October there was a flying hospital at Yorktown. Reports from the army east of the Hudson continued to come in, however, since forty-four remained hospitalized thereafter forty-nine were sent on to a general hospital.19
Although the men camped along the Hudson saw no major action after the summer of 1778, Indian and Loyalist attacks on American settlements at Wyoming, Pennsylvania, on the Susquehanna River and at Cherry Valley, New York, on the Mohawk River in 1778, led in 1779 to a coordinated campaign under the overall command of Maj. Gen. John Sullivan against the perpetrators of these massacres. (Map 7) General Sullivan personally led 2,500 men based at Easton, Pennsylvania. Brig. Gen. James Clinton commanded 1,500 men from New York State and Col. Daniel Brodhead 600 men based at Fort Pitt, Pennsylvania. General Clinton`s units left Albany in the spring of 1779 to establish a base at Canajoharie, New York, and then moved southwest to the Susquehanna River. They followed the river to Tioga, where they met General Sullivan`s men. Colonel Brodhead, however, because of his inability to obtain adequate guides, failed to meet the Sullivan-Clinton force at Genesee, New York, as had been planned.
Before undertaking these operations, General Sullivan established a hospital unit at Easton and ordered his regimental surgeons to provide the necessary medicines for those whose health would not permit them to accompany the expedition. Many of these patients were ill with intermittent fevers which were blamed on the overly long baths they were accustomed to taking in the river.
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General Sullivan was among those whose health was precarious at this time, but although his condition seems to have gradually worsened, he continued with his men throughout the entire campaign.20
Leaving Easton, General Sullivan`s men moved on to Sunbury, where Dr. Francis Alison was in the process of creating a general hospital to care for their casualties, arriving there on 21 June. Two days later they continued on up the Susquehanna River toward Wyoming. At Wyoming, General Sullivan ordered his regimental surgeons to report about their patients to the "Senr.
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Surgeon to the Flying Hospital" once a week.21 An officer noted while here that "A No. of the troops" were down with "thedissentary."22 In mid-July, the sick at Wyoming were moved "to the genl Hospital under the Direction of Doct. McCrea," but whether McCrea`s unit was the hospital which seems to have remained at Wyoming after General Sullivan`s troops left is not clear.23
Both before leaving Wyoming to continue his northward march and after arriving at Tioga on 31 July, General Sullivan continued to plan the details of his order of march. He decided that the Surgeon General, by whom he presumably meant the head of the flying hospital, should remain by his side, the surgeons attached to the flying hospital, with their mates, should march at the rear of the entire army, and the regimental surgeons should remain at the rear of their respective brigades or regiments.24
While awaiting General Clinton`s arrival at Tioga, General Sullivan`s men built a small fort which was duly named Fort Sullivan. Here also plans were made for the operations of the next few weeks and regimental surgeons were ordered to obtain the supplies they believed they would need from McCrea. The problem of supplying milk for those staying at Tioga was among the difficulties most easily met; by a decision worthy of Solomon, a cow whose ownership was being disputed by two officers was confiscated for the benefit of the hospital.25
On 26 August, after General Clinton`s arrival at Tioga, General Sullivan, although he was by this time too ill to ride his horse, led the force north once again, leaving 250 able-bodied men behind to guard the hospital. Three days later, they defeated a combined Indian-Loyalist force near the village of Newtown and suffered about forty casualties. These men, along with those few who had fallen ill since leaving Tioga, were sent back to Fort Sullivan by water, along with the heavy artillery and ammunition wagons, all of which threatened the maneuverability of the force. As the expedition continued forward, this procedure was repeated, patients being sent back to Tioga each time, usually by water, with a small guard to ensure their safety on the trip.26
After reaching Genesee on 14 September and failing to encounter Colonel Brodhead`s men, the expedition turned back toward Tioga, arriving there 30 September. On 3 October, the sick and wounded were sent on to Wyoming by water. When the main army passed through that town, a small group of officers was left behind to conduct them to Easton.27
An officer from the Sullivan expedition estimated that the total casualty list, including both the wounded and those dead because of enemy action or disease, did not exceed fifty. The total number of those who became ill at some time during the expedition, however, is difficult to estimate ,although one authority suggests a figure approaching 450.28
Patients not only from General Sullivan`s army but also from that of General Washington necessitated the opening or expanding of a number of general hospitals even when some of those in operation in the winter of 1777-78 were being closed down. In the fall of 1778, Shippen was confident that the few hospitals remaining in both the Middle Department and the Eastern Department were functioning well. Only six months later, however, a Hospital Department physician stated that while he agreed that the Middle Department was "really now upon a respectable footing," in the Northern and Eastern Departments, "everything is carried on, as in the beginning, with wild anarchy and uproar."29
In the Middle Department, by the fall of 1778, a number of the older units in Pennsylvania and New Jersey were apparently closed or on the verge of closing, but in the
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following three years, others within the department opened in response to the needs of the Army`s operations.
The Schaefferstown, Pennsylvania, hospital was caring for seventy patients in early August of 1778 but does not appear in later records. A unit at French Creek, Pennsylvania, held 130 patients in September and 89 a month later. It is possible that this unit was later included in reports as apart of the Yellow Springs hospital, but it does not appear under its own name after October. There was also a unit at Downingtown, Pennsylvania, west of Philadelphia, in the summer of 1778, where in early August there were approximately seventy patients, but further information on this facility ,too, is lacking. The Lititz, Pennsylvania, hospital was closed in late August 1778 and its patients were moved to Yellow Springs. The unit at Reading, Pennsylvania, was closed as of 1 January 1779, although hospital stores were apparently still being kept there the following spring.30
The facility at Yellow Springs was destined through the two years following 1778 to take in all the patients still remaining in other Pennsylvania hospitals outside of Philadelphia. In October 1778, there were 115 recorded at Yellow Springs; after this point, the number there began to decline. The unit continued to be highly regarded, however, and the Reverend Dr. James Sproat recorded his belief that "the hospitals [are] well provided for, and the gentlemen take good care of the sick," despite the fact that Dr. Bodo Otto, director of the unit, continued to find it necessary to plead for stores and clothing for his patients and salaries for hisstaff.31
By mid-1780 only fifty-one patients were still at the Yellow Springs hospital, all of whom were suffering from "chronic affections." In September 1781, when fewer than thirty patients could be found there, even before the victory at Yorktown, the Continental Congress finally ordered the Yellow Springs hospital closed and the remaining patients moved toPhiladelphia.32
In July 1778, not long after the British evacuated Philadelphia, the Hospital Department reopened its facility in the Bettering House there. Dr. Jonathan Potts and Dr. Thomas Bond, Jr., then arranged with the managers of the privately owned Philadelphia Hospital to use that institution`s "elaboratory" as a Hospital Department pharmacy. In September, Bond, whose father was one of the founders of the Philadelphia Hospital ,also arranged to have some of the Army`s convalescents taken in there, agreeing to give the hospital control over what cases could be admitted. The Army was to be held responsible for bedding and provisions as well as for the pay of nurses.33
The charity hospital in Philadelphia appears to have served as an emergency overflow facility for the department`s Bettering House several times during the last years of the Revolution. In the spring of 1779, for example, the Bettering House was again overcrowded, and in late March a department spokesman asked the Philadelphia Hospital to take in more convalescents. On this occasion the hospital board refused to do so and referred scathingly to the "Inexpediency and impropriety of the request." The board maintained that it had been assured that the use of the laboratory was all that would be asked of it.34 The behavior of soldier-patients appears to have been the principal cause of the board`s wrath, since when Bond agreed to have a physician remain with Continental patients and to personally "do everything in his power to restrain the Soldiery, and prevent their committing damages and behaving irregularly," he was able to obtain a reversal of the adverse decision. Bond also agreed to try to have these convalescent soldiers out of the Philadelphia Hospital within six weeks and to guarantee that no patient with an infectious disease would be brought in.
