History

Chapter 6

Between Wars, 1783 to June 1812

The period between the end of the Revolutionary War and the spring of 1812 was a low point in the history of the medical service of the U.S. Army. The very concept of a regular standing army was suspect to the leaders of the new nation, who believed that the Army should be strictly limited to as small a force as was compatible with the protection of westward moving settlers and the magnitude of the threat from abroad. Much reliance was placed upon militia and volunteer units which were employed as more appropriate to the defense of a republic than the Regular Army. A force of as limited numbers as that initially maintained in this period did not require the establishment of a formal medical department, and, indeed, there were no top management posts in the Army at this time.¹

The strength and organization of the Army, however, fluctuated with the threat to the nation as perceived by its leaders. The resultant instability was increased by the inadequate size, organization, and leadership of the Department of War, which was created in the summer of 1789. Despite the fact that three Secretaries of War in the interwar period, Henry Dearborn, James McHenry, and William Eustis, were physicians and that the number of men actually in the Army had greatly increased by 1794, no central organization was established for the medical services. (Table 7) Even for those brief periods before 1812 when laws calling for a central organization were on the books, the medical department, like the Army itself, existed largely on paper. (See Appendix H.)

The organization created on paper by the legislation of 1799, a medical department for both Army and Navy, indicated that the lessons of the Revolution had not been entirely lost. A purveyor, for example, was specifically called for, to handle the buying of medicine and the other requirements of the projected department, and the regimental surgeons were fully under the control not only of the physician-general, or head of the department, but also of the senior hospital surgeon of an army or district. The relationship of medical officers and line officers was in some instances carefully outlined. A regimental surgeon could be temporarily reassigned away from the care of the patients of his regiment, for example, only by the physician-general or a senior hospital surgeon with the consent of the commander-in-chief or of the commander of an army. In addition, the rules which the department was to draw up for hospital discipline and camp sanitation were to be subject to the approval of the commander-in-chief or the commander of a separate army or district as well as, ultimately, to that of the President of the United States. Provision was also made for the calling of medical boards to examine candidates for positions within the department, but the establishment of these boards was to be at the discretion of the physician-general.²(See Appendix H.)

Initially it was only the constant threat of Indian attack that made the maintenance

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TABLE 7-ORGANIZATION OF MEDICALSUPPORT OF THE REGULAR ARMY, 1784-1813

Date	Regular Army	Medical Personnel
1784, June:	All but 80 men from Continental Army to be discharged 700 men called up from state militias to form regiment for 1-year service	.... ....
1785, April:	700 men called up from state militias for 3-year service	1 surgeon, 4 surgeon`s mates
1789, August:	1 infantry regiment: to consist of 560 men 1 artillery battalion: 280 men. Dept. of War established	1 surgeon, 4 surgeon`s mates 1 surgeon`s mate
September	Army`s organization accepted under new Constitution	. . . .
1790, April:	Infantry regiment expanded: to include 1,216 enlisted men and noncommissioned officers	1 surgeon, 2 surgeon`s mates for infantry regiment; 1 mate for artillery battalion
1791, March:	Second infantry regiment authorized: 912 more men	Ratio of 1 surgeon and 2 surgeon`s mates per regiment maintained, but President may take on more mates
1792, March:	3 more infantry regiments authorized, plus 1 squadron light dragoons	1 surgeon, 2 surgeon`s mates per regiment, plus a surgeon`s mate for the dragoons
December:	Army reorganized into form of Legion: composed of 4 sub legions, 1,280 men in each	1 Surgeon-General for Legion plus 1 surgeon and 3 surgeon`s mates per sub legion and 6 mates for garrison duty
1794, May:	Corps of Artillerists and Engineers established: 4 battalions	1 surgeon, 4 surgeon`s mates
1796, May:	Legion organization abolished: Army reorganized into 4 regiments of infantry, 2 companies of light dragoons, and the Corps of Artillerists and Engineers	For each regiment, 1 surgeon, 2 surgeon`s mates; no medical attendants for dragoons; 1 surgeon, 4 surgeon`s mates for Corps of Artillerists and Engineers; up to 10 more surgeon`s mates could be appointed by the President
1798, April:	Second regiment of Artillerists and Engineers authorized	1 surgeon, 3 surgeon`s mates
May:	Increase in size of Army up to 10,000 men authorized	President authorized to appoint a Physician-General if he believed it advisable, to serve until dismissed by President
July:	12 infantry regiments authorized; 1 dragoon regiment created	1 surgeon, 2 surgeon`s mates per regiment: more if President believed it advisable, to serve until dismissed by President; James Craik appointed Physician-General
1799, March:	Additional 24 infantry regiments authorized, as well as 3 cavalry regiments, another battalion of Artillerists and Engineers, a regiment and a battalion of riflemen	Medical Department created by Act to Regulate the Medical Establishment^a ^{Each regiment, regardless of type, to have 1surgeon, 2 surgeon`s mates}
1800, May-June:	All but 4 infantry regiments, 2 regiments of Artillerists and Engineers, 2 troops of dragoons, to be mustered out	Only 6 surgeons and 12 surgeon`s mates retained in Army; Craik mustered out
1801, March:	. . . .	Only 7 mates still in Army
1802, March:	Army reduced to 2 infantry regiments, 1 artillery regiment	2 surgeons and 25 surgeon`s mates authorized, all to be attached to garrisons and posts

