Chapter 7
Administration of Medical Support, June 1812 to January 1815
Largely because of British impressment of American seamen and their aid to the Indians, the United States had been anticipating war with Great Britain for several years before the actual declaration on 18 June 1812, but neither the Army nor the organization of the Army`s medical support was ready for open hostilities when they came.1
OPENING MONTHS OF THE WAR OF 1812
The direction of the nation`s armed forces at this crucial time remained in the somewhat inept hands of Secretary of War William Eustis. It was Eustis who sent Brig. Gen. William Hull orders hours before war was formally declared but did not inform him that this step was imminent. It was also Eustis who assigned Maj. Gen. Henry Dearborn to command in the North without telling him that his command included Detroit, leaving General Dearborn to assume that Detroit was not his responsibility. Eustis resigned in December 1812, however, and was replaced by John Armstrong.
Initial preparation for war involved little in the way of organizational change for the Army despite the increase in size from slightly more than 6,500 in 1812 to 19,000 in 1813. The nation`s leaders had little enthusiasm for centralization and staff offices; the medical department which had been established in anticipation of war with France at the turn of the century had been disbanded when the threat abated. The enrolling of surgeons and mates to be directly attached to hospitals had been authorized in 1808,however, and the assignment of surgeons and mates directly to regiments was revived in January 1812. (See Table 7.)
Eustis continued LeBaron in his informal position as inspector of the supplies needed by the Army`s surgeons in their work but supervised his work closely. With the coming of war, however, it became necessary to establish depots beyond the one already planned for Albany, which Eustis was planning to turn into a major medical supply center for troops all along the Canadian frontier. Late in August, the Secretary of War sent LeBaron a series of orders requiring him to send at once to Pittsburgh "medicine & apparatus for five Regiments, in small chests; also to Annapolis, medicine, surgical instruments & ca, for four hundred militia on duty at that place."2 Only a few days later, Eustis also ordered LeBaron to send "the necessary medicine & Stores for an Hospital Establishment at New York."3
Although the militia called into federal service supplied its own surgeons, it looked to the Regular Army for medical supplies. LeBaron was, therefore, required to send sufficient hospital stores and medicines from his Albany warehouse to Niagara for the 5,000 militia there and to be prepared, should there not be a sufficient quantity on
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hand at Albany to meet this requirement, to send more north from Philadelphia at once. Supplying the militia, however, made anticipation of needs much more difficult. Although militia and volunteer units played an important role in the War of 1812, the accurate prediction of how many such units might come in or when they might appear was impossible. Should unexpected large numbers come in during the autumn or spring, the "sickly seasons," shortages could occur very rapidly.4
Eustis directly supervised the financial management of medical supply and ordered LeBaron in October 1812 to prepare estimates on projected expenses for 1813. He also informed LeBaron that the Quartermaster believed that money could be saved by purchasing supplies where they were to be used, thus avoiding shipping expenses. LeBaron, however, explained that local sources of supply, even for such easily obtained items as vinegar and cornmeal, were uncertain and that he could not be sure of obtaining these items locally when they were needed.5
Eustis also personally made decisions such as the one involving the size of the medicine chests to be constructed for the Army`s use. LeBaron was ordered to have small chests made, despite the fact that surgeons could not seem to agree about what medicines were absolutely necessary to such a chest. LeBaron pointed out that when large chests were used, he could include adequate amounts of all the drugs which might be required without being forced to try to predict what each individual surgeon might use in every possible situation. It was not until the following spring that the discussion was finally resolved in favor of small chests.6
LeBaron himself criticized the lack of system and organization which made "wanton waste" possible and noted that the surgeons themselves were complaining that they were unsure as to the nature of their responsibilities. He cited an instance when a militia surgeon reported for duty at a site where three months` allowance of hospital supplies was stored for militia use, then invited in his friends, "and eat, & drank them up, "returning home before the hospital surgeon for the area could discover what had happened.7
WORK OF THE MEDICAL DEPARTMENT
Nine months of the War of 1812 passed before the offices of Physician and Surgeon General and Apothecary General were created in March 1813. Although demands upon the Army`s physicians were heavy, it was June before appointments to these positions were actually made, and the additional regulations necessary to complete the central organization of the Army Medical Department and to define its functions were issued at irregular intervals throughout the remainder of the war.
