The Hospital Department
The colonists at the outbreak of the Revolutionary War lacked experience in organizing or administering a medical department. Some colonial physicians appointed during the war to important posts in the Hospital Department, as the medical department was designated, had garnered practical experience as surgeons or surgeon’s mates in the French and Indian War and had profited by observing the functioning of the Hospital Department of the British army in America during those years.1 Only a few colonial physicians had attended European medical schools, or had acquired firsthand knowledge of military hospitals and the structure of medical departments in European armies. Among them were Benjamin Church, John Morgan, William Shippen, Benjamin Rush, James Craik, William Brown, Thomas Bond, and Peter Fayssoux-all of whom served at one time or another in the Hospital Department during the Revolutionary War.
Care of the sick and wounded in the American Revolution was hampered by many factors. There was a scarcity of well-trained physicians; a lack of hospital facilities; an ignorance and downright carelessness regarding sanitation in camps, barracks, and military hospitals; and a shortage of medicines and surgical instruments. Few colonial doctors had earned degrees at medical schools.2 The first American medical school had opened in Philadelphia only ten years before the outbreak of the Revolutionary War. Since few Americans could afford to pursue their medical studies at Edinburgh or London, most colonial physicians received their medical education in the apprenticeship system. Indentured for three to seven years to an established doctor, the student acquired his medical knowledge by reading a few books and observing his master. Undoubtedly, much of this training was crude and inadequate. In view of the meager knowledge that many medical
1. Among those who served in the French and Indian War were John Morgan, who became Director General of the Hospital Department for the first two years of the war; John Cochran, who headed the department during the last two years of the war; and James Craik, who served throughout the war and was director of the hospital at Yorktown.
2. In eighteenth century Virginia, only about one doctor in nine had a medical degree, and according to Boorstin, that general proportion seems to have applied throughout the colonies. Daniel J. Boorstin, The Americans: The Colonial Experience (Vantage Books ed., New York, 1958), p. 233; for a general appraisal of colonial medicine, see pp. 209-39.
practitioners possessed, it is not surprising that they were not held in high esteem and that one writer expressed the view that "the quacks abound as the locusts of Egypt."3
Hospitals in colonial America were even more rare than physicians holding medical degrees. Dr. Thomas Bond founded the Pennsylvania Hospital in Philadelphia in 1751. Twenty years later a second permanent hospital opened in New York. In the absence of hospitals, a patient commonly was housed in the home of his physician. In the course of the Revolution, churches, colleges, and other public buildings were utilized as general hospitals, while private homes and barns also were frequently appropriated for hospitals. Huts and tents provided temporary hospitals in the field. Designated military hospitals, all were commonly overcrowded, inadequately ventilated, and shockingly unsanitary. Brig. Gen. Anthony Wayne in 1776 called the hospital at Ticonderoga a "house of carnage," in which the dead and dying lay mingled together.4 Dr. James Tilton, who became a physician and surgeon in the Hospital Department, was appalled by the loss of life in military hospitals. He was convinced that more men were "lost by death and otherwise wasted, at general hospitals, than by all other contingencies that have hitherto affected the army, not excepting the weapons of the enemy."5 Dr. Benjamin Rush, a prominent physician of Philadelphia who served in the Hospital Department, was equally condemnatory. "Hospitals," he wrote, were "the sinks of human life in an army." In a pamphlet published by order of the Board of War in 1777 and addressed to the officers of the Continental Army, he observed that a "greater proportion of men have perished with sickness in our armies than have fallen by the sword," and for proof he pointed to the first two campaigns of the war.6
That overcrowding of hospitals resulted in high mortality rates was a recognized fact. When Dr. John Jones, professor of surgery at King’s College, New York, published a book in 1775 on the treatment of wounds and fractures, he appended a discussion on camp and military hospitals for the use of young military surgeons. He wrote that overcrowding in London and Paris hospitals had been the main cause of the great mortality in them, and he
3. Joseph M. Toner, Contributions to the Annals of Medical Progress and Medical Education in the United States Before and During the War of Independence (Washington, 1874), p. 49.
4. Force, Am. Arch., 5th set., 3:1359 (Wayne to Pa. Committee of Safety, 4 Dec 76).
5. James Tilton, Economical Observations on Military Hospitals: And the Prevention and Care of Diseases Incident to an Army (Wilmington, Del., 1813), p. 15.
6. (1) Benjamin Rush, Medical Inquiries and Observations, 5 vols., 2d ed. (Philadelphia, 1784), 1:262. (2) Rush, Directions for Preserving the Health of Soldiers (Philadelphia, 1777), p. 3. (3) For a recent biography of Rush, see David F. Hawke, Benjamin Rush: Revolutionary Gadfly (New York, 1971).
drew pertinent lessons. He emphasized the need for cleanliness, the avoidance of overcrowding, and the importance of keeping the sick separated from the wounded in military hospitals.7 His recommendations, however, went unheeded, for the most part, by physicians in the Revolution.