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TABLE 7-ORGANIZATION OF MEDICAL SUPPORT OF THEREGULAR ARMY, 1784-1813-Continued

Date	Regular Army	Medical Personnel
1807, December:	. . . .	2 surgeons in Army, only 1 on duty; 31 surgeon`s mates, only 27 on duty
1808, April:	Army of 9,900 authorized, to include 3,300 already serving	Addition of 5 surgeons, 15 surgeon`s mates for hospitals, plus 1 steward and 1 wardmaster per hospital authorized
1812, January:	Increase of 10 infantry regiments, 2 artillery regiments, and 1 dragoon regiment authorized	Ratio set of 1 surgeon, 2 surgeon`s mates per regiment of any type plus hospital surgeons and mates as needed and 1 steward per hospital
18 June:	When war declared, authorized strength of Army was 35,603 men in 17 infantry regiments, 4 artillery regiments, 2 dragoon regiments, a Corps of Engineers, and 1 regiment of riflemen	. . . .
26 June:	Army reorganized: size of infantry regiments set at 900 men and authorized number of infantry regiments raised to 25	Each infantry regiment to have 1 surgeon, 2 surgeon`s mates, dragoon regiments 1 surgeon`s mate each
1813, January:	Raising of up to 20 more regiments authorized	Each new regiment to have 1 surgeon, 2 surgeon`s mates

NOTE: For actual strength of Army, see Weigley, Army, p. 566.
SOURCES: Emory Upton, Military Policy of the United States (Washington: Government Printing Office, 1904) pp. 69, 75-76, 78, 80, 82, 83, 85-86, 89; U.S. Congress, American State Papers: Documents, Legislative and Executive of the Congress of the United States. Class V: Military Affairs,7 vols. (Washington: Gales and Seaton, 1832-61), 1: 5, 40-41, 154-55;Callan, Military Laws, pp. 212-13, 230, 238; Weigley, Army, p. 118.
^aSee Appendix H.

of any regular military force acceptable. Periodic expeditions with small numbers of regulars and their surgeons serving as a nucleus for larger numbers of untrained militia and volunteers were sent into the Northwest Territory to forestall large-scale Indian attacks. Forts were also established to protect the settlements going up in these areas formerly held by the Indians. In time, however, the defeat of poorly organized campaigns such as those of Brig. Gen. Josiah Harmar in 1790 and Maj. Gen. Arthur St. Clairin 1791 led to increases in United States military strength which, because of the growing fear of war with either France or England, were maintained even after Maj. Gen. Anthony Wayne`s defeat of Tecumseh and the Shawnee Indians at Fallen Timbers in 1794.³

As the threat from France waned, the Indian menace once more became uppermost among the Army`s concerns, although the northwestern campaign of Maj. Gen. William Henry Harrison against the Shawnee in 1811 was the only active move against the Indians after 1800 and before the War of 1812. In 1802, the organization of medical support was changed to center it around the garrisons which were now being established as a line of defense along the nation`s perimeters. The President, after congressional approval, assigned surgeons and mates by fort rather than by regiment. To meet the new approach, the number of mates was increased, but it was not until 1808 that the need for physicians other than garrison surgeons was recognized and a plan was created which authorized the assignment of both medical and administrative personnel specifically to hospitals. Ap-

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MAP 9

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parently only one hospital surgeon and one hospital mate were actually appointed at this time. It was only six months before the outbreak of war that provision was once again made for the assignment of surgeons and mates directly to individual regiments.⁴ (See Table 7.)

The prestige of the military surgeon at this time could not have been high. He still had no official rank and was paid a salary lower than thatof major. Lewis and Clark apparently did not consider the services of a surgeon to be necessary for their famous expedition to explore the lands beyond the Mississippi River, and only two years before the beginning of the War of 1812, a group of surgeons complained to the Secretary of War that they were "the mere menial drudges of camp."⁵

CONTINENTAL ARMY PATIENTS REMAINING IN HOSPITALS

After the peace treaty of 3 September 1783 brought the formal end of the American Revolution there was no further reason to delay the final closing of those hospitals which were still caring for patients from the Continental Army. Presumably the medical board which was formed in the summer of 1782 to decide whether to transfer the "invalids and debilitated men" remaining in the Army to the Invalid Corps or to discharge them from the Army, as well as to determine their eligibility for a pension, continued in operation until all in this category had been processed. For a time, however, the remnants of the Continental Hospital Department functioned as a peacetime organization dedicated to the care of these men at WestPoint, Albany, and Philadelphia. In the summer of 1783, however, Gen. George Washington predicted that it would be possible to close this
establishment completely by the following summer. The staff of the former Hospital Department was gradually dismissed as the need for its servicesdiminished.⁶ Since, except for fewer than 100 men assigned to guard stores and magazines at such places as West Point and Fort Pitt, the men still remaining in service from the Continental Army were dismissed on 2 June 1784, one can only assume that by this time all former Continental Army patients, including those in the Corps of Invalids, had also been discharged.