It was on 3 March 1813, in an act reorganizing the general staff of the U.S. Army, that the Congress also created in a few brief words the positions of Physician and Surgeon General and Apothecary General, both of which were to be filled by civilians. (See Appendix I for texts of those portions of major legislation which affected the Medical Department.) Unlike the department designed in 1799, this new organization involved only the Army, and rather than detailing the responsibilities of both officers, it made the President responsible for outlining the specific duties ofboth.8 In May 1813, therefore, President Madison issued his "Rules and Regulations of the Army of the United States."
The new regulations forbade private practice to all Army physicians and outlined the duties of the Physician and Surgeon General, who was made responsible for the specific assignments of individual surgeons. The Physician and Surgeon General was also responsible for the appointment of stewards
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TABLE 8-PAY AND ALLOWANCESFOR THE STAFF OF THE MEDICAL DEPARTMENT, MAY 1813
|
Position |
Monthly Salary |
Forage Allowances |
Rations |
|
Hospital Surgeon |
$75 |
2 |
6 |
|
Hospital Surgeon`s Mate |
40 |
2 |
2 |
|
Steward |
20 |
0 |
2 |
|
Wardmaster |
16 |
0 |
2 |
|
Surgeon |
45 |
2 |
3 |
|
Mate |
30 |
2 |
2 |
SOURCE: American State Papers: Military Affairs,1:435.
NOTE: The Physician and Surgeon General received a straight salary of $2,500 a year without allowances, the Apothecary General $1,800 without allowances.
and nurses and for the management and use of the stores, instruments, and medicines bought for the Medical Department by the Purchasing Department, with the Apothecary General serving as his assistant. A scale of pay and allowances was also established for the department and, in addition, every hospital and regimental surgeon was granted the privilege of a private room at whatever facility he was serving. (Table 8) Another passage in the May 1813 regulations prescribed a uniform for the Physician and Surgeon General, the Apothecary General, and hospital surgeons and mates. It was to resemble that of the general staff, but was specifically characterized by an embroidered gold star on the high collar of the black coat, "pocket flaps, and buttons placed across the cuffs, four to each, and covered buttons in all instances, of the color of the coat." 9
The following December, further regulations were issued to govern the department`s operations. The senior surgeon assigned to each of the nine military districts into which Secretary of War Eustis had divided the military organization of the country in 1812 was to be the director of the medical staff of that district, including regimental surgeons. The specific assignment of each physician was to be based upon his personal ability and training. All Army surgeons had to be either graduates of approved medical schools or capable of passing an examination administered by an Army examination board. In the spring of 1814, one such board consisted of the Inspector General of the Army, the Physician and Surgeon General of the Medical Department, two hospital surgeons, and three regimental surgeons.10
The areas covered by the military districts in the spring of 1813 were as follows:
1: Massachusetts, New Hampshire
2: Rhode Island, Connecticut
3: New York to the Highlands, part of New Jersey
4: Part of New Jersey, all of Pennsylvania and Delaware
5: Maryland, Virginia
6: North Carolina, South Carolina, Georgia
7: Louisiana, Tennessee, Mississippi
8: Kentucky, Ohio, Northwest Territory
9: New York north of the Highlands, Vermont
SOURCE: Marguerite McKee, "Service of Supply in the War of 1812," Quartermaster Review 6 (1927): 49-50, 50n.