Rarely was a building erected specifically to serve as a hospital during the war. An exception was the large building constructed some ten or twelve miles west of Valley Forge at Yellow Springs that served as the principal hospital unit for the camp. Later called Washington Hall, it was 106 feet long by 36 feet wide. In this three-story building, the third floor contained many small rooms; the second floor consisted of two large wards; and the first floor housed the dining room, kitchen, and utilitarian rooms. Nine-foot porches surrounded the first two stories on three sides of the building.8
A more significant exception was the specially designed experimental hospital that Dr. James Tilton constructed and used successfully at Basking Ridge near Morristown in the winter of 1779-80. Modeled "upon the plan of an Indian hut," his one-story log structure provided a three-ward hospital consisting of a large central section and two smaller wings set at right angles to the central room. The wards were separate entities, for there were no windows or doors in the walls between them. The three wards, equipped with bunks, accommodated twelve patients in the central section and eight in each wing. In cold weather a "fire was built in the midst of the ward, without any chimney, and the smoke circulating about, passed off through an opening about 4 inches wide in the ridge of the roof." The patients lay with their heads to the wall and their feet turned to the fire. The smoke, Tilton wrote, combatted "infection, without giving the least offense to the patient, for it always rose above their heads, before it spread abroad in the ward." Thus, he maintained, he had provided a small, uncrowded, completely ventilated hospital in which patients suffering from fevers could be separated from the wounded.9
More commonly, the troops constructed huts for temporary use as hospitals in the field. In April 1777 Congress provided for a flying hospital to be attached to each army. By Washington’s order the following January, the commanding generals of each division selected suitable ground near their respective brigades where hospitals, one for the sick of each brigade, were to be erected as soon as troops could be spared from work on their own huts.10
7. John Jones, Plain Concise Practical Remarks on the Treatment of Wounds and Fractures (New York, 1775), pp. 82-90.
8. James E. Gibson, Bodo Otto and the Medical Background of the American Revolution (Baltimore, 1937), p. 151. It was discontinued as a hospital late in 1781 by the Board of War.
9. Tilton, Economical Observations on Military Hospitals, pp. 49-50.
10. Fitzpatrick, Writings of Washington, 10:284 (GO, 9 Jan 78). Four days later another General Order established specifications for the hospital huts. They were to be 15 feet wide, 25 feet long, and at least 9 feet high, covered with boards or shingles. There was to be a window on each side and a chimney at one end. Two such hospitals were to be erected for each brigade, (Continued)
These small huts were used throughout the period of encampment at Valley Forge as places to treat simple ailments and as clearing houses for the seriously ill. The latter were sent to outlying hospitals as directed by officials at Yellow Springs or by Dr. James Craik, the assistant deputy director of the Hospital Department who was stationed at Valley Forge.
In the absence of hospitals, the sick were generally lodged in whatever buildings were available, though there was often opposition from local inhabitants who feared the spread of contagious fevers. An illustrative incident occurred in the spring of 1779 when Dr. Barnabas Binney was in legal possession of two churches and the courthouse at Somerset Court House, New Jersey, for use as hospitals. He considered their use, however, dangerous to the health of the men in his care. Accordingly, he followed the usual practice in such cases and applied to the civil magistrate for neighboring barns to accommodate the convalescents. The magistrate threatened "to imprison the first who shall prostitute a Barn to the use of sick Soldiers." Dr. Binney appealed to Quartermaster General Nathanael Greene for aid; otherwise, he would have to return some of the sick to camp or "let them lye in the open fields." Washington’s solution to this not unusual problem was to direct the removal of the sick from Somerset to the huts vacated by artillerymen at Pluckemin, New Jersey, when the troops marched from camp.11
(Continued) in the rear and as near the center as possible-ideally, not more than 300 nor less than 100 yards from it. 10:300 (GO, 13 Jan 78).
11. (1) APS, Greene Letters, 5:39 (Binney to Greene, 18 May 79). (2) Fitzpatrick, Writings of Washington, 15:220-21 (to Director of Military Hospitals, 3 Jun 79). (3) Doctors with the Southern Army met with the same difficulties. Magistrates would not permit quartermasters
Scarcity of Drugs and Instruments
Medical knowledge in the eighteenth century even among European physicians was not impressive. Although American doctors relied on the so-called heroic remedies of emetics, purges, and bleeding in the treatment of patients, they were inclined by necessity to use simpler remedies that utilized native herbs. Their treatments were possibly no more effective in curing their patients than those administered by their European counterparts, but "they probably interfered less with the patients’ recovery."12 As revealed in orders and correspondence, the "capital" drugs used by physicians during the war included chiefly jalap, ipecac, Peruvian bark (cinchona), calomel, and opium. Because such imported drugs were scarce and expensive, physicians made great use of native plants valuable for their medicinal qualities. These could be readily found in the woods. The first pharmacopoeia ever printed in British America was published in Philadelphia in 1778. This 32-page
to impress houses suitable for use as hospitals, and if they acted without the magistrates’ assistance, the latter threatened the officers with law suits. Greene Papers, vol. 14 (Dr. James Browne to Greene, 4 Jan 81).