CAMPAIGNS AGAINST THE INDIANS

The first major operation involving the U.S. Army was that led by General Harmar in 1790 against the Indians in the Northwest Territory, near present-day Fort Wayne, Indiana. (Map 9) At this time the Army consisted of one infantry regiment, to which was assigned a surgeon and two mates, and an artillery battalion with its surgeon`s mate. (See Table 7.) Serving as the Army`s top physician was Dr. Richard Allison, of whom a contemporary said, "none were more brave, humane, and benevolent."⁷Allison was assisted by surgeon`s mates John Elliott and John M. Scott, while the mate assigned to the artillery battalion was Nathan Hayward. Little is known of the medical care received by the 320 regulars who accompanied the 1,100 militia men on this expedition, but the sick rate was high and Allison complained long before the campaign began that the medicines provided for his use constituted an "injudicious assortment" of "the refuse of the druggists` shops" and were of such poor quality that he was unable to determine proper dosages.⁸

The governor of the Northwest Territory during this period was Arthur St. Clair. In 1791, St. Clair was assigned the rank of major general in the Army, which had been enlarged for a second attempt to subdue the Indians in the Northwest. It is interesting to note that General St. Clair, like so many

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RICHARD ALLISON. (Courtesy of National Library of Medicine.)

other men in prominent positions with the Army at this time, had had some medical training. Among the members of his expedition who served as physicians were Allison, as chief surgeon, and Elliott, who continued to function for a time as Allison`s mate and then, with Allison`s full approval, was promoted to surgeon of the 2d Regiment. This latter post had first been offered to Eustis who, destined for greater things, turned it down. Among other medical attendants was Victor Grasson, a surgeon`s mate attached to a volunteer unit.⁹

General St. Clair`s force of 1,500 militia men and volunteers and 600 regulars was larger than that of his predecessor, but the general himself was in poor health and so badly afflicted with gout that he could not walk without aid. Before the expedition was over, he was unable to so much as mount his horse without assistance. His men, furthermore, were "badly clothed, badly paid and badly fed." Since they were for the most part recruited from cities and large towns, they were also reputed to be "enervated by idleness, debaucheries, and every species of vice."¹⁰

By the fall of 1791, General St. Clair`s surgeons were faced with severe problems. Hospital stores, particularly wine, were in very short supply and the number of men who were sick had risen so high that the general decided to remain at Fort Jefferson, near present-day Greenville, Ohio, until the end of October, hoping that both health and supply problems might improve. By the end of the month, however, when they resumed their march, 120 men were so ill that they could not continue any further.¹¹

Considering the nature and condition of his force, it is not surprising that on 3 November, General St. Clair was soundly defeated by the Miami Indians, who attacked him about thirty miles from Fort Jefferson. Of a total of 1,400 effectives, 632 were killed and 264 wounded. Surgeon Grasson was among those killed, but Allison distinguished himself in the desperate confusion by aiding the officers in rallying their men. Even before the battle was over the Indians were scalping their victims. A witness noted: "I saw a Capt. Smith just after he was scalped, sitting on his backside, his head smoaking like a chimney & he asked me if ye battle was nota most over."¹²

The retreat which followed was so rapid that those among the sick and wounded who were fortunate enough to be taken along by their fellows were deposited at Fort Jefferson, twenty-nine miles from the battleground, less than eight hours after the flight began. Having settled the disabled there, however, the able-bodied set out again and reached Fort Washington, where Cincinnati now stands, on 8 November. The wounded continued to straggle in to Fort Jefferson for days after the battle. "Some soldiers have come in with ye Skin & Hare taken clean off of their Heads, "an officer

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wrote his brother,¹³ and one had not only been scalped but also had "a tomehawk stuck in the head in two places."¹⁴Although two medicine chests were lost in the defeat, every possible effort seems to have been made to establish hospital facilities and to obtain all the provisions needed for the wounded, whose situation was "truly distressing."¹⁵

The failure of two attempts to subdue the Indians in the Northwest led to a reassessment of the approach to the problem. The leaders of both expeditions were officially exonerated of any major blame, which was placed upon the War Department, the Quartermaster`s Department, and contractors. Maj. Gen. Anthony Wayne was given the Army`s five regular infantry regiments and cavalry and artillery to establish the Legion for a new effort against the Indians. General Wayne was also granted the time to train his men thoroughly near Pittsburgh before taking them into action, but although Congress had by this time authorized a ratio of one surgeon and two surgeon`s mates per infantry regiment as well as a mate for the light dragoon squadron, there was only one surgeon actually with the army when it began its training.¹⁶(See Table 7.)

General Wayne regarded "the health and comfort of the soldiers "as "objects of the first consideration" and was personally concerned with the maintenance of their health and the proper care of those who became ill. The general ordered the single surgeon, Dr. John F. Carmichael, with his men to begin at once to set up a tent hospital.¹⁷ When, in addition to "a virulent Veneri," smallpox broke out, General Wayne ordered Carmichael to begin inoculating all men who had never had the disease.¹⁸ Shortly thereafter he also ordered Carmichael to locate "two industrious humane and honest Matrons to assist in nursing and cooking for the Sick." Although he had little control over the shortage of hospital supplies, General Wayne decided to deal with the severe

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FORT DEFIANCE. (Courtesy of Library of Congress.)

and prolonged shortage of vegetables by offering the whiskey ration of his men, both sick and well, to the local inhabitants in exchange for their produce.¹⁹

Discipline within the hospital also concerned General Wayne even after the arrival of a second surgeon to help Carmichael. On at least one occasion, the general was required to court-martial a sergeant "for riotously beating a Woman kept by him as a Mistress to the injury of the Sick in the Hospital . . . for abusive language and using Menacing [sic]words and gestures to Doctor Carmichael, when requested by him to desist from the above purpose."²⁰