Modifications and additions to these regulations continued to appear during the course of 1814. In March, for example, two rations a day and forage for two horses were added to the salary already allowed the Physician and Surgeon General, and $15 a month was added to the pay of regimental surgeons and mates. The President was now also permitted to hire as many assistant apothecaries as he believed necessary. In December 1814, yet another set of regulations for the Medical Department was issued and policy limiting the number of patients admitted into general hospitals was officially stated; unless the movements of an army required leaving its patients behind, only the wounded or the chronically ill should be sent to the general hospital. The Apothecary General and his assistants were at this time made directly responsible to the superintendent general of military supplies for the disbursement of all hospital supplies bought for the Medical Department by the Commissary General of Purchases.11 (For a detailed description of the duties of various members
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of the department as understood at this time, see Appendix J.)
By the end of 1814, the departmental structure included hospital surgeons, who were assigned responsibilities according to their seniority, and their mates, as well as post or garrison surgeons and regimental surgeons and mates. The senior hospital surgeon in an army or district served as its medical director and was responsible for the medical staff of that army or district. Although regimental surgeons and mates seem to have been identified with their regiments more closely than with the Medical Department and the reports of the Physician and Surgeon General did not even mention them, they were nevertheless required to submit monthly and quarterly reports to the medical director of the army or district in which they were serving. These reports were consolidated with those from hospital surgeons and post surgeons by the senior surgeon in charge and forwarded on to the Physician and Surgeon General.12
The precautions necessary to ensure high standards of cleanliness and sanitation were officially spelled out in the December 1814 directives. The wardmaster, for example, was responsible for seeing that closes tools were cleaned at least three times a day and that either water or charcoal was kept in them. Beds and bedclothes were to be aired each day and exposed to sunlight when possible. The straw in each bed sack was to be changed at least every month. When a patient was discharged or died, the straw from his sack was to be burned. Each patient was to be washed every day and his hair combed. At least one female attendant was to be assigned to each hospital or infirmary to perform such menial tasks as the cleaning or washing of bunks, floors, bedding, and cooking utensils, for which she was to be paid no more than $6 a month plus one ration a day.
The regulations of December 1814 also went into detail concerning the housing of regimental and post surgeons and mates. Although the latter were regarded as having a lower status than their colleagues assigned to regiments, they were, like the regimental and hospital surgeons, assigned to single rooms. To heat each room, regardless of occupancy, a half a cord of wood was allotted in the May-October period and three times that amount during the colder months of the year.
Regimental surgeons were made responsible for the continued training of their mates and private practice once again was forbidden in this last set of instructions. Should medical care be required at any time for units unaccompanied by an Army surgeon, however, provision was made for the officer in command to hire a civilian physician and pay him according to the patient load. Should there be more than thirty patients involved, the civilian doctor would be paid a salary identical with that of the surgeon`s mate.
It was not until 11 June 1813, however, that the position of Physician and Surgeon General of the Medical Department was filled with the appointment of Dr. James Tilton. Tilton, who has been described as "one of those American eccentrics who had that combination of erudition and native radicalism which has provided this country with some of its most engaging characters, "had become familiar with the problems of military medicine during the Revolution and had already expressed some distinct ideas on the best approach to some of them.13
At this time, however, Tilton himself was not in the best of health. In the summer of 1814, he commented often on his "frail condition," citing his "anthrax," which was "still an open wound of some extent," and the "rheumatic swelling of my knee that is not a little inconvenient."14 The growth on his knee was "threatening to make a cripple of me" in September 1814 and apparently later proved to be malignant, his leg being amputated within less than a year and a half of these references to it. There is no specific
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JAMES TILTON. (Courtesy of National Library of Medicine.)
evidence, however, to indicate that his poor health and the fact that he spent much of his term of office at his home in Wilmington, Delaware,15interfered with his effectiveness as head of the Medical Department.