12. Boorstin, The Americans, p. 214.
pamphlet, written in Latin and intended for the use of military hospitals, listed the simplest, cheapest, and most available drugs. It was compiled by Dr. William Brown, then serving at the hospital at Lititz, Pennsylvania.13
If there were few drugs used in the colonies, there was also a scarcity of surgical instruments. Among those needed by regimental surgeons were amputating and trepanning instruments, lancets, forceps for extracting bullets, incision knives or scalpels, catheters, and needles. They also required lint, rags, or linen sheets for bandages, tourniquets, and ligatures. In 1776 Director General John Morgan called upon the regimental surgeons with the main Continental army in New York to submit reports on the supplies and surgical instruments in their possession so that he could present a consolidated report to the Medical Committee of Congress. Fifteen regimental surgeons responded. All of them indicated that their surgical instruments were private property. Among them, however, they had only 6 sets of amputating instruments, 2 sets of trepanning instruments, 15 cases of pocket instruments, 4 scalpels, 3 pairs of forceps, some pins and needles, a few bandages and tourniquets, a little old linen, and two ounces of sponges-an "amazing deficiency," Morgan wrote to the Medical Committee. When he inquired of the regimental surgeons how they could think of marching so unprepared, they replied that their superior officers had said they would be supplied; if Morgan did not assist them, they did not know. how they could obtain supplies.14 Similar deficiencies were to be found among the regimental surgeons of the Northern Army and the Southern Army.
Wounds, Fevers, and Smallpox
Amputation was the one major operation performed by Continental Army surgeons. For the patient it was an excruciating experience since anesthetics had not yet been discovered. However, Dr. Tilton wrote that the longer military surgeons continued in service, the "less fashionable" amputation and cutting in general became for they learned that "limbs might be saved which the best authorities directed to be Cut Off."15 One general factor that affected the type of surgery performed in the Revolution was that fieldpieces were generally of small caliber, had a short range, and used only solid
13. (1) Joseph W. England, ed., The First Century of the Philadelphia College of Pharmacy (Philadelphia, 1922), p. 84; for a reproduction of the pamphlet, see pp. 86-94. A second edition of the pamphlet was published in 1781. (2) John W, Jordan, "The Military Hospitals at Bethlehem and Lititz During the Revolution," Pennsylvania Magazine of History and Biography 20 (1896): 137-57.
14. John Morgan, Vindication of His Public Character in Status of Director-General of' the Military Hospitals and Physician in Chief to the American Army (Boston, 1777), pp. 58-60 (to Sam Adams, 25 Jun 75 [sic]; should be. 1776). Hereafter cited as Morgan, Vindication.
15. (1) Tilton, Economical Observations on Military Hospitals, p. 62. (2) For the general state of military surgery in 1775, see Jones, Plain Concise Practical Remarks on the Treatment of Wounds and Fractures.
shot and grape. Most wounds consequently were caused by musket balls rather than artillery missiles.16
Since the Hospital Department developed no regular system for collecting soldiers wounded in battle, the seriously wounded often lay unattended for days. When finally delivered to a hospital after a jolting ride in an uncovered wagon, pure chance dictated whether a soldier would recover from his wounds or fall victim to the contagious fevers that swept through the hospitals with disastrous consequences to patient, doctor, and attendant alike. The most feared disease was "putrid fever"-also called hospital, camp, or jail fever-which included typhoid as well as typhus.17 The two other principal diseases affecting the Revolutionary soldier were dysentery and smallpox. The latter was the one infectious disease that the physicians of the Revolution understood and could combat with some success. Until inoculation was ordered for all soldiers who had not had the disease, however, it caused great havoc in the Continental Army and influenced the result of some campaigns.
Smallpox was a major factor, for example, in the failure of the Quebec campaign. As soon as he arrived at the camp before Quebec in May 1776, Maj. Gen. John Thomas examined the state of the troops. Of 1,900 men, 900 were down with smallpox, and he would die of the disease himself.18 "Our misfortunes in Canada are enough to melt the heart of a stone," John Adams wrote on 26 June. "The small-pox is ten times more terrible than Britons, Canadians, and Indians together. This was the cause of our precipitate retreat from Quebeck." In violation of orders, many soldiers had inoculated themselves, hoping to prevent an attack of the disease, but inadvertently at the same time they had spread the disease. Smallpox also accounted for the great mortality of the troops as they fell back to Crown Point and then to Ticonderoga in May and June 1776. Adams summed up the situation early in July 1776.
"Our Army at Crown-Point is an object of wretchedness enough to fill a humane mind with horrour; disgraced, defeated, discontented, dispirited, diseased, naked, undisciplined, eaten up with vermin; no clothes, beds, blankets; no medicines; no victuals, but salt pork and flour."19
The ravages of smallpox in the Northern Army and also in Washington's army in 1775-76 materially reduced the number of available troops, and fear of the disease discouraged recruiting. Official action to inoculate the whole Continental Army was delayed because differences of opinion had long existed
16. Louis C. Duncan, Medical Men in the American Revolution (Medical Field Service School, Carlisle Barracks, Pa., 1931), p, 12.