General Wayne began his active campaign in the spring of 1793, moving first to Fort Washington (Cincinnati) and then slowly westward, establishing forts as he went. He was now accompanied by at least four physicians, including his chief surgeon, Allison. As the summer progressed, however, his men began to fall ill in increasing numbers, fevers and influenza posing the greatest problem. Supplies of hospital stores and medicines were quickly exhausted. Finally, in desperation, the general ordered Allison to buy the needed items wherever he could find them, regardless of price.²¹

The decisive action of General Wayne`s campaign against the Indians was the Battle of Fallen Timbers, which took place on 20 August 1794 not far from the new British fort near the site of present-day Toledo and shortly after the building of Fort Defiance. The wounded, a total of approximately 100, eleven of whom later died of their injuries, were considered fortunate to be moved from the battlefield in a carriage, but at least one witness believed that the evacuation could have been better managed. "The wounded of the third sub-legion are under obligations to doctor Hayward for his attention and humanity to them in this distress," he wrote, but "Doctor Carmichael through neglect had the wounded men of the artillery and cavalry thrown into wagons, among spades, axes, picks, &c. "and as a result, they had to endure "extreme pain, beside the frequent shocks of a wagon on the worst of roads." By 27 August, however, the wounded had reached Fort Defiance and were "happily fixed in the garrison, and the doctors say there is no great danger of any of them dying."²²

Even before Fallen Timbers, General Wayne himself had become gravely ill with gout; Allison reported him to be "in agony." The sick rate among his men, already high in the early summer,²³ was still increasing in September, the principal ailment being "the fever and ague." An officer explained that "The number of our sick increase daily, provision is nearly exhausted, the whiskey had been out for some time. . . . Hard duty and scanty allowance will cause an army to be low spirited, particularly the want of a little of the wet. General Wayne may

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have believed it advisable to trade whiskey for vegetables, but not everyone agreed with him; "the troops would much rather live on half rations of beef and bread, provided they could obtain their full rations of whisky" than enjoy the ample supply of vegetables now available at Fort Defiance. Unfortunately for the whiskey lovers, however, their favorite beverage was in very short supply by that time.²⁴Shortages continued until a member of General Wayne`s staff commented of the wounded that "no set of men in the like disabled situation ever experienced much more want of conveniences &c." and from time to time the general still found it necessary to have Allison make purchases on an emergencybasis.²⁵

September was a bad month for malaria in many areas of Ohio in this period, and in September of 1795 the number of sick was again growing rapidly. The burden of the hospital at Greenville, moved from its initial location in a blockhouse to huts, grew from 120 to more than 300 patients in the space of a month. Patients from General Wayne`s army had been "totally destitute of any kind of Hospital stores . . . since last Winter, except a little occasionally purchased from the Merchants at this place &Cincinnati in cases of the last necessity." Finally the general moved the entire hospital into the open woods in an attempt to stem the onslaught of disease. Since Allison was no longer able to find either opium or peruvian bark in adequate quantity locally, his surgeons began trying substitutes for peruvian bark, fearing that if the tide were not turned, they might soon be facing an epidemic of putrid fever. October found General Wayne once again pressing the War Department for supplies, pointing out that he was "totally destitute of . . . Medicine & Hospital stores, "but only in mid-November did even a portion of the desperately needed hospital stores begin to arrive at General Wayne`s camp.²⁶

Supply shortages occurred yet again and to an alarming degree in 1796, at a time when the number of physicians available to care for General Wayne`s men was also inadequate. Secretary of War McHenry seems to have believed this situation hopeless, for he suggested that the area of present-day Toledo be abandoned because of the prevalence of the disease there. The supply of peruvian bark was exhausted, and in the garrisons the general had assigned to posts from Fort Washington to Detroit, more than 400 officers and men were sick, most of them with malaria.²⁷ General Wayne, however, was not required to contend with these problems much longer. His health had continued poor, and in December 1796, on his way home from Detroit, he died.

The last campaign against the Indians in the Northwest to be undertaken before the outbreak of the War of 1812 was launched in 1811 when it seemed that the Shawnees under Tecumseh were becoming an ever greater threat to settlers. At Vincennes, approximately 300 regulars and twice that many militia men were placed under the command of the Indiana Territory`s governor, William Henry Harrison, who was in time commissioned a brigadier general. General Harrison, who had studied briefly at the Medical School of the University of Pennsylvania, was another of the Army`s leaders who had received some training as a physician.²⁸

General Harrison established a general hospital at Vincennes under the supervision of two physicians from the 4th Infantry Regiment. The head of this hospital, Dr. Josiah Foster, was a man whom Harrison knew and very much admired. Militia units appear to have, as usual, provided their own surgeons for this campaign.²⁹

Although during the summer his men were in generally poor health and suffering particularly from "bilious autumnal fever,"³⁰in September 1811, General Harri-

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son moved his men from Vincennes up the Wabash River to erect Fort Harrison near the site of Terre Haute, Indiana. At this time, he ordered that the sick from his force, many of whom were afflicted with the painful disease then called "the fever and ague," or intermittent fever, be sent to Fort Knox, where a surgeon`s mate supervised their care.³¹