Serving under Physician and Surgeon General Tilton was Apothecary General Francis LeBaron, officially appointed to this position on 11 June 1813, although he had been managing the supplies since before the outbreak of war. Not long after he became Apothecary General, LeBaron requested the appointment of assistant apothecaries, but fourteen months elapsed before the first two assistants were hired. By the end of 1814, however, there were nine assistants working under LeBaron, assigned to Philadelphia, Norfolk, Charleston, New Orleans, Williamsville, Sackett`s Harbor, New York City, New London, and Boston.16
There was confusion, however, as to the whereabouts of many of the other members of the Medical Department. In the spring of 1814, for example, the Adjutant General wrote Tilton to request from him a list of the assignments given his surgeons and commented that "with your list and by the help of the records in this office, probably we shall be able to account for and where the officers of your department are."17 In responding to this request, however, the head of the Medical Department pointed out that, although the list he was enclosing was accurate concerning hospital surgeons and mates, "The garrison surgeons and mates may be defective, as they are a species of Surgeons that I have had but little to do with."18There was also apparently some confusion about which surgeon was in charge in each area. In his final report for 1814, for example, Tilton commented of the 8th District that he had been told that a Dr. Turner, who was only a regimental surgeon, had "very improperly assumed the directing."19
The difficulty experienced in establishing the locations of members of the department can be illustrated by the wanderings of one of its members, Dr. John R. Martin, who was ordered in June 1813 to join Maj. Gen. William Henry Harrison in Ohio. In February 1814, however, Martin was in Washington, D.C., but was ordered to go to Pittsburgh, Pennsylvania. This order was rescinded two days later and he was ordered to remain where he was. The next month he was ordered to Erie, New York, but two months after this he was apparently located in Ohio and was sent a letter which ordered him to go to Buffalo. His presence in Buffalo, however, was by August considered to be "likely to interrupt the harmony which subsisted" there and his assignment was changed to Sackett`s Harbor, New York. One cannot be sure of where Martin was actually located while his assignments were being changed.
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It seems likely, for example, that the "Dr. Martin" who assisted another physician in caring for wounded Americans taken captive by the British in late August north of Washington, D.C., at a time when John R. Martin had been ordered to upstate New York was none other than this same John R. Martin.20 The length of time it must have taken Martin to go from one place to another would only have added to the confusion, and it is possible, of course, that some of these changes of assignment never caught up with him.
The relationship of the staff of the Medical Department to the numerous militia and volunteer units which served at various times against the British in the War of 1812 appears never to have been specifically outlined. In practice, the surgeons reporting for service with these units usually cared for their own sick and wounded. On at least one occasion, at the time of the British raid on Washington in 1814, a separate hospital was established for militia wounded.21 When necessary, however, the hospital staff of the Medical Department cared for these men within the general hospital system.
Despite the criteria established in December 1813, the caliber of the physicians serving in the Regular U.S. Army at this time was by no means uniform. While some surgeons earned enviable reputations among their colleagues, others were less fortunate. According to the outspoken Tilton, a garrison surgeon`s mate at Detroit, for example, was "not only incompetent in medical knowledge, but so sottishly abject in his conduct, as to be utterly unworthy of trust or confidence." A surgeon with the 18thInfantry Regiment was "not only incompetent, but deranged to such a degree as to make it unsafe & improper to trust patients in his charge. "The much-transferred Martin, his superior noted, had been "accused of purloining the rations of the sick." Martin and another surgeon were, indeed, "nothing more than disorderly excrescenses . . . that had better be lopped off."22
In the opinion of at least one experienced Army physician, it was difficult to retain the surgeons who served on the regimental staff because of thein adequate pay they received. Costs along the Canadian frontier were particularly high, he pointed out, and regimental surgeons and their mates tended to serve a year because of "Curiosity alone" and then leave.23It should be noted, however, that well over half of the surgeons on the regimental staff in 1813 returned the next year to serve either in the same capacity as they had been serving in 1813 or in a different one within the regimental framework.