17. Tilton, Economical Observations on Military Hospitals, pp. 56-61.
18. Force, Am. Arch., 4th set., 6:453-54 (Thomas to Washington, 8 May 76).
19. (1) Ibid., 4th set., 6:1083 (26 Jun 76); 5th set., 1: 103 (7 Jul 76). (2) One writer has claimed that smallpox was the main factor that kept Canada from failing to America. Hugh Thursfield, ‘Smallpox in the American War of Independence," Annals of Medical History, 3d ser., 2 (1940): 315.
on the subject. In some colonies inoculation was practiced; in others it was prohibited by law. On 6 January 1777, immediately after Washington had established his headquarters at Morristown, he directed Dr. William Shippen to attack the problem of smallpox by inoculating all the troops. The Commander in Chief then revised these instructions, making them applicable only to recruits who had never had smallpox. Some weeks later Congress also sought a solution. On 12 February it directed the Medical Committee to consult with Washington on "the propriety of causing such of the troops of his army, as have not had the small-pox to be inoculated and recommended that measure to him," and on 23 April it authorized Dr. Tilton to go to Dumfries, Virginia, to take charge of the inoculation of all recruits coming from the south.20 He set up inoculation stations and infirmaries at Dumfries, Alexandria, and Fairfax, Virginia. In 1777 compulsory inoculation of recruits became routine. While it did not entirely free the Continental Army from smallpox, the disease never again caused the losses that were suffered in 1775-76.
In making preparations for possible conflict with the mother country, the provincial congresses and committees of safety were aware that medical supplies would be needed to care for the sick and wounded. On 24 February 1775, for example, the Massachusetts Committee of Safety directed a committee of six, including Dr. Joseph Warren and Dr. Benjamin Church, to inquire where and on what terms medical chests might be obtained for its regiments, which each had a surgeon and a surgeon’s mate. About ten days later the committee voted to place 500 pounds in the hands of the two doctors to enable them to purchase such medical supplies for the medicine chests as could not be procured on credit.21 Available medical supplies were limited, and in June there were still not enough medicine chests to provide one to each regiment. Consequently, the Massachusetts Provincial Congress directed its Committee of Supplies to furnish one to the surgeon of the regiment at Cambridge and another to the surgeon of the regiment at Roxbury. It instructed all other army surgeons to apply to these two surgeons for medical supplies until more ample provision could be made. The scarcity of medicines was such that the Committee of Safety in May had directed John Thomas, who was then a general of the Massachusetts forces and who had been a doctor at Marshfield in private life, to dole out the medicines for the sick at Roxbury until the surgeons were supplied.22
20. (1) Fitzpatrick, Writings of Washington, 6:473-74 (6 Jun 77). (2) JCC, 7:110, 292. (3) Burnett, Letters, 2:249 (Medical Committee to Washington, 13 Feb 77). 21. Force, Am. Arch., 4th ser., 1: 1369 (24 Feb 75); 1370 (7 Mar 75). 22. Ibid., 4th set., 2:756 (13 May 75); 1404 (12 Jun 75).
The events at Lexington and Concord led the Massachusetts Provincial Congress to establish the first general hospital in the war. On 29 April 1775 it directed and empowered Dr. Isaac Foster to move all sick and wounded, then under the care of regimental surgeons, to a hospital if they could be moved. It selected three houses in Cambridge for what was in effect a general hospital. The Provincial Congress also authorized Dr. Foster to supply beds and bedding, clothing, food, furniture, and the like. He was to draw these supplies from Andrew Craigie, whom the Massachusetts Committee of Safety had appointed commissary of medical stores. The committee had directed Craigie to impress beds, bedding, and other necessaries, giving the owners receipts for the articles taken.23 By July many complaints were being made about the lack of medicines, the controversy between the hospital and the regimental surgeons, and the consequent disorder in the department. A director was needed, authorized to supervise and control the general hospital, the regimental hospitals, and all the doctors. The Massachusetts Provincial Congress was moving toward the appointment of such an officer when Washington arrived at Cambridge to assume command of the troops on 3 July 1775. It then referred the problem to him, submitting for his consideration the resolutions it had formulated for improving the department.24
First Organization of the Hospital Department
After Washington inspected the camp and the fortifications at Cambridge, he examined the hospitals. On 20 July 1775 he informed the President of the Continental Congress that there was neither a principal director nor any subordination among the surgeons. He considered it essential to introduce some system. On 19 July Congress had already appointed a committee of three, not one of whom was a doctor, to report on establishing a hospital department.25 Eight days later, following a debate on the committee's report, Congress established the Hospital Department to support an army of 20,000 men. To head the department it provided a Director General and Chief Physician, who was paid 4 dollars a day. He furnished and paid for all medicines, bedding, and other necessaries; superintended the general hospital; and reported to and received his orders from the Commander in Chief. The personnel of his department initially included 4 surgeons and an apothecary, each paid 1 1/3 dollars a day, as well as 20 surgeon’s mates and a clerk, each paid two-thirds of a dollar per day. The surgeons, mates, and apothecary visited and attended the sick. In addition, the department employed 4 storekeepers, each paid 4 dollars a month; one nurse for every 10 sick soldiers, paid one-fifteenth of a dollar a day or 2 dollars a month; and occasional laborers as
23. Ibid., 4th ser., 2:748 (29 Apr 75); 756 (14 May 75).
24. Journals of Each Provincial Congress of Massachusetts, pp. 455-56.
25. (1) Fitzpatrick, Writings of Washington, 3:350 (20 Jul 75). (2) JCC, 2:191.