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On this occasion the department used only a garret and a lower ward and again provided bedding and food as well as firewood and other necessities. On 16 June 1779, having removed the Army`s patients from the charity hospital, Bond was careful to thank the board for the use of the hospital`s rooms. During the next year, the number of patients in the Hospital Department`s facilities fluctuated, from a high of 130 in December 1779 to a low of 4 in May 1780. Once again in the summer of 1781, Hospital Department facilities in Philadelphia were so crowded that the department turned to the Philadelphia Hospital for help with its patients, who included about ninety sick British prisoners. This time it was the Superintendent of Finance Robert Morris who worked out an agreement with the hospital board which permitted the department to send soldiers to that institution. The department was to pay 15 shillings a week for each man and to agree that military patients would be required to obey the hospital`s rules.35
In 1780, the Continental Congress urged its Medical Committee to move the department hospital out of Philadelphia to a site where the cost of living would be lower. Nevertheless, although by 1780 there were more hospitals in New Jersey than in Pennsylvania, Philadelphia remained the site both of a department hospital and of a hospital stores warehouse. The number of patients there may well have remained small, however, until the fall of 1781, when from the eight reported in July, the number rose in September to seventy-two and in October to eighty-five.36 There was also a general hospital at Baltimore, Maryland, which stayed open through the summer of 1778. In August of that year, this facility began to dismiss its last patients, furloughing some and distributing the rest among relatives, so that by September it was no longer in operation.37
The old New Jersey hospitals at Trenton and Princeton appear only sporadically in reports dating from mid-1778 to the end of 1781. (See Map 6.) Twenty patients were at Trenton on December 1779, ten at the end of March 1781, and nine a month later. The Princeton hospital may have been open in the summer of 1778, at which time a typhus epidemic was reported raging there, but it does not appear in the reports of any later period. Also mentioned in the records surviving from 1778-79 was the unit at Brunswick which cared for some of the men who fell ill after the battle of Monmouth and served the Middlebrook camp the following winter.38
Among the new hospitals set up in the Middle Department in the last years of the war were three facilities in Pennsylvania, which cared almost exclusively for patients from General Sullivan`s campaign against the Indians and Loyalists, and two in New Jersey which managed the care of General Washington`s sick and wounded.
According to the 6 October 1779 report of Director General Shippen, the three fixed hospitals serving patients from the various units operating against the Indians and Tories in 1779 were at Fort Pitt, Pennsylvania, which presumably cared for Colonel Brodhead`s casualties, at Sunbury, Pennsylvania, and at Fort Sullivan at Tioga, Pennsylvania. (See Map 7.) The records of the Fort Pitt and Tioga facilities are few, while those of the Sunbury hospital, more numerous, are not always entirely legible.
Shippen listed thirty patients at Fort Pitt and thirty-seven at Fort Sullivan on 6 October 1779. On 31 December he recorded thirty still at Fort Pitt but made no reference to any patients remaining at the Tioga facility, which was evacuated early in the fall at the conclusion of the campaign. The returns from the Sunbury unit began in the summer of 1779.They indicate that during the following months only a minority of Sunbury`s patients were suffering from wounds. Of the 165 patients remaining there
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on 22 September 1779, for example, the diagnosis in 31 instances was bilious fever, in 11 diarrhea, and in 19 dysentery, but only 33 were listed as wounded. In the fall, with the campaign over, the number of patients at Sunbury began to drop, reaching 28 by mid-December 1779, and the proportion classified as convalescent to rise until it reached over 50 percent early in 1780.39
The conditions most frequently bringing sick men to Sunbury included a high proportion of dysentery and diarrhea like ailments, although by the autumn of 1779 this type of illness appeared less frequently. Other diseases seen in significant quantity were "lues veneria," bilious and intermittent fevers, rheumatism, and ophthalmia.40
By mid-April 1780, when the last report to be found among the papers of the physician who directed the Sunbury unit was prepared, only twelve patients remained there, four being convalescent, five wounded, and one each suffering from dysentery, asthma, and rheumatism. Precisely when this hospital finally closed its doors is not known, but since plans were being laid for its termination as early as October 1779,41 we can perhaps assume it did not remain open much after the spring of 1780, when its patient load had become quite small.
The three new general hospitals opened in New Jersey first appeared in records dating from 1779. (See Map 6.) Two, those at Basking Ridge and at Pluckemin, were destined to care for patients during the grim winter spent by General Washington`s men at Morristown. The latter unit was opened in the summer of 1779 when the general ordered that patients who were being cared for in barns in the vicinity of the Middlebrook camp be moved to the huts which had been used during the preceding winter by the artillerymen of Brig. Gen. Henry Knox at Pluckemin. By October 1779,ninety-eight patients were on the rolls of the new hospital.42
The second New Jersey hospital serving Morristown opened in the winter of 1779-80 at Basking Ridge, under Tilton`s direction. Here a log building on a hill near a brook appears to have been Tilton`s famed experimental hospital hut. It was apparently Basking Ridge`s main building, since the facility could hold more than half of the maximum number of fifty-five patients reported being cared for at Basking Ridge at one time. Among the features of this structure were smaller units than those usually found, packed earth floors, walls without windows, and a fireplace in each section, the smoke from which left the room by means of a four-inch hole in the roof. As many as twenty-eight patients were placed here, with their feet toward the fire.43
While the number of patients at the Pluckemin facility increased throughout early 1780, that at Basking Ridge declined. The two hospitals, however, shared a common problem at this time in the form of patients who, upon recovery, chose to desert rather than return to duty.44 By summer, the patient load at both hospitals had begun to fall off until on 1 July1780 they held only fifty-three patients between them.