By the end of 1813, the staff of the Medical Department had become quite large and the several documents issued since the spring of 1813 had to some degree outlined the way in which the department should operate, but the policy concerning the hiring of additional personnel appears to have remained unclear. A question which arose in the summer of 1814, however, was answered in the December 1814 additions to the regulations. Dr. Benjamin Waterhouse, hospital
BENJAMIN WATERHOUSE. (Courtesy of National Library of Medicine.)
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surgeon in Boston, commented that he was not sure whether nurses should be allotted rations in addition to their salaries of $6 a month. The rules of the department as he then understood them stated that nurses should receive no more than $6, but nurses of the necessary caliber could not be hired at that rate, in his opinion. Waterhouse also posed another question. Young men were being actively sought to work in the department, but he wondered whether those "of a family, habits & connexions notorious for opposition to the Administration, the war, & the loaning of money to the government" should be hired. He himself believed "that no man should eat the bread of the government who throws himself into the scale of the opposition," especially since the Army was already "sadly encumbered by people of this class" who were "afraid or ashamed to wear even the cockade."24
During the less than two years he was in office, Physician and Surgeon General Tilton attempted to initiate a system of reporting from Army surgeons around the nation. He wished to accumulate not only data on the numbers of hospitalized patients, their diseases, and the number who died, but also other information of value to medical science concerning weather, climate, and the siting of hospitals. The department was still in such a state of confusion, however, and the surgeons were so accustomed to working independently that in August 1814, when Tilton turned in his report for the department to the Secretary of War, he was forced to point out that his subordinates had provided him with little of the requested information. Six months later, furthermore, the situation had changed very little.25
On the basis of the reports he did receive, however, Tilton concluded in the summer of 1814 that in general the health of the Army was good. He believed that while improved discipline and the resultant greater personal and hospital cleanliness played a major roll in the Army`s health, the effort to avoid crowding general hospitals was also an important factor.26
In February 1815, the Physician and Surgeon General submitted his second report, which included all but the last weeks of the hostilities of the War of 1812. There was so little improvement in the response of the various surgeons under him that he pointed out to the Secretary of War that "The negligent habits, which had gained footing, in the medical department before anything like system was attempted to be established can hardly be reformed, without further legislative & executive aids." Only one report had come in from the 1st District, for example, there was no report whatever from the 8th, and even in the 3d District, where the senior hospital surgeon had apparently gone to considerable trouble to collect data from the physicians under him, the reports were not complete.27
Because of the attitude prevalent among his subordinates at the time he became head of the Medical Department, it is difficult to assess Tilton`s performance as Physician and Surgeon General fairly. He proposed measures, among them the creation of examining boards and the submission of regular reports from the field, which would in the hands of his successors make it possible for the department to operate with notably greater efficiency and effectiveness than it had ever done before 1815; but Tilton was not in office long enough to achieve any significant success along these lines himself or to leave any clear indication whether his health was seriously limiting his ability to enforce the orders he issued. Years of effort would have been required to effect the necessary improvement in discipline, and his attempts to exercise effective supervision and control over the selection and assignment of Army surgeons under the relatively rapidly changing conditions of war were also frustrated by the inevitably slow communications of the period.