By late October, General Harrison was ready to move directly against the Shawnee in their village on the Tippecanoe River near the site of present-day Lafayette, Indiana. At this time the 900 to 1,000 men under his command were accompanied by three physicians, a surgeon, and two mates, two of whom appear to have been attached to the Regular Army. The health of the regulars had improved, but that of the militia was apparently deteriorating. The sick, among whom were presumably both militia and regulars, were left behind at a small blockhouse built for their use, with a sergeant`s guard to protect them.³²

The Indians, led in Tecumseh`s absence by his brother, launched a surprise attack on 7 November 1811 upon General Harrison`s camp near their village, but the level of discipline which the Americans had attained was such that they were able to resist the attack and mount a counterattack of their own which culminated in the destruction of the Indian confederacy Tecumseh had formed. General Harrison`s men suffered total losses of fewer than 200. Of this number, 37 were killed in action and more than 150 were wounded, among whom was a militia surgeon`s mate. Despite the relatively primitive conditions under which he was forced to work, among the operations which Foster apparently performed were two amputations at the shoulder, a type of surgery not often undertaken at the time.³³

General Harrison`s force returned to Vincennes on 18 November, moving the wounded much of the way by boat, but by the time they reached that post, the injuries of twenty-five of them had proven fatal. By 4 December, three more men had died in the general hospital at Vincennes and so many wounds were proving unusually slow to heal that Foster suspected that the Indians had used poisoned ammunition. Examination of the balls found in wounds revealed that they had been "chewed before they were inserted into rifles for the purpose of enlarging the wound and lacerating the contiguousflesh."³⁴

FORTS AND THEIR GARRISONS

The defense policy of the new nation called for the establishment of forts or fortifications at strategic points both in areas where Indians and settlers were likely to come into conflict and along the coast, to guard against attacks from European nations. Among the concerns of the Secretary of War in 1794, for example, was the completion of fortifications on three islands in New York harbor, at eight New England ports, at eleven towns and cities from Philadelphia south to Georgia, and at West Pointon the Hudson River.³⁵

One such coastal fort was Fort Jay, on Governors Island in the Harbor of New York City, constructed in 1794 in anticipation of war with France. A surgeon`s mate was sent there in the spring of 1802, when the policy of assigning medical support by garrison rather than by regiment was adopted.(See Table 7.) A difficulty which was by no means unique to the New York City garrisons arose, however, when the Army surgeon assigned to the area allowed other concerns to distract him from his Army duties. About eight years after this physician was sent to Fort Jay, testimony at a court-martial revealed that the only Army physician then assigned to care for the New York garrisons was living and practicing medicine within the city and on occasion unavailable to these men when they needed him.³⁶

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Fort Adams on the Mississippi River south of Natchez seems to have served as a supply distribution center for lesser outposts in the area. So important had this fort become by 1802 that it was assigned to the care of Carmichael, one of the two surgeons still remaining in the Army at that date. Carmichael had previously spent some time at Fort Adams and was, therefore, familiar with the climate and the problems associated with it. In 1803, a surgeon`s mate was sent to work under Carmichael, a move which could have been necessitated either by unexpectedly heavy demands upon Carmichael`s time or by the fact that this surgeon, too, had found other duties to keep him busy. He functioned as a customs collector during part of his stay at Fort Adams, for example, giving up this position only in the spring of 1803. The Secretary of War commented on this particular occasion, "I trust in the future his whole attention will be paid to his medical duties." By the spring of the following year, however, Carmichael was preparing to resign.³⁷

The character of the forts in the Northwest Territory varied greatly; some were simply stockades while others were relatively complex installations where life was not entirely devoid of luxuries. At Fort Washington, for example, a physician owned a summerhouse which stood in the midst of the extensive gardens lying just beyond the walls of the fort.³⁸

Particularly detailed records which provide insight into the work of a garrison surgeon were left by the surgeon`s mate at Fort Defiance in Ohio in 1795. Here Dr. Joseph Gardner Andrews was responsible for the health not only of the garrison of approximately 160 officers and men, but also of a small number of civilians, including five women and a child. In addition, Andrews, like other Army physicians during this period, cared for the ill among neighboring Indians.³⁹

In the course of fulfilling his duties in 1795, Andrews confronted diseases which were undoubtedly familiar to most of the surgeons serving with the U.S. Army. On 1 January, he had thirty-seven patients, all members of the garrison, twenty-five of whom were wounded. Four of the remainder were suffering from what he diagnosed to be rheumatism, three from diarrhea, one from dysentery, and one from intermittent fever. A month later, although one of his earlier patients was dead, the total number had dropped to twenty-seven, three of whom were convalescents and fifteen wounded. By 1 March, the doctor had lost another patient and a child was among those listed as sick. By April, although the child was well again and Andrews`s patients numbered only twenty-one, intermittent fever had made its appearance among them.⁴⁰

Both the total number of patients and the number with intermittent fever gradually dropped as spring and summer wore on, however, despite the fact that in July there were "musketoes plenty" in the area between Fort Defiance and Fort Wayne. By late August, Andrews was himself acutely ill, and by 1 September, all nine of his patients were sick with intermittent fever. Ten days later, despite his own condition and the fact that he had "not a particle of Hospital Stores," he was attempting to care for fifteen patients, all of whom had intermittent fever. Less than a week later, when he himself still "Had the Ague & fever extremely severe, "he turned to "the Dogwood bark in simple decoction" in an attempt to treat his intermittent fever patients, who now numbered twenty-one.