Beginning in the summer of 1780, the huts serving the Pennsylvania Line during the second Morristown encampment were taken over for a third New Jersey general hospital, established to care for the sick who were left in camp when the army returned to New York State. The huts at Morristown were small and in very bad condition, partially because of the "disorderly Behavior of the Patients." Only in a few instances were the individual compartments large enough to hold three men. Most of the huts did not provide adequate shelter from the rain and snow. Nevertheless, in the fall of 1780, patients from units in the area of Paramus, New Jersey, which was considered to be threatened by possible enemy action, were ordered moved to Morristown. In January 1781, Dr. Malachi Treat, reporting
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on the situation at the Pennsylvania huts, urged that the patients at Morristown be transferred to Trenton. He pointed out that, in addition to its thirty-five patients, the unit was encumbered by many women and children "who are a Nuisance at present." By March 1781, there were only nineteen patients in the huts, six of whom were classified as convalescent and five as wounded, and no new patients were being admitted. The number of patients continued to go down, and in June the hospital wasclosed.45
In theory, the setting of the Hudson River as the boundary between the Middle and Eastern Departments should have prevented any confusion over the extent of the authority of the head of the Eastern Department. The documents of the period, however, show Foster, the Deputy Director for the Eastern Department, exercising authority over storage facilities on the west bank of the Hudson. The hospital at Fishkill, to the east of the river, on the other hand, seems to have been in some ways independent of the Eastern Department. How much this confusion of authority added to the dissension which characterized this department in the years 1778-80 cannot be ascertained, but the personal antagonisms prevailing among Eastern Department physicians at this time were a matter of record.46
Named without indication of state on an Eastern Department return of the fall of 1778 were hospitals at Boston, Bedford, Pound ridge, Springfield, Fishkill, and Danbury. It was a 1780 return, however, that listed Fishkill but maintained that no report had been received from the Eastern Department. Furthermore, a Middle Department physician, Dr. Charles McKnight, was in charge at Fishkill. This hospital had at least one small claim to fame; it was here that Cochran attended the Marquis de Lafayette while that nobleman was seriously ill with a fever.47
The Fishkill unit was still in operation in mid-1781 and its patients numbered as many as forty-five. The diseases found here included rheumatism and venereal diseases while the number of wounded in 1781 was low, apparently less than half a dozen. By July 1781, however, the decision to close the Fishkill hospital had been made.48
Two more Hudson River hospitals were those at New Windsor and at Robinson`s House, but considerable confusion exists concerning both their status and the details of their operation. The New Windsor facility, located at this time in a church large enough to accommodate fifty patients, may have served as an administration center for some of the other units along the river, since Dr. Francis Alison, sent to the area in the fall of 1778, worked at Robinson`s House, on the east bank of the Hudson, but sent his returns in to New Windsor.49 The Robinson`s House hospital was still referred to as a flying hospital, despite the fact that on a return of May 1781, it was listed separately from the flying hospital.50 The overall capacity of the Robinson`s House unit seems to have been comparable to that of the hospital at New Windsor, and in the summer of 1780, when it held 126, it was considered to be seriously overcrowded. This condition was relieved by sending some of these men to Fishkill.51
At some point in the winter of 1780-81, both the Robinson`s House and the New Windsor units appear to have been closed, for in July 1871, before General Washington`s army moved south to besiege Yorktown, Director General Cochran referred to new hospitals which he had only recently established at Robinson`s House and huts formerly used by artillery units at New Windsor as well as in the barracks of West Point.52
Reports were again submitted for the unit at Robinson`s House beginning in May 1781 and running at least through October of that year. The number of patients in that period varied from 60 to 142. A high proportion of these in the fall were suffering from bilious
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putrid fever, 57 percent, for example, in October. Reports from the New Windsor huts apparently began to come in by July 1781. The number of patients ranged from 96 in July to an estimated 250 in October. Here, too, the number of cases of bilious putrid fever rose sharply with the onset of autumn, as did those described as intermittent and remittent fevers. The West Point unit was in a barracks and served the garrison there. Of the 135 men hospitalized at West Point in the month of September 1781,more than half were ill with dysentery.53
Two other hospitals, both quite large and located not far from the Hudson River, appear on a single Hospital Department return, that of 6 October 1779, but are never mentioned again in the records which have survived from that period. The Otterkill facility, located quite close to New Windsor on the west bank of the river, held 112 patients at this time. (See Map 6.) It was not identical with the New Windsor facility, which was listed separately on the same report. There is no indication given as to why the existence of such a large facility as that at Otterkill should have been so brief. The second of these two units, at New Hackensack, on the east side of the Hudson, was comparable in size to that at Otterkill, and its origins and fate are equally mysterious.54
A large number of hospitals of varying size also operated in New England in the period 1778-81. Among the largest of these was the unit at Danbury, Connecticut, which admitted 938 patients in the course of September and October 1778. (See Map 6.) Of these, 69 died and 716 were dismissed as cured. Of the 294 remaining at the end of October, 208 were classified as convalescents. Some of the men at Danbury were probably those transferred there from smaller units to the west whose security was considered to be threatened by their proximity to the British in New York City.55
Although no returns exist from Danbury after that of 7 November 1778, when 162 of its 197 patients were convalescent, the hospital there continued in operation at least through the spring of 1780 and was quite possibly still functioning a year later. Like the patients at other hospitals in this period, those at Danbury suffered from the shortages afflicting the Hospital Department, particularly a lack of straw for bedding and vegetables.56
At least two other Eastern Department units reporting on their patients in the early autumn of 1778 seem to have been closed by the end of October. One of these was at Bedford, New York. (See Map 6.) During September and October, Bedford admitted 107 patients, 59 of whom were considered cured before the unit was closed. In August 1780, however, the Bedford hospital was open again and caring for 300 to 400 patients, according to Dr. William Eustis.57
Poundridge, New York, twenty miles northeast of White Plains, admitted seventy-four patients in the early fall of 1778, one of whom died and only one of whom was claimed to have been cured. It is possible that this hospital was also considered endangered by its proximity to New York City and its patients were moved elsewhere, perhaps to Danbury.58
There were at least two other general hospitals in Connecticut and one in Rhode Island during this period. (See Map 6.) The facility at Hartford, established for the sick and wounded of units stationed near that town, was short-lived. This hospital was closed in March 1779 and its patients were sent to New London. The latter unit may also have been closed not long after this time, for in the spring of 1780, the Continental Congress ordered Shippen to open a facility in New London to receive such sick prisoners as might be exchanged by the British and in so doing made no reference to any institution already existing there. This unit appears to have been little used and was closed in the spring of 1781.