required. The storekeepers received and delivered bedding and other supplies on the Director General’s orders; the clerk kept the accounts of the Director General and the storekeepers; and a matron, though not included in the personnel or pay specified, supervised the nurses. Congress elected Dr. Benjamin Church as Director General and Chief Physician of the Hospital Department, leaving it to him to appoint the four surgeons, the apothecary, the clerk, the storekeepers, and the nurses. It authorized the surgeons to appoint the mates, whose number fluctuated according to need.26
As in the case of other supply services, the Continental Congress provided an unsatisfactory skeletal organization for the Hospital Department, anticipating that the Director General would modify it on the basis of experience. This first. regulatory measure simply designated the personnel of the department and prescribed their duties and pay. It attached no military rank to the positions to be filled-and, in fact, never did so during the war. In establishing the Hospital Department, Congress made no mention of regimental surgeons and their mates, though both continued to be carried on Continental Army rolls. Four months elapsed before Congress, on 8 December 1775, authorized a surgeon for each regiment in Continental service, with a pay of 25 dollars a month. Not until March of the following year did it provide for a surgeon’s mate for each regiment, who was to be paid 18 dollars a month.27 At the same time, Congress resolved that suitable surgical instruments were to be purchased with each medicine chest. This resolution was admirable, but months later regimental surgeons were by no means well equipped. The director of the hospital for the army in the Northern Department reported that a majority of regimental surgeons had gone to Canada with neither medicines nor instruments.28 One is left to wonder how useful they could have been in preserving the health of the troops.
Dr. Church did little to improve the operations of the Hospital Department, and the controversy between staff and regimental surgeons persisted. Within little more than two months after his appointment, he was arrested for carrying on a correspondence with the enemy and convicted by a general court-martial. Washington laid the findings before Congress and directed Dr. Isaac Foster to superintend the Hospital Department until further orders.29 On 17 October 1775 Congress elected Dr. John Morgan of Philadelphia to succeed Dr. Church as Director General and Chief Physician of the Hospital Department in Massachusetts Bay.30
26. Ibid., 2:209-11 (27 Jul 75).
27. Ibid., 3:416 (8 Dec 75); 4:242-43 (30 Mar 76). The regimental surgeon’s pay was increased to 331A dollars a month on 5 June 1776; see 5:419.
28. Force, Am. Arch., 4th ser., 6:417-18 (Dr. Samuel Stringer to Washington, 10 May 76).
29. (1) For the arrest and conviction of Dr. Church, see ibid., 4th ser., 3:958-60,
1159-60, 1466, 1477, 1479-87, 1489-98, 1512, 1517-18, 1636. (2) Fitzpatrick, Writings of Washington, 4:2 (GO, 3 Oct 75); 9-13 (to Pres of Cong, 5 Oct 75).
30. (1) JCC, 3:294-95, 297 (14 and 17 Oct 75). (2) See Whitfield J. Bell, Jr., John Morgan, Continental Doctor (Philadelphia, 1965).
On 14 September the Continental Congress had appointed a committee to devise ways and means of supplying the troops with medicines.31 It thereby created what became known as the Medical Committee. Until the spring of 1781 this committee actively engaged in the domestic purchase of medical supplies, the delivery of these supplies to the armies, the reorganization of the Hospital Department, and the supervision of all matters pertaining to that department and its personnel. On 28 May 1781 Congress discontinued the Medical Committee and directed that all its returns and papers were to be turned over to the Board of War.32 The latter was vested with all the powers formerly exercised by the Medical Committee. This authority was short-lived; before the end of that year the Board of War also was discontinued. For the remainder of the conflict Congress vested all the board's powers, including supervision of the Hospital Department, in the Secretary at War.
In the summer of 1775, shortly after Maj. Gen. Philip Schuyler took command in the Northern Department, he wrote the President of the Continental Congress that he had appointed Dr. Samuel Stringer of Albany to take charge of a hospital and care for the large number of sick in his command. He had promised Stringer that the Continental Congress would allow him the same, pay as was given the Director General of the Hospital Department with Washington’s army.33 On 14 September Congress confirmed Stringer’s appointment as director of the hospital, chief physician, and surgeon for the army in the Northern Department, at a pay of 4 dollars a day. It authorized him to appoint, depending on the need, as many as four surgeon’s mates, at two-thirds of a dollar a day. Congress directed that in this instance the deputy commissary general was to pay Dr. Stringer for such medicines as he had purchased for the Northern Army, and in future the deputy was to purchase and forward such other medicines as General Schuyler directed.34
These resolutions did not clarify the relationship between Dr. Stringer and the Director General of the main Continental army. The failure of Congress to define the relative authority of each man, together with the fact that Dr. Stringer's commission antedated that of Dr. Morgan, furnished an excuse for constant controversy. Dr. Stringer's efforts were directed toward acquiring sufficient authority to operate independently of Dr. Morgan. The latter, supported by Washington, Was of the opinion that all the various parts of the Hospital Department should be subordinated to the control of the Director General.
31. JCC, 2:249-50; for later changes in the committee’s membership, see 6:1064; 9:1079.
32. Ibid., 20:570.
33. Force, Am. Arch., 4th ser., 3:443 (Schuyler to Stringer, 27 Aug 75).
34. JCC, 2:249-50 (14 Sep 75).
On 18 May 1776 Congress appointed Dr. William Rickman as director and chief physician of the Hospital Department in Virginia. The personnel of his department included two surgeons and one apothecary, appointed by the director, and six mates, appointed by the surgeons. In addition, Congress authorized employment of one clerk, one storekeeper, a nurse for every ten sick soldiers, and laborers when necessary. Congress again made no specific mention of the relationship between Dr. Rickman and Dr. Morgan. However, since its resolution indicated that the department in Virginia was to be "on the same establishment’ as that under Morgan in the Eastern Department and that its officers were to be paid the same, it apparently had no intention of giving the Director General overall control.31 Certainly, Dr. Rickman did not consider his department subordinate to, or under the direction of, Dr. Morgan, and he acted accordingly.