The situation as far as hospital supplies were concerned had come to the attention of the officers at Fort Defiance, who finally managed to obtain eight gallons of liquor for the fort hospital by promising to pay for it themselves should the government refuse to do so. By the end of September, Andrews had also received a keg of wine and 30

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pounds of brown sugar, items which were sorely needed by the time they actually began to arrive. By 1 October, sixty-one of the total population of Fort Defiance were sick. Of this number, fifty-eight were listed as having intermittent fever and three remittent fever. Andrews observed that "The Intermittents in this place are extraordinarily rapid in deprivin the patients of strength." The prevalence of fevers was not limited to Fort Defiance, 500 having been reported sick with the two types of fever at Fort Jefferson.

By 7 October, Andrews was feeling well enough to pronounce himself recovered, but two weeks later his fever recurred, fortunately, it seems, for a brief time only. Others were also recovering at this time, and his report of1 November records only thirty patients, one of whom was suffering from wounds and two, one of whom died a short time later, from typhus. By December1795, Andrews`s patients numbered only eleven, two of whom were convalescent and seven afflicted with "debility."

Although the Indians Andrews treated included even a Delaware chief, it was an American who seems to have caused him the most trouble. Ensign Frothingham was, to the surgeon`s great disgust, much given to treating himself and brought with him to Fort Defiance "a quantity of medicines, lotions & unguents almost equal to the contents of my Chest, like a person who has dabbled sufficiently in medicine to render it a dangerous tool." With the aid of an Indian squaw, this officer "induced a dropsy, or rather a very dangerous relapse, as . . . he had the anasarcalast year." Although he at last promised to follow Andrews`s advice exclusively, two weeks later, on 6 December 1795, "after a tedious illness wch he did not endure with that christian fortitude, that his affectation of religion seemed to induce an expectation in the minds of his Brother Officers," Ensign Frothingham "died . . . without a pang. "Andrews stated that an autopsy revealed that his kidneys had ceased to function.

WILKINSON IN THE LOUISIANA TERRITORY, 1809

In 1808, fear of a possible attack by the British upon the newly acquired Louisiana Territory led to the assignment of Brig. Gen. James Wilkinson, another physician who had abandoned the active practice of medicine and an officer who moved successfully from one scandal, including the Aaron Burr conspiracy, to another, to command the troops to be sent to strengthen the defenses there.⁴¹

The units assigned to General Wilkinson in 1809 included three regular infantry regiments and elements of a fourth, in addition to companies of dragoons, light artillery, and riflemen, for a total which at times approximated 2,500 regulars. It is difficult to ascertain precisely the number and status of the physicians on duty with General Wilkinson`s forces in 1809, but records surviving from this period indicate that among their number were the surgeons for two or more infantry regiments and one for a regiment of riflemen, in addition to a surgeon and a mate assigned to the general hospital at New Orleans as hospital physicians; there were probably other there as well. General Wilkinson, however, believed that there should have been more physicians with his men.⁴²

A general hospital was established at New Orleans to care for the sick of General Wilkinson`s command, but exactly how many patients this facility could handle is not clear. The general maintained that two empty barracks next to the hospital would be used to add as many as 500 places to the hospital`s capacity. During the summer of 1809, the immediate supervision of this unit was the responsibility of the hospital

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surgeon`s mate. The hospital surgeon reportedly had a large private practice in the New Orleans area.⁴³

As far as the Army`s health was concerned, the situation was building up to disaster by the spring of 1809 in New Orleans. General Wilkinson`s troops were undisciplined, his officers inexperienced, and hospital stores short. In mid-April, only two surgeons, one of whom was ill himself, and two mates were actually on duty to care for the 550 regulars who were ill in the New Orleans area, and General Wilkinson finally believed it necessary to hire private physicians to help care for his men. Although the fevers which were expected in the summer in this area had not yet appeared, the health of the men continued poor, the diseases most frequently seen being "mostly of the bowels, and ascribable to a change of diet, and the water of the Mississippi." Eustis, Secretary of War at this time, expressed great concern for the future health of General Wilkinson`s men and agreed with him that the Army should leave the city of New Orleans.⁴⁴

Although on 30 April, Eustis suggested that General Wilkinson move his men north up the Mississippi River to Fort Adams and Natchez, in the late spring the general moved them to a location twelve miles south of New Orleans, on the west bank of the Mississippi, an area known as Terre aux Boeufs; he later claimed that he did not receive Eustis`s communication of 30 April until after the move to Terre aux Boeufs had been completed.⁴⁵

Terre aux Boeufs had a reputation for pools of water which stagnated long after a rainfall, but General Wilkinson maintained that the site he had chosen was a healthy one with good water. Although he had found it necessary to order drainage ditches dug there, he claimed specific all that the area was dry.⁴⁶

The sick rate at the new campsite continued very high, although General Wilkinson, in defense of his decision, pointed out that Terre aux Boeufs was an improvement over New Orleans. In an eight-day period at New Orleans in early June 1809, ten men died and nine more deserted, but in the last twenty days of the month, when the army was at Terre aux Boeufs, only eleven men died and three deserted. He also stated that on 14 June, shortly afte the move, 565 of the 1,662 men present at camp were sick, but that on 27June, only 429 were sick of a total of 1,690.⁴⁷