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Dr. James Thacher in his Military Journal also mentioned a hospital at Providence, Rhode Island, operating in 1779, and Dr. Philip Turner`s1778 return listed patients at a unit at Springfield, in an unmentionedstate.59
There was a general hospital at Boston, Massachusetts, during this entire period, under the direction of Dr. John Warren, who, like Shippen, conducted classes while he served as a member of the Hospital Department. The hospital, like so many others, experienced severe supply shortages. Many returns in the period complain that no report had been received from the Eastern Department, or, specifically, none from Boston, and indications of the capacity of the Boston facility were, for this reason, scarce. A total of thirty-six patients were being cared for there at the end of October 1778 and thirty-seven in the spring of 1781.60
In the spring of 1778, the days of the Albany general hospital, the one remaining general hospital in the Northern Department, where Robert Johnston was acting as Deputy Director, had seemed numbered. (See Chapter4.) Before the launching of the Sullivan expedition, many of the patients there were chronically ill or permanently crippled. Many of the other patients were ready to rejoin their units but unable to do so because of a lack of clothing. General Washington attempted to remedy this situation early in 1779 by ordering clothing sent north and requesting General Clinton to be most careful in its distribution. At the end of January 1779, Treat, Physician General in the Northern Department, maintained that all was going relatively well at the "out Post of God`s Creations" where "your Eyes behold only Dutchmen" in spite of the continued lack of money and the fact that the clothing ordered for patients ready to return to their units had not yet arrived.61
When General Clinton set out to join General Sullivan in the campaign against the Indians and Loyalists, he decided to leave behind him in charge of the guard for the Albany hospital one Captain Gregg, the same officer who had earlier survived a scalping. Captain Gregg`s wish to join the operations against the Indians was not granted by General Clinton, who commented that "if the Indians ketches him again they will Cut of [sic] his head as scalping Can`t kill him."62
On 6 October 1779, only fifteen patients remained at Albany, but from that date to 31 December of that year, the patient load increased to 140. During this same period, the number of patients at Sunbury dropped markedly twice in close succession. The number at Albany slowly decreased after the end of 1779, reaching 86 by the end of February 1780, 62 at the end of March, and 35 by early July. By August 1780, it was being suggested that although there were six surgeons at Albany, one would suffice and the others should be sent to where they were more needed.63
All was not well at the Albany hospital in the summer of 1780, however, despite the plethora of physicians. Treat wrote the Medical Committee of the Continental Congress that "Our hospital is at present destitute of everything that can afford Comfort to a sick soldier" and that the hospital had no wine, sugar, tea, coffee, rice, or molasses and only a little rum, a state of affairs which was neither new nor unique.64
The patients at Albany still numbered more than thirty in the spring of 1781, and a report of May 1781 added that twenty-seven women and children were also being cared for by the hospital. Throughout the summer and early fall the number of patients at Albany fluctuated between sixty and ninety and the recorded diagnoses were scattered among many diseases, including intermittent and remittent fevers, dysentery and diarrhea, rheumatism, and "various chronic."65 The shortage of supplies continued "and the sick suffer extremely at
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times for want of provisions," but by the summer of 1781 the staff at Albany had been reduced to one surgeon and four mates.66
Smallpox was no longer among the diseases most frequently listed by the Army`s surgeons in any of the departments. The lesson taught by the devastating effects of smallpox in the early years of the Revolution was not forgotten in the later years and care was usually taken, north of the Carolinas, once the campaign season was out of the way each year, to inoculate those who were not already immune to the disease, especially if smallpox had already begun to appear among the men. The women and children accompanying the army might also be inoculated and although some of the men were not in good condition when subjected to this procedure, the death rate was still quite low, in one instance only four of 500.67
An added responsibility for the Hospital Department developed in July 1780, when 4,000 troops of the French Army under the Comte de Rochambeau arrived off New England to aid in the fighting against Great Britain. In anticipation of their arrival, General Washington and the Marquis de Lafayette began in the spring of 1780 to plan to acquire appropriate accommodations for patients from the French forces. The American general ordered Craik, as his personal friend and then Assistant Director General in the Middle Department, to take over responsibility for the establishment of a hospital near Providence, Rhode Island, for the new allies and urged specifically that Craik acquire sufficient space. These facilities were to contain room for a kitchen, an apothecary shop, storage, a bakery, and surgeons` quarters. There should also be enough meat and vegetables on hand to meet the initial needs of the French troops.68
Craik experienced considerable opposition from Rhode Island citizens, however, when he first tried to find the desired facilities. Local inhabitants apparently regarded hospitals as foci of infection and were of the opinion that the plague would arrive with the French fleet. At last Rhode Island College (now Brown University) in Providence surrendered its buildings for this purpose. In time, the French created their own hospital establishments at other sites, including Conanicut Island in Narragansett Bay. It was fortunate, indeed, however, that the initial housing problems were solved by 11 July, when the French fleet arrived off Newport, Rhode Island, because an estimated 1,700 to 2,600 Frenchmen of both the army and the navy were suffering from scurvy. The French, furthermore, had not been long in Rhode Island before their men began to show symptoms of dysentery as well. Fortunately, the French Army`s medical organization was highly developed and the physicians were thoroughly capable of caring for their own men.69
SOUTH OF THE POTOMAC: BEFORE THE VICTORY AT YORKTOWN
As far as the care of sick and wounded soldiers was concerned, the South was, until March 1781, for all practical purposes divided into three sections, only one of which was a part of the Continental Hospital Department system.(Map 8) Although its position in relation to the position of Director General was at times in dispute, the establishment in Virginia was, from its inception, a part of the Hospital Department. (See Table 1.)In the Carolinas and Georgia, however, two separate systems, one centered about Charleston, South Carolina, and the other covering North Carolina, gradually emerged, independent both of the Hospital Department and of each other. The existence and the independence of hospitals south of Virginia were recognized, more or less in passing, by the legislation of Sep-
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tember 1780, and the Director General of the Hospital Department did not formally assume responsibility for the operations of these institutions until 22 March 1781, at which time units from the North were moving into the South in ever greater numbers. Even under these circumstances, however, the congressmen from South Carolina opposed the subordination of the systemin their state to the Hospital Department.70
The first general hospital established for American troops fighting south of Virginia was apparently that created in June 1776 in the Charleston area under Charleston`s Dr. David Oliphant for "State troops, Militia, Sailors and Negroes in the public Service." Although some seem to have thought that Oliphant should have been responsible to the Hospital Department, he did not consider himself to be so and the post in which he served was not a creation of the Continental Congress.71
In time, as the tempo of the war in the South began to increase, Oliphant was encouraged to set up a medical organization which would include all of South Carolina and Georgia as well, a course of action which must have seemed particularly desirable because of the heavy toll which sickness was taking from the forces fighting the British in the South. At somewhat the same time, the sick and wounded in North Carolina (or perhaps only those of the militia of that state) were placed under the overall direction of Dr. Hugh Williamson. The operations of Oliphant`s organization were severely impeded when its members were captured by the British on 12 May 1780, at the time of Maj. Gen. Benjamin Lincoln`s surrender of Charleston. It was these men, nevertheless, who attempted, with little cooperation from their captors, to care for the sick and wounded among the American prisoners accumulated by the British at Charleston. Despite British denials, it appears that the general lack of cooperation these physicians received from the enemy was matched by the experiences of Williamson when he crossed enemy lines to care for prisoners wounded at Camden, South Carolina, later that year.72
DAVID OLIPHANT. (Courtesy of National Library of Medicine.)