Regimental Versus General Hospitals
A problem of more immediate urgency to Director General Morgan than departmental control was one that had developed under his predecessor, stemming from action taken by the Massachusetts Committee of Safety. Early in May 1775 the latter had approved a report "that great uneasiness may arise in the Army by the appointment of Surgeons who may not be agreeable to the Officers and Soldiers in their respective regiments." In consequence, the Provincial Congress voted to allow the colonel of each regiment to nominate his regimental surgeon.36 In establishing a Hospital Department for the Continental Army, Congress initially not only failed to mention regimental surgeons and mates but made no provision for regimental hospitals. Many members of Congress must have agreed with Elbridge Gerry that regimental hospitals were unnecessary institutions as well as a dead weight when an army moved.37 Yet many regimental surgeons had established such hospitals for their own men. Such a hospital was merely a house, barn, or shed in which the sick of a regiment were collected. They brought with them their own blankets, which were spread on straw, and drew their regular rations. Since the ration often was not suitable for a sick soldier, the regimental surgeons regularly applied to the general hospital for appropriate subsistence. They soon contended that under Dr. Church’s administration they could not get suitable supplies. Dr. Church viewed regimental hospitals as highly expensive, wasteful, and generally unnecessary; when a soldier was too sick to be cared for in camp, the Director General thought, he ought to be sent to the general hospital. The regimental surgeons, of course, disagreed, and they tended to evade the authority of the Director General by
35. Ibid., 4:364-65.
36. Journals of Each Provincial Congress of Massachusetts, pp. 538, 203 (7 and 8 May 75).
37. Pennsylvania Packet, 17 Jun 79 (Gerry to Morgan, n.d.).
appealing to the authority of the regimental officers who had nominated them.
The complaints on each side grew in volume, and the controversy reached such a level that on 7 September 1775 Washington ordered each brigadier general and the commanding officers of the regiments in his brigade to sit as a brigade court of inquiry into the complaints. He directed them to summon the Director General and the regimental surgeons of the brigade and to report their findings to him. Washington agreed with the Director General that when a soldier was so sick that he could not be left in camp, he should be sent to the general hospital. There was no need for regimental hospitals when a well-equipped general hospital was near.38
The brigade courts of inquiry agreed with Washington, but shortly thereafter Dr. Church was arrested and removed as Director General. Dr. John Morgan, his successor, was an able administrator, and he immediately set about introducing a more systematic management of the department. Having heard that the regimental surgeons had made enormous requests for expensive subsistence items for special diets, he limited their demands to such articles as Indian meal, oatmeal, rice, barley, and molasses. When their sick required other supplies, they were to be sent to the general hospital, where such supplies would be issued under his direction. He then instituted an examination of the surgeon’s mates in the general hospital to determine their abilities. At Washington’s order, he planned to extend the examination to all regimental surgeons and mates. The opposition of the regimental surgeons to such an examination, the intercession of their colonels, and the movement of the main army to New York in April more or less halted this effort.39
Dr. Morgan’s difficulties with the regimental surgeons increased. He conferred with them in New York early in the summer of 1776 and drew up instructions covering their duties, particularly in case of action. Washington approved of these instructions and directed each regimental surgeon to conform to them.40 At the same time, Morgan proposed a number of regulations that not only included the duties of the regimental surgeons but also governed the establishment and operation of occasional regimental hospitals and the supply of special subsistence stores to them. The regimental surgeons agreed to these regulations, which were submitted to the Continental Congress for its approval. At Morgan’s suggestion, the regimental surgeons drafted a memorial to Congress asking that it also take their particular problems under consideration.41
38. Fitzpatrick, Writings of Washington, 3:480-81 (GO, 7 Sep 75).
39. Morgan, Vindication, pp. 2-3 (memorial, Morgan to Washington, I Feb 77).
40. (1) Fitzpatrick, Writings of Washington, 5:213 (GO, 3 Jul 76). (2) Pennsylvania Packet, 19 Jun 79 (Morgan to Sam Adams, 25 Jun 76).