The summer was a grim one. General Wilkinson claimed that hospital tents were set up for each regiment at Terre aux Boeufs and eventually an eighty-man hospital as well, but, even so, at times the sick had to remain in their own tents. The supply of medicines was inadequate and the surgeons in attendance were often sick themselves. The flour was at times moldy, worm-infested, and so hard as to challenge an ax. It was suspected that the general was in collusion with the contractors who were responsible for supplying hisforce.⁴⁸

The supply problem was not alleviated, however, by either the management of Secretary of War Eustis or the custom of allotting supplies by company without reference to hospital requirements. Eustis alternated between forbidding the purchase of the expensive eggs, poultry, and wine physicians wanted for their patients and maintaining that he could not understand why all things necessary for the health of the troops had not been purchased. The general himself blamed the youth and inexperience of the contractor`s agent and finally resorted to the step of authorizing his hospital surgeon to buy personally whatever the sick needed.⁴⁹

General Wilkinson did not initially move his men upstream when he finally did receive Eustis`s suggestion because, he maintained, those familiar with the area told him that such a move at that time would endanger the health of his men. The general

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stated to Eustis that since the trip would have to be made by water, it could lead to the deaths of as many as nine-tenths of his men. On 22June, however, Eustis specifically ordered an immediate move to Fort Adams and Natchez.⁵⁰

Despite General Wilkinson`s misgivings, the voyage up the Mississippi River was undertaken, albeit not as soon as Eustis wished. Dr. Alfred Thruston, surgeon for the 7th Infantry Regiment, had officially protested the idea of moving the men during the heat of summer, but in September, the sickest men having been sent back to the general hospital at New Orleans, 1,542 men began the journey. All of them were taken across the river to the east bank in boats, and then the 982 men able to do so were put on shore to proceed north on foot. The remainder, 382 of whom were convalescents still too weak to march, stayed in the boats for the entire trip.⁵¹

Although there seems to have been no lack of both medicines and such staples of the diet of the sick as tea, sugar, chocolate, brandy, and wine during the voyage, it was soon impossible to provide the sick with proper medical care. Their number multiplied rapidly and the boats were soon so crowded with the ill that the surgeons could move among them only at night, when camp was set up on shore.⁵²

The trip from Terre aux Boeufs to Natchez was completed in approximately 45 days. By early October, however, there were so many ill among the men that two groups of patients, each accompanied by a physician, were left off before they reached Natchez. The officers took up a collection to buy supplies for the hospital which was set up for 100 patients south of Fort Adams, and another 120 sick officers and men were landed at Fort Adams itself. An estimated 300 more men died on the journey.⁵³

General Wilkinson himself, however, was not with his men for this tragic voyage. At the time of the departure, being seriously ill with "remittent fever, attended with very violent paroxysms," he remained at New Orleans. In November, he set out for Natchez, where a short time later he was relieved by Brig. Gen. Wade Hampton.⁵⁴

It seems reasonable to assume that several diseases were to blame for the devastation of General Wilkinson`s army in the spring, summer, and fall of 1809, when at least 500 and possibly as many as 1,000 died. The surgeon for the 5th Infantry Regiment, Dr. William Upshaw, reported that the most prevalent diseases in the early summer were "chronic diseases, bilious and intermittent fevers, some cases of scurvy." The chronic ailments seem to have been diarrheas, which were blamed on changes in food and water despite the fact that some cases predated the arrival at New Orleans, and a violent dysentery.⁵⁵

General Wilkinson himself noted that the heat was usually blamed when the number of sick was high and that although June and July were wet months, the disease rate among his men did not peak until later. If one were to assume that malaria was one of the principal diseases afflicting the men along the southern Mississippi River, however, the late summer peak would not be unusual. More recent records indicate, for example, that the number of admissions to Army hospitals in the continental United States because of malaria in 1921 was greatest in August and September and that the peak month during both world wars generally came no earlier than July and a times as late as the early fall.⁵⁶

General Wilkinson and the others concerned with the health of his troops, however, appear to have had no real suspicion that mosquitoes were related to the high disease and death rate in 1809, even though they did try to protect the troops from them. In August of 1808, the Secretary of War suggested to the military agent for New Orleans the purchase of "a reasonable

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supply of mosquito nets for the troops." In April of the following year, General Wilkinson ordered 100 mosquito bars specifically for the field hospital serving his sick and still more for the rest of his men. It was noted at the time, however, that since the diarrhea common in his army caused non-hospitalized men to leave and reenter their tents frequently in the course of an evening, mosquito bars did not always solve the mosquito problem.⁵⁷

At least one attempt was made by a surgeon familiar with the sufferings of General Wilkinson`s men to find a single disease which could be blamed for most of the illness. Dr. Jabez Heustis chose scurvy as the culprit, but admitted that not all of the symptoms he had recorded were those usually associated with it.