From the spring of 1780 onward, the medical care received by the troops south of the Virginia-North Carolina border seems to have been haphazard, lacking both organization and physicians, as well as nurses, food, and medicines. Despite the efforts of Maj. Gen. Horatio Gates to establish a general hospital and an appeal to Dr. William Rickman as "Director of the General Hospital of the Southern Army," for aid, care was almost, if not entirely, in the hands of regimental and militia surgeons. It appears, indeed, that, except for regimental surgeons, such representatives of the Hospital Department as were with units moved in from the North may have been required to stay behind when the troops crossed into
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THOMAS TUDOR TUCKER. (Courtesy of National Library of Medicine.)
North Carolina. One authority reports, furthermore, that there seemed to be not a single American surgeon of any kind in attendance for the battle of King`s Mountain in October 1780.73
The September 1780 reorganization of the Hospital Department officially recognized the existence of the hospitals south of Virginia, although it neither defined the relationship of these institutions to the Hospital Department nor affected the work of physicians south of Virginia. The growing pace of activity in this area, however, required that an attempt be made to impose some form of organization upon the physicians caring for the men under Maj. Gen. Nathanael Greene, who was appointed to command in the South in October 1780. A general hospital seems to have evolved at Charlotte, North Carolina, during the summer of 1780, but the care provided there, which was largely, if not entirely, in the hands of volunteer physicians, was very poor and, in General Greene`s opinion, "shocking to humanity. "In November, a Board of War meeting at Hillsboro, North Carolina, appointed Dr. James Browne director of the medical establishment in that state and assigned Williamson to the post of surgeon general. One author believes that Browne had been in charge of a hospital caring for General Greene`s men at Cheraw, South Carolina.74
At about the same time, plans were also being made to transfer the Charlotte facility to Salisbury, North Carolina, where it was to be directed by Dr. William Read. Read, however, had barely established his hospital when General Greene began his retreat north into Virginia and the hospital had to be evacuated. Patients unable to ride on this occasion were, according to Read, moved on litters.75
In South Carolina, Oliphant was paroled by the British during the winter of 1781, but he remained in charge of the hospital for the American prisoners at Charleston. His chief assistant, Dr. Peter Fayssoux, as well as two junior hospital surgeons and four regimental surgeons, was exchanged in March 1781.76
In the spring of 1781, however, Dr. David Oliphant became Deputy Director for the area south of Virginia, with a deputy purveyor, chief physician of the hospital, chief physician of the army, and two hospital physicians under him. Despite the organizational change, inadequate care, as before, continued to add to the sufferings of men who were wounded or who became ill while serving in the South. Oliphant seems not to have been active on their behalf at this time and one of the physicians under him, Dr. Thomas Tudor Tucker, served as director of the Charleston hospital, which was still held captive by the British. The regiments which came in from North Carolina were in a particularly poor situation because they had neither physicians nor medicines of any kind.77
As the heat of summer began to settle
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upon "a country as hot as the Anti chambers of Hell," the incidence of disease mounted, triggering an increase in the number of desertions.78Fatigue and "frequent skirmishes" also added to the list of the disabled. The situation was made worse by the fact that a large quantity of the hospital stores was destroyed by the raids of the much dreaded British Lt. Col. Banastre Tarleton.79
Fighting in the summer months this far south was generally considered unwise, and so, as the temperature reached its peak, Maj. Gen. Nathanael Greene, now commanding in the Southern Army, led his men to camp for the summer in the High Hills of Santee in South Carolina. Dr. William Read, in charge of a hospital at Charlotte, North Carolina (a unit which had been reestablished there after having been moved earlier to Salisbury),was ordered to leave that facility in charge of a subordinate and to join General Greene to create and direct a flying hospital for his army. It appears that the chief physician of the hospital for General Greene`s army was at this time Fayssoux, who joined him after being released from Charleston as the result of an exchange of prisoners in March 1781.80
The health of General Greene`s men, while it may have benefited to some degree from the summer spent in the High Hills of Santee, was far from what might have been hoped for by the beginning of the autumn campaign season. Many hundreds were still sick, and supplies of bark, inadequate from the outset, were totally exhausted by mid-October. Oliphant was by now in Philadelphia, but the number of patients under Fayssoux, acting in his stead, increased after the engagement at Eutaw Springs, South Carolina, on September 1781, when more than 250 men were wounded, and physicians were themselves now falling ill. The burden of nursing fell on soldiers fortunate enough not to be seriously ill or wounded, few of whom had any real aptitude for this type of work. General Greene was profoundly distressed by the inadequate care his wounded were receiving and noted that "number of brave fellows who had bled in the cause of their country, have been eat up with maggots, and perished in that miserable situation."81
WILLIAM READ. (Courtesy of National Library of Medicine.)
The sick among those still imprisoned at Charleston in the late spring and summer of 1781 were many. Oliphant claimed, however, that the British were forcing ill prisoners to leave the hospital before they had completely regained their health and were feeding those still in the hospital a "salt diet," rather than supplying the type of nourishment considered necessary for sick men in a hot climate. Unfortunately, the Continental Congress, because of the shortage of funds, was unable to supplement this diet. That body did, however, retain in service the Continental physicians of the South Carolina system, who, in captivity themselves, were caring for the wretched men at Charleston.82
The hospital system in Virginia was
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directed by Dr. William Rickman and was independent of that in the colonies further south. It is difficult to pinpoint exactly where Rickman`s facilities were located in the summer of 1778, although he had apparently rejected the College of William and Mary because it had too many partitions which would interfere with the free circulation of air. Private homes had been deemed less than ideal because they implied a larger staff and higher operating costs. The palace at Williamsburg, used as a hospital during the siege of Yorktown, was seriously considered by Rickman several years earlier but was not taken over at that time.83
It is possible that a facility called the Vineyard Hospital, outside of Williamsburg on the road to Yorktown, was used for both Continental and Virginia militia patients beginning at least as early as May 1779, and that private homes, despite the disadvantages, were used before that time to house Army patients. Since recruits were at times inoculated in Virginia, special facilities were also set aside when needed as smallpox hospitals, such as those used in 1777 at Dumfries, Colchester, and Alexandria.84
A hospital was apparently in operation in the fall of 1778 near Fredericksburg, Virginia, at the time that units under the command of Maj. Gen. Benjamin Lincoln, newly appointed to command in the South, were passing through, since on 25 October, Cochran reported that 562 patients were being cared for in this area. Of these, 65 were described as flying hospital patients, 166 convalescent, 111 sick with either intermittent or remittent fever, 83 with bilious fever, and 34 "lame & rheumatism."85 It is difficult to say whether this unit was serving as both flying and general hospital or whether those referred to as flying hospital patients were merely those transferred from the flying hospital.