41. Force, Am. Arch., 5th set., 1:108-09 (regulations, - Jul 76); 694-96 (memorial, Jul 76).
Congress never ratified Morgan’s proposed regulations, and whatever hopes for modifications the regimental surgeons had entertained were soon shattered. On 17 July 1776 it passed resolutions that greatly disturbed the regimental surgeons and alarmed the Director General. To prevent losses, Congress provided for inspection of the regimental chests of medicines and surgical instruments by the directors of hospitals and by the Director General. Furthermore, from time to time the regimental surgeons were required to present an account of these medicines and instruments to the hospital directors or, if there was no director in a particular military department, to the Director General for transmittal to Congress. In addition, Congress ordered that when a regiment was reduced in size, the medicines and instruments not needed by the regimental surgeon were to be returned to the hospital director and an account was to be submitted to the Director General, who in turn was to send it to Congress. Of greatest concern to the regimental surgeons was the resolution that prohibited them from drawing upon the general hospital of their military department for such subsistence stores as were necessary in diets for the sick. When sick persons required these stores, Congress ordered, they were to enter the general hospital. Congress added that their regular rations were to be stopped as long as they remained in that hospital; it thereby eliminated the drawing of rations twice, a practice that had grown into an abuse that both the Commander in Chief and Congress felt had to be corrected.42
The regimental surgeons sent a memorial to Washington protesting that these resolutions vested in the surgeon of the general hospital the sole right of judging whether a patient was fit to be moved from a regimental to a general hospital. The regimental surgeon, they argued, was in an equal if not better position to make such a determination in regard to his patient. They asked the Commander in Chief to redress their grievances.43 In the meantime, Morgan had already advised Washington of their reaction. As the resolutions stood, the regimental surgeons complained, they could not supply the sick under their care with the necessary items of special diets, and they would have no other recourse except to send all their sick to the general hospital. Such action, Dr. Morgan explained, would overtax the facilities of the main army's general hospital. ‘Instead of about 300 which is the present number of sick in the General Hospital, it would immediately amount to 2,000 or upwards, and the number would increase every day." He suggested that Washington either approve the regulations formulated earlier in the conference between the Director General and the regimental surgeons, or let the regimental surgeons keep those of their sick who had "putrid or infectious distempers" in the regimental hospitals while their names were borne on the list of patients admitted to the general hospital. Their regular rations would therefore stop, and in their place the general
42. JCC, 5:568, 569 (17 Jul 76).
43. Force, Am. Arch., 5th ser., 1:695-96 (31 Jul 76).
hospital would furnish, as its means allowed, such subsistence stores as wine, molasses, and meal. This procedure would eliminate the abuse of drawing rations twice.44
By the fall of 1776 this impasse showed no sign of being resolved, for Maj. Gen. Nathanael Greene wrote that "the sick of the Army, who were under care of Regimental Surgeons are in a most wretched condition." They were too numerous to be accommodated in the general hospital, but at the same time the Director General claimed that he had no authority to supply their needs: "The general hospital being too small to accommodate much more than half, the remainder lies without any means of relief than the value of the rations allowed to every soldier. Many hundreds are now in this condition and die daily for want of proper assistance; which means the Army is robbed of many valuable men at a time when reinforcements are so exceedingly necessary." Some measure, Greene urged, should be taken to confer authority on the Director General to furnish the regimental surgeons with such supplies as the sick needed. As to the Director General’s insistence that his supply of medicines was barely sufficient for the general hospital, Greene could "see no reason either from policy or humanity, that the stores for the General Hospital should be preserved for contingencies which may never happen and the present regimental sick left to perish for want of proper necessities." It was wholly immaterial, in Greene’s opinion, "whether a man dies in the General or Regimental Hospital."45
Washington at this time had little sympathy for the regimental surgeons. Many of them, in his view, were "great rascals countenancing the men in sham complaints to exempt them from duty and often receiving bribes to certify indispositions with a view to secure discharges or furloughs." In numerous instances they had drawn medicines and stores in the "most profuse and extravagant manner for private purposes." As long as they were independent of the Hospital Department, the bickering between them and the Director General would continue. He thought that Congress ought to authorize regular examinations of the regimental surgeons, who, if not appointed by the Director General and surgeons of the Hospital Department, ought nonetheless to be subordinate to, and governed by the instructions of, the Director General.46 In response, Congress recommended that the states appoint skilled practitioners to examine those offering to serve as surgeons or surgeon’s mates. Only on production of an examiner’s certificate would the applicant receive a commission or warrant. It ruled that all surgeons and mates, whether in regiments or in general hospitals, were to be subject to the direction and control of the directors of hospitals (including the Director General with the main army) in the several military departments.47