This disease first made its appearance among the soldiers in the form of an intermitting fever, which, by degrees, assumed a more malignant aspect, acquiring the character of the bilious remitting, or yellow fever; becoming more malignant as the season advanced, and the heat increased. In some instances this fever was of a violent inflammatory character, in others, typhoid symptoms marked both its invasion and progress . . .. Towards the end of July the epidemic malady appeared among the troops in a new form, of such an anomalous aspect, as at first to occasion doubts as to its nature.⁵⁸

Before the more obvious symptoms appeared, according to Heustis, the "features became sad . . . and the face assumed a sallow hue. "In time the joints became stiff "and the tendons in the arms rigid and contracted." The patient then began to experience "pain in the parotid glands," and, in time, "buboes . . . in the groin, "petechiae, loose teeth, and bleeding gums. From this point onward the disease progressed rapidly, according to Heustis, "destroying the whole inside of the mouth in twelve hours, and frequently in less than half that time. "In one case, a patient was so severely affected that he took "hold of his tongue . . . deliberately drew it from his mouth, and threw it on the table, for the contemplation of his companions."⁵⁹

Heustis was not entirely satisfied with scurvy as an explanation for the illnesses which afflicted General Wilkinson`s men. The symptoms he observed reminded him in some ways of descriptions of "the Eastern plague," which, as he understood it, was also characterized by enlarged glands, "feotor of the breath," buboes in the groin, and petechiae. Furthermore, he noted, scurvy was not usually accompanied by diarrhea and dysentery. Officers did not often contract this illness, a phenomenon which Heustis attributed to their custom of buying fresh food from local inhabitants, something enlisted men could not afford to do, but he concluded that "The efficient cause of this pestilential distemper was undoubtedly the use of unwholesome and corrupt provision" such as "old, rancid" pork and beef which was "poor, lean," and that air "highly impregnated with noxious miasmata" was undoubtedly a contributingfactor.⁶⁰

Heustis blamed 1,000 casualties upon the disease he was attempting to define. He estimated that 150 of that total had been "destroyed at Terre-aux-Boeufs," 250 during the journey upriver, and 600 at the new campsites. He believed, however, that the chief physician caring for General Wilkinson`s men in the Natchez area had contributed to the high mortality rate with his "injudicious use of mercury, which was prescribed as a general remedy by the superintending physician . . . . A few doses of this medicine relieved the patient of his misery, and put an end to his earthly sufferings." He added that other physicians with General Wilkinson`s men did not share the faith of their superior in mercurials and in his absence omitted his prescriptions in favor of "vegetable remedies," such as sorrel and wild peppergrass.^6l

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MANAGEMENT OF SUPPLIES

Army physicians had no supply system of their own in this period, and for much of the time, no physician was directly involved in the purchasing and distributing of hospital supplies and medicines. Attempts were made to control the use of these items and to increase the efficiency of the supply system by such steps as establishing separate lists of medicines to be purchased for southern and northern areas, but complaints of shortages and poor management continued to come in from the field, and physicians were forced to exercise what ingenuity they could. To augment their supplies of medicines, they turned to such locally available remedies as the barks of wild cherry, sassafras, willow, and other trees, using them for conditions ranging from fevers to consumption. It should be noted that in spite of the fact that it was so difficult to keep its physicians adequately provided, the War Department at times permitted some of them to use government supplies for their own private patients.⁶²

Complaints were heard involving both the quantity and quality of medicines bought, according to Secretary of War Eustis, by the "Purveyor of Public Supplies." Eustis, apparently determined that something bed one to give a physician a role in the purchasing and distributing of medicines and hospital supplies, finally turned to Dr. Benjamin Rush for advice. He also asked for the name of someone who could work with the men who had the overall responsibility for purchasing. Rush recommended Dr. James Mease, who worked at this task during the winter and spring of 1810. With Rush`s aid, Mease composed a list of the necessary supplies and then personally inspected and packed the items to be distributed to the surgeons.⁶³

Mease`s services seem to have been rendered on a temporary basis, for in February 1812, Dr. Francis LeBaron was given the task of managing the" selection, inspection and putting up of the medicines and hospital stores." LeBaron`s position was not an official one, a fact which seems to have very much concerned him. He urged that Congress create the official position of "Inspector of Medicine & Hospital Stores, "but by the end of 1812, nothing had been done about the matter.⁶⁴

LeBaron`s duties included the composition of standardized lists of drug needs and the solicitation of bids on them from the leading druggists in Boston, New York, and Philadelphia. He was also responsible for constructing and outfitting of medicine chests, each of which was intended to serve500 men and to be carried on a baggage wagon three and one-half feet long.⁶⁵

LeBaron`s center of operations appears to have been Philadelphia, but he was also expected to establish storage depots elsewhere. On 8 June 1812, a few days before war was officially declared, he was ordered to set up a depot at Albany, "for an Hospital Establishment for the Northern Army."⁶⁶

Throughout the entire period from 1783 to the outbreak of the War of 1812, the medical support of the units composing the Regular U.S. Army lay, for all practical purposes, entirely in the hands of individual surgeons. Separated from one another by vast distances, frustrated by shortages of medicines and supplies, they struggled with the health problems of soldiers who were poorly trained, poorly clothed, poorly fed, and only too often poorly led as well. It was of physicians caring for the Army`s sick and wounded under just such circumstances, however, that a soldier who had witnessed their efforts wrote "too much cannot be said in their praise."⁶⁷

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"ESTIMATE OF MEDICINE,HOSPITAL STORES, ETC. FOR EIGHTY MEN [FOR] ONE YEAR." (Courtesy of National Archives.)[page1]

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"ESTIMATE OF MEDICINE,HOSPITAL STORES, ETC. FOR EIGHTY MEN [FOR] ONE YEAR." (Courtesy of National Archives.)[page2]

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"ESTIMATE OF MEDICINE,HOSPITAL STORES, ETC. FOR EIGHTY MEN [FOR] ONE YEAR." (Courtesy of National Archives.)[page 3]