In 1779, when General Washington began moving all Carolina and Virginia troops south, at least one of these units, that under the command of Brig. Gen. Charles Scott, was not accompanied by an adequate number of medical attendants. General Washington at first suggested that Rickman supply the deficiencies, but finally, since Scott was in "utmost distress" on this account, he turned to Shippen with the request that the Director General send two surgeons and two mates to join General Scott at Petersburg, Virginia. At least one surgeon and one mate joined General Scott in the summer of 1779, but twenty to thirty patients who could not move with his unit were left behind at Petersburg without a single surgeon to care for them. Despite the unhealthy reputation of that town, Continental hospital facilities were still there in the fall of 1780.86
Another Virginia hospital was established by Rickman in the spring of 1780 at Chesterfield Court House, which seems to have been along the route taken by troops moving into the Carolinas. This particular site was not the first choice of the Hospital Department but was urged upon it by the governor of Virginia. In early June, eighteen patients were being treated here, but by the end of the year, the log house which sheltered the unit was not finished and medicines, as elsewhere, were badly needed. The unit was still in operation in March 1781, with 55 patients on its rolls, 17of them wounded and 25 convalescent.87
By the spring of 1781, however, Rickman was no longer in charge of the hospital in Virginia, having been dropped from the department at his own request the preceding fall. The identity of his successors is unclear. Dr. David Gould, who may have been his first replacement, died in July1781. Either Dr. Goodwin Wilson, who supervised facilities at Beaverdam, Hanover, and Charlottesville at some time in 1781, or Dr. James McClurgmay have followed Gould.88
In the spring of 1781, the British troops
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under Lt. Gen. Charles Cornwallis marched north into Virginia and joined the units already in that area. Shortly after their arrival, reinforcements from New York joined them. The tempo of the war in that state, therefore, increased, and by midsummer, the hospital at Williamsburg was the main southern facility for the Hospital Department. This unit appears initially to have been under the direction of Tucker, who came up with his patient upon their release from Charleston.89
In the late spring of 1781, the men of Maj. Gen. Anthony Wayne`s command began to move south. On 4 June, their sick were left behind them just south of Leesburg, Virginia, under the care of a surgeon. On 10 June, Wayne joined Lafayette on the North Anna River, and by 19 June, both units were in the vicinity of Richmond and "destitute of every necessary, both of life and convenience." Many of the physicians accompanying General Wayne did not have so much as blood-letting instruments.90
On 6 July, the combined forces of General Wayne and Lafayette met the British at Green Spring, Virginia, where General Wayne`s men, who took the brunt of the action, suffered ninety-nine wounded. These men were cared for at a church nearby and on the 7th sent to an unidentified hospital.91
The number of sick from both Continental and French units in Virginia increased during the late summer, and wagons moved flying hospital patients from place to place in the heat. In early August, some of the sick from among General Wayne`s men were sent to a general hospital located in a private home at Hanover, Virginia; the officers from this group were moved on to Pennsylvania later in the month. By late August, the Hanover unit was running short of almost all the stores it required, especially medicines, and the number of patients was so great that eight or nine buildings, some of them containing as many as eight rooms, were taken over. Untrained soldiers, here as elsewhere, were pressed into service as nurses. In September, as preparations for the siege of Yorktown increased, the physician at the Hanover hospital himself died and the responsibility for the care of his fellows fell entirely upon one of the patients.92
JAMES MCCLURG.(Courtesy of National Library of Medicine.)
A combined American and French force of 15,000 men was in place at Yorktown by the end of September, under the overall command of General Washington. Three or more hospitals were opened at Williamsburg, where Director General Cochran reported a total of 250 patients, and in Yorktown flying hospitals for both French and Americans settled down with the armies for the siege the Continental unit under Craik`s direction since Cochran had remained behind along the banks of the Hudson. Not all department reports identify the location of flying hospitals, but one report which still exists without question originated from the American Yorktown flying hospital. It is dated October 1781 and does not record the number of admissions and discharges,
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COLLEGE OF WILLIAM AND MARY:WREN BUILDING. (From Duncan, Medical Men.)
but it lists 6 dead and 147 convalescent, 209 with intermittent fever,103 with diarrhea, and 646 remaining at the end of the month.93
In Williamsburg, the French took over the building belonging to the College of William and Mary which they, in contrast to Rickman, considered well suited for a hospital. They were particularly impressed with its size and sturdy construction, but in time found it necessary to take over the Capitol as well. Before they returned the college to its owner, one wing burned down. The Americans used the palace, which was not in good condition, and two churches to house their sick and wounded. A 200-man detachment from the forces besieging Yorktown stayed behind to guard hospitals and the stores left in Williamsburg while the main army moved against the British.94
Casualties for the allied armies during the siege of Yorktown were not great, but sickness, particularly malaria, took a heavy toll and an epidemic of smallpox was anticipated. The French experienced a rate of disease in their hospitals no better than that of the Americans even though their military hospital organization was elaborate and their physicians so much respected that Continental doctors were glad to have their aid and advice. Tilton blamed poor sanitation and a tendency to avoid the use of the medicines ,including opium, popular among American physicians, for the limited success of French units.95
Early in the siege of Yorktown, the number of patients in American hospitals in the area rapidly increased. New England troops, especially, were suffering from the remittent and intermittent fevers considered endemic in that area. Craik noted that blankets were in short supply and that, unless action were taken at once, an unnecessarily high mortality rate could ensue. At the time of the
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British surrender, 600 Americans were too sick or too severely wounded to be cared for by camp hospitals, approximately 400 of them at Williamsburg and more than 200 at Hanover. Thacher estimated that seventy-three Americans were wounded during the siege.96
AFTER THE VICTORY AT YORKTOWN
From November 1781 to the end of the war, an unofficial truce prevailed throughout the colonies. General Washington remained near New York City until the end of the war, while General Greene set up camp near Charleston, South Carolina, until the summer of 1783, when the last of the Southern Army left for home.97
The number of patients resulting not only from battle but also from the malaria-ridden environment was increasing at such a pace that even before the Articles of Capitulation were formally signed, General Washington himself was active in the attempt to find additional hospital space. He wished as many as possible to be cared for within the town of Williamsburg and emphasized the need for separate housing for those who came down with smallpox while in the area. He was distressed by conditions in the Army`s hospitals there but apparently believed that captured funds would now make improvements possible. As soon as the Articles were signed, the general prepared to move his army out of the unhealthy climate as quickly as possible. The transports which were being loaded before the month was out sailed4 November, but a sufficient number of officers was left behind to escort patients back to their units as they recovered.98
At the end of November 1781, 186 patients were still at Williamsburg, 23 of whom were suffering from smallpox and 49 each from wounds and dysentery. At Hanover there were another 114 patients who could not accompany the army when it moved north. Only 74 remained at Williamsburg and 32 at Hanover by the end of December, however. There is some question as to which physician was in charge of the Williamsburg hospitals at this time and no evidence to indicate who had charge of the Hanover facility. Apparently both Tilton and Treat directed the Williamsburg units at one time or another during or after the siege, but it seems likely that Treat, who was a Chief Physician and Surgeon of the Hospital at this time, held overall authority in Williamsburg during the siege and that Tilton, as a Hospital Physician and Surgeon, succeeded Treat.99