During this period, purchasing was still,
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in theory, handled on an Army-wide basis, by the Commissary General of Purchases. This system has since been evaluated as a total failure, with the work of the contractors who supplied rations receiving particularly heavy criticism. Except where a specific contract had been arranged, the Army`s purchasing department was assigned the responsibility for buying such hospital stores as the Medical Department needed and turning the mover to the Apothecary General`s department. In practice, the situation was not so simple and the management of supply for the newly appointed Apothecary General was also complicated by poor roads, the long distances which often separated garrisons and armies from supply centers, the shortage of specie, and a general distrust of paper money.28
Having been ordered on 21 June 1813 to "establish" himself at Albany, LeBaron arrived in upstate New York at the end July. Surgeons were ordered to send him their estimates there, where he was to requisition his needs from the deputy commissary of purchases and turn for transportation to the Quartermaster General. Apparently these three gentlemen as well as the Army contractor for the area all experienced particular difficulty in meeting militia needs, and in October 1814, the Adjutant General ordered them to design a form which would include the pertinent regulations and which could be used in an effort to improve the management of supply for these units.29
LeBaron`s role was never an easy one; he came under fire not only for the quality of some of the stores he provided, which suggests that he may have actually been doing his own buying directly, but also for the way in which medicines were packed. The Secretary of War complained in the spring of 1813 that the medicine contained unnecessary ingredients which made "the preparations elegant"30 and in the fall of the same year that LeBaron`s chocolate was "a vile cheat and highly pernicious to the sick," and his port wine was "vile stuff," "the worse and weakest kind." The secretary maintained that LeBaron, who at the time complained about high prices and a lack of funds, could afford stores of a better quality if he acquired them locally wherever possible, thus avoiding high transportation costs.31 To follow this suggestion, however, LeBaron would have had to do his own purchasing.
The problem of the size of the medicine chests which he distributed continued to plague LeBaron. Some surgeons were refusing to take chests with them because of the difficulties involved in moving such large containers when the Army was on the march, and one physician was so impressed by their size that he referred to them as "the most astonishing things. "LeBaron, however, maintained that the larger chests were used because there had been a requirement that no regiment have more than two chests. Since initially neither he nor the surgeons had had enough experience to predict precisely what types or quantities of drugs would be needed, he had found it necessary to supply a greater variety and a greater quantity than might actually be needed.32
The Secretary of War finally ordered LeBaron to reduce the size of the chests he issued in the future, and the Apothecary General began to prepare smaller ones, weighing approximately 160 pounds, in addition to storage chests, weighing from 120 to 200 pounds, from which they could be replenished. He was actually, however, faced with the problem of disposing of at least eight of the large boxes which he now could no longer send out to the Army`s surgeons. He hoped that the Navy would take them, since size would not be a handicap on shipboard, but the Navy had no need for more chests. LeBaron then suggested sending them to New Orleans, using water transportation as much as possible, to serve there as a source of supply for new posts which might be opened in that area. The Secretary of War pointed out that it would be wise to send
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these containers to posts which could not be easily supplied and where there would also be no need to move them about.33
LeBaron tried to emphasize planning as a method of preventing unnecessary distribution problems and urged such steps as the establishment of a distribution center for the South at New Orleans. Despite his efforts, however, events he could not foresee added to his troubles. On one occasion, while he was away on an inspection trip, supplies which had been accumulated at Pittsburgh for two divisions were all sent to the single division under General Harrison. On another occasion, in the Niagara area, stores which had been at Sackett`s Harbor simply disappeared, "mostly lost, destroyed, or stolen. "The troops at French Mills were in need at this time, but Maj. Gen. James Wilkinson`s men had already used up all the stores which had been stockpiled at Burlington, Vermont.34
In December 1814, a third difficulty arose when Dr. James Cutbush, Assistant Apothecary General, arrived at Philadelphia to take up his duties. LeBaron had placed all the medicines stored there in the hands of a civilian apothecary following the death of an otherwise unidentified Dr. West, but the retail druggist made up into medicines some of the simple drugs which had thus fallen into his hands and proposed that the Army pay the retail rate to get them back.35
Many of the problems experienced by LeBaron and other members of the new Medical Department resulted from the fact that the outbreak of the War of 1812 found the Army`s system of medical support unprepared to meet the suddenly escalating demands placed upon it. Congress, however, appeared relatively unimpressed by the seriousness of the situation and assigned to the executive the task of establishing guidelines for the management of a Medical Department which it created only nine months after the declaration of the war. Hastily and casually conceived and staffed for the most part with men unaccustomed to the demands of military medicine, the Medical Department was severely handicapped in its attempts to provide adequate care for the Army`s sick and wounded.