Despite General Washington`s hopes, the sufferings of the patients in Williamsburg continued unabated after the siege, not only because of the lack of such fundamental items as wood and straw for bedding but also, in the opinion of at least one observer, because the surgeons there behaved in an irresponsible manner, failing to make the required purchases even when they had the money to do so. In December, matters were made even worse by a disastrous fire which burned the palace to the ground. Fortunately, there was only one casualty and the French took in those who would otherwise have been without shelter. In January, fifty-five Continental soldiers, nineteen of whom were wounded, were still hospitalized at Williamsburg. At last, in the spring of 1782, General Washington decided that there were so few patients remaining at Williamsburg that he could have the facilitiesclosed.100
After the Yorktown victory, General Greene moved southeast toward Charleston. His men had been in poor health since the engagement at Eutaw Springs a month earlier and now many had to be left behind at the hospital in the High Hills of Santee under the care of Fayssoux. A second hospital was maintained at Charlotte, North Carolina, in late 1781 and early 1782.101
Many of the units which had been sur-
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rounding Yorktown, including those of General Wayne and Maj. Gen. Arthur St. Clair, were now sent south to join General Greene. These men were also in poor condition and inadequately fed and clothed. Some, at least, maintained themselves in good spirits by whatever means presented themselves, repeated references in at least one journal to the dire state of the author`s health being followed by repeated references to "last night`s carouse. "As these troops neared Charleston, they came upon an area of very bad water with many stagnant swamps and ponds "full of little insects."102
When the troops of Generals Wayne and St. Clair reached the vicinity of General Greene`s camp near Charleston early in January 1782, many were sick enough with fever to require hospitalization at the facility which had been established at Ashley, apparently in a private home. Although its physicians were "very kind" and it was "furnished with some stores, sugar, tea and molasses," the Ashley hospital was reputed to be a "very disagreeable place--all sick, and some continually dying. "By March, although the health of the Southern Army had markedly improved, talk of mutiny was being heard.103
The journals kept during the spring and early summer of 1782 suggest that many of the men of the Southern Army did not lightly turn to physicians and hospitals for aid. The author of one account, for example, mentioned in his entry of 28 May 1782 that he was "loaded with sickness and distracted with toothache . . . almost dead with pain." He continued to make similar complaints for more than ten days without ever suggesting that he was seeking professional help, and on one occasion, apparently on his own initiative, took "a vomitt which almost killed" him.104
During the summer of 1782, General Greene`s men again began to suffer from fevers, just as they had in previous summers, and matters grew worse as the summer progressed. By the end of August, they were "dayly experiencing instances of mortality . . ., soldiers dying fast," the hospital was crowded, many were sick at camp, and deaths were so frequent that funeral ceremonies were no longer conducted. By the second week in September, it was estimated that more than half of the men remaining in camp were ill, although there appears to have been at least some bark available.105
Treating oneself apparently continued to be an accepted practice in the fall of 1782. In one instance, for example, the victim`s fever and aching began on 29 September. He first tried treating himself on the 30th, using an emetic. Still feverish on 2 October, he started taking bark and within the week felt very much better. He suffered a relapse ten days later, however, and again tried an emetic before turning to bark because of the "violent fever and pain" in his "head and bones." The fever returned once more for two days in mid-November, but the diarist unfortunately did not record his treatment on this occasion.106
This "cursed disorder," presumably malaria, which was still severely affecting the Southern Army in the autumn of 1782, led to the deaths of almost 100 men in September. Characterized by "ague and fever," it was blamed not on insects, despite the fact that their presence had been the subject of comment, but on the climate. General Wayne himself fell victim to it early in September and was treated with emetics and peruvian bark. He was still ill at Christmas and wrote Dr. Benjamin Rush that he was "broken down and nearly exhausted" as a result.107
In December, the British evacuated Charleston and, although General Greene remained there until the following August, the number of men in his command began to diminish. The Secretary at War ordered at the time that they be furloughed until peace was officially signed and some units were granted leave at once. Transportation
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difficulties interfered with the departure of others, and since it was July before the units from Pennsylvania and Maryland boarded their ships, the diseases which characterized the summer months in the South appeared again. One-third of those who were awaiting transport to their home states that summer were ill.108
There had been rumors during the siege of Yorktown that the British were trying to infect the Continental Army by sending out from the town "a large number of negroes, sick with the smallpox." Whatever the truth of the matter was, by January 1782, smallpox was spreading in the Continental Army in the North, and it was decided once more to inoculate all those who had not already had the disease. By the end of the month, approximately two thousand men had been immunized, and by May the process was complete.109
To care for men returning north from Yorktown who might become ill along the route and be unable to continue because of the winter weather, temporary hospitals were established along the route from Virginia northward. One such unit, at Head of Elk, Maryland, was opened no later than 22 November 1781. During December, 118 patients were admitted here, but only 38 remained at the end of the month, 60 having been discharged and 2 having died. Dr. Henry Latimer set up another such unit at Wilmington, Delaware, and 105 patients were admitted during December, of whom 23 died and 35 remained at the end of the month. General Washington decided to have the Head of Elk patients moved there, and late in January, thirteen convalescents from Head of Elk were moved to the Delaware unit. In February, plans were laid to move these patients and those at Trenton to Philadelphia.110
Upon their return from Virginia, the physicians of General Washington`s army set up their flying hospital at New Windsor, New York. At some time before the fall of 1782, Dr. David Townshend became director of this unit. Regimental surgeons were required to report to him weekly about their patients and to receive their bandages and ointments from him. Obtaining wood was a constant problem here, and as early as 9 December 1781, patients were suffering as a result of the inadequate supply.111
Director General Cochran recorded that at the end of December 1781 there were 239 patients, including 25 women and children, in the New Windsorhuts. Of this number, 27 were convalescent, 29 suffering from "ulcers,"23 from inflammatory fever, 27 from intermittent and remittent fevers, and 36 from diarrhea or dysentery. By the end of January 1782, however, the number of patients had dropped to 187, remaining below 190 until June 1782. In June and July, however, the number of patients again rose to 225 or more, with 38 of the men suffering from venereal disease, apparently the most common ailment at this time, although many cases of the various types of fever could also be found.112
The hospital at the New Windsor huts continued in operation at least until the end of December 1782, when the last of Cochran`s reports which are still in existence was made up. By the last two months of the year, the patients were numbering well over 200, and as many as a quarter of them at any one time might be women and children. The incidence of malarial type fevers fell off rapidly until none was listed in the September, November, and December reports (there is no report for October), but "inflammatory fevers" afflicted thirty-three patients in the last two months of the year.113
Because of the rather casual use of nomenclature and the equally casual attitude toward reports, it is difficult from the documents of the period to separate one flying hospital from another and flying hospitals from regimental hospitals. In his report of
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November 1781, for example, Cochran lists a flying hospital with the Eastern Army. Although it was obviously not the unit at New Windsor, no identification of it is available. In November, however, 17 were admitted to this unit, 24 were discharged, 2 died, 35 were sent to the general hospital, and 84 remained at the end of the month. The report of March 1782 lists "sick with the army," which was then broken down into two categories, the army at West Point and the army east of the Hudson. At the former, 100 were confined with smallpox, presumably, considering the time of the year, from inoculation, and forty-two with bilious fever. Eight died during the month there and 345 remained. East of the Hudson there were 35 patients with smallpox, 26 with bilious fever, 171 convalescents, and 367 remaining at the end of the month. February of 1782, however, was the busiest month for the hospital serving the army at West Point. During this month, 1,149were admitted, and although 1,002 of these had smallpox, there were only 39 deaths. In the spring of 1783, an epidemic of measles struck the WestPoint area and General Washington urged that fresh meat, which was considered desirable for victims of this disease, be procured. The West Point unit was still in operation late in 1783.114
The total remaining sick with the Army at the end of each month throughout the year ranged from 370 in May to a high of 729 in July, when 216 were sick with intermittent and remittent fevers. Other diseases in the last eight months of 1782 were bilious and putrid fever, which hospitalized as many as 90 patients in the late summer before tapering off as the fall wore on to November`s 34 and December`s 26. As many as 170 men might be placed in the category of "casual hurts" each month.115
It was during the winter of 1781-82 that Cochran and Craik appear to have given some thought to improving the equipment of the Continental Army`s flying hospital. They decided that dimensions of 15 feet by 26 feet were the most suitable for the tents which the hospital apparently used while the army was on the march. They should also either "have fly`s to them" or "be made of the best stuff." Their idea pleased General Washington, who passed it on to the Secretary at War.116
It is difficult, however, because of the relatively imprecise information given by eighteenth century documents, to be sure of the number and type of the hospitals in the vicinity of General Washington`s army after the Yorktown victory. One unit is listed as located at New Boston on the Hudson River and, according to some sources, under the direction of Eustis in December 1782. Thacher, however, also mentioned that both Townshend and Eustis were at the New Windsor hospital in December 1782. Eustis himself wrote of being Hospital Surgeon at New Boston in the autumn of 1782. General Washington referred in November 1782 to "the Hospital of Dr. Eustace, "thus distinguishing it from Townshend`s unit, but did not further identify it.117
The returns submitted by Director General Cochran in the last half of 1782 called the New Boston unit the "New Boston huts," where the August 1782 population of 216 gradually dwindled to 34 at the end of December 1782. The number of wounded here was always small, no more than four according to the records available today, but in the summer, fevers of both the intermittent-remittent and bilious-putrid types accounted for a large proportion of the sick, almost half in August. General Washington was particularly concerned about the fuel supply for Eustis`s unit, presumably New Boston, as the winter of 1782 approached, but believed that it could be kept adequately supplied because no more patients were being sent there.118
Several of the oldest general hospitals in the department`s organization were still in operation when General Washington`s
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victorious army left Yorktown. The hospital at Trenton, New Jersey, for example, was still in operation as General Washington`s men made their way north. Cochran recorded 72 American patients and 23 British prisoners at Trenton at the end of November and 38 Americans at the end of December.119
The number of patients at the department`s Philadelphia hospital, already rising before the battle of Yorktown, reached a peak of 314 in November 1781. Only 30 of these men were listed as wounded, however, while 43 had inflammatory fevers, 40 diarrhea, 52 "various chronic," and 63 smallpox. Early in December, there were approximately 100 smallpox patients at Philadelphia, although no differentiation was made between those who had acquired the disease by inoculation and those who had contracted the disease naturally. The patient load decreased markedly, to 107, in December1781 and vacillated between 94 and 146 until June, when only 68 patients remained. Bilious-putrid fevers do not appear to have posed a serious threat in the winter and early spring of 1782, although other fevers afflicted from a quarter to a half of the patients there. This unit was apparently sufficiently crowded in the spring of 1781 to cause the Hospital Department once more to contact the privately run Philadelphia Hospital to request the use of its facilities for Continental patients and sick British prisoners, but the appeal was denied.120
The total number of patients remaining at the military facility in Philadelphia continued to be less than 100, except for August, and until late fall a sizable proportion was afflicted with intermittent and remittent fevers. Women and children at that time formed a third of the facility`s patients. Sick British prisoners were a responsibility of the department in Philadelphia throughout 1781 and 1782, and their number ranged from twenty-eight to seventy. Reports concerning them are less detailed, however, than those on American patients in Philadelphia, and in many reports they are all lumped together under the heading "various diseases." Despite the strain on the Philadelphia unit, it was only in 1783 that the department was successful in placing some of its patients in Philadelphia`s civilianfacility.121
The Albany unit, like that in Philadelphia, was still open when the Hospital Department was disbanded, even though its closing had been ordered two years earlier. In November 1781 fifty-four patients were at Albany. This unit seems to have been closed early in 1782 and then reopened in the spring, since forty-five patients were reported to be there in May. From forty-four to fifty-four patients, as many as half of whom might be women and children, were cared for at Albany through November 1782, beyond which time there apparently are no further reports still in existence The staff there in late 1783 consisted of one surgeon and his mate.122
By the spring of 1782, General Washington had come to regard the continued operation of the general hospital at Boston as an unjustifiable expense, especially since the Corps of Invalids was no longer stationed there. Asa result, the general ordered Cochran to close that facility at once.123
Although there was no major action after the victory at Yorktown and Congress had forced the closing of some of the major hospitals even before the end of 1781 (see Chapter 2), the concern of General Washington and, until its termination in the fall of 1783, of the Hospital Department fort hose soldiers who were still suffering from wounds and sickness did not diminish. The general continued to inspect such hospitals as still remained open and to urge that they be "amply Supplyed with Medicines, refreshments and accomodations."124 Even under the adverse conditions of the last two years of the Revolution, therefore, there were patients for whom the Hospital
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Department was still responsible who could praise "the humane treatment and comfortable accommodations they. . . invariably experienced."125
In 1783, although they did not realize it, physicians were unable to offer their patients anything better than humane treatment and comfortable accommodations. Although the often cold, half-starved, poorly clothed men of the Continental Army suffered more from disease than did their disciplined and seasoned opponents, eighteenth century medicine was everywhere helpless against disease and infection and had little to offer against pain. The time had not yet come, furthermore, when an understanding of the importance of scientific observation to medicine would make it possible for those physicians who cared for the victims of war, regardless of the army in which they served, to contribute significantly to the progress of medical science. Administrators may have learned much about the management of a military hospital system in the course of the Revolution and individual surgeons undoubtedly added to their skills while confronting diseases and injuries which they would never otherwise have encountered in such numbers, but no significant insights into the prevention, diagnosis, or treatment of disease appear to have resulted from the American Revolution. Indeed, although they did not know it, physicians would continue for many decades after the signing of the Peace of Paris to be unable to offer their patients anything of a value to rival that of their compassion and concern.