44. Ibid., 5th set., 1:416-17 (Morgan to Washington, 18 Jul 76).
45. Ibid., 5th set., 2:973-74 (Greene to Pres of Cong, 10 Oct 76).
46. Fitzpatrick, Writings of Washington, 6:113 (to Pres of Cong, 24 Sep 76).
47. JCC, 5:836-37 (30 Sep 76).
In January 1777 Washington sent John Cochran, a volunteer doctor who had much impressed him, to consult with Dr. William Shippen on improving arrangements in the Hospital Department. He instructed them to include plans for a "flying hospital" for his army in the field. Both doctors considered a flying hospital a necessity and proposed that it consist of a director, Who on occasion would act as a surgeon and physician.; two surgeons; four surgeon’s mates; a steward; and male or female nurses.48 In the spring of 1777 Congress then passed a new regulatory measure for the Hospital Department that provided for one physician and surgeon general for each separate army to head a flying hospital. Though this officer was subject to the orders and control of the Director General and the deputy director general of the district (as the military department was called in the Hospital organization) in which he acted, Dr. James Tilton later complained that the flying hospitals remained a kind of separate department to the end of the war.49
Each physician and surgeon general of a separate army superintended the regimental surgeons and mates and heard all complaints against them. He reported offenders to the Director General or, in his absence, to the deputy director, or in the absence of both from the army concerned, to the commanding officer, so that they might be brought to trial by court-martial. The physician and surgeon general was to receive from the Director General or deputy a suitable number of large strong tents, beds, bedding, medicines, and hospital stores for the sick and wounded who could not be moved to the general hospital. When any of the sick under his control were to be conveyed to the general hospital, the Director General or deputy were to supply him with wagons and drivers. He appointed such number of surgeons, nurses, and orderlies as the Director General or deputy judged necessary, plus a steward to receive and dispense such articles of diet as the Director General or deputy ordered to be given to him by the commissary of the army or the Hospital Department. The surgeons made daily returns to the physician and surgeon general of each army of all the sick and wounded who had been moved to the general hospital, all who remained in hospital tents, all who had become fit for duty, all who were convalescent, and all who had died. In turn, the physician and surgeon general submitted weekly returns to the Director General or deputy. In time of action or other emergency when there were insufficient regimental surgeons to care for the sick and the wounded who could not be removed to a general hospital, the Director General or the deputy of the district, at the request of the physician and surgeon general of the army, were to send as many physicians and surgeons from the general hospital as could be spared. Congress filled the newly created posts by
48. (1) Fitzpatrick, Writings of Washington, 7:44-45 (20 Jan 77). (2) Washington Papers, reel 39 (Shippen and Cochran to Washington, 31 Jan 77). (3) For Cochran, see James Thacher, American Medical Biography, 2 vols. (1828; Da Capo Press reprint, 1967), 1:227.
49. Tilton, Economical Observations on Military Hospitals, p. vi.
electing Dr. John Cochran, Dr. William Burnett, and Dr. John Bartlett for the armies, respectively, in the Middle, Eastern, and Northern Departments.50
The new arrangements, however, did not resolve the friction between the Hospital Department and the regimental surgeons. A year later when the main army lay at Valley Forge, Washington advised a congressional committee that "they seem always to be at variance." The regimental surgeons still complained that lack of medicines and other necessaries prevented them from giving assistance both in slight cases and in the first stages of more dangerous complaints when immediate attention could save lives. On the other hand, the Hospital Department continued to maintain that its stores were not sufficient to meet the excessive drafts made by regimental surgeons. Washington thought it was surely possible to fix some general rule for regulating the supplies allowed to regimental surgeons. Since care of the sick was the first consideration, the regimental surgeons ought not to be left destitute of a reasonable quantity of medicines. He pointed out that the consequences were serious. The regimental surgeons either had to send men who were only slightly ill to distant hospitals, thus depriving the Continental Army of the services of many who could have been restored to health in a day or two if the means bad been at hand, or they had to keep them until their diseases got beyond the power of cure. Moreover, sending so many men away to a distance from an army, Washington explained, also led to desertions and to waste of arms and clothing.51 In 1779 Washington returned to the failure to allow regimental surgeons adequate supplies to care for the sick. He advised a congressional committee that it would be helpful "if a little more latitude were granted to the Regimental Surgeons" under the supervision of the head of the flying hospital.52
The field organization remained unchanged until the last year of the war except for one modification in procedure that was introduced in September 1780. In its regulations Congress authorized the Director General to instruct the purveyor and the apothecary to supply the regimental surgeons with such medicines and "refreshments" as were needed for the sick and wounded before their removal to a general hospital. These supplies were dispensed under the direction of the chief physician and surgeon of the army. After 1780 the latter drew and received from the purveyor the tents, beds, bedding, and hospital stores he needed, and from the apothecary or his assistant, suitable medicines for men who could not be removed safely to the general hospital-or who might quickly be restored to fitness for duty. At the same time, Congress retained Dr. John Cochran as chief physician and surgeon of the army until he succeeded Dr. William Shippen as head of the Hospital
50. JCC, 7:235-36, 244-54 (7, 8, and 11 Apr 77).
51. Fitzpatrick, Writings of Washington, 10:394-96 (to committee, 29 Jan 78).
52. Washington Papers, reel 55, set. 4 (to committee, 8 Jan 79).
Department fifteen months later.53 "On 3 March 1781 it then elected Dr. James Craik to fill the post of chief physician and surgeon of the army. Less than a year later it extended the Director’s authority to all military hospitals, including those in camp, and thereby eliminated the position of chief physician and surgeon of the army.54
With the removal of the main Continental army to New York in April 1776, problems of departmental authority and responsibility increased as the relationship between Dr. Stringer in the Northern Department and Director General Morgan remained unclarified. When Dr. Stringer received orders to support operations in Canada with the hospital under his direction, he laid before General Schuyler the state of his establishment. It consisted of himself, four surgeon's mates, and a clerk. Having failed in an earlier attempt to receive authorization to enlarge his staff, Stringer now submitted to Washington an estimate of the additions he would need to execute the orders of Congress. This increase included 4 senior surgeons, 12 mates, 1 matron, 1 or 2 clerks, and 1 or 2 stewards, as well as apothecaries, laborers, cooks, and other servants. He also enclosed a list of required medicines that he wanted the Director General to furnish. Washington advised Stringer that he would send his request for personnel to Congress and that be would direct Dr. Morgan to send such medicines as he could spare. Congress approved Stringer’s petition on 22 May 1776 and shortly thereafter assigned Dr. Jonathan Potts of Reading, Pennsylvania, as physician and surgeon in Canada or at Lake George, depending on Schuyler’s direction.55
The state of the Northern Army was deplorable; some 3,000 men were sick. When Dr. Potts set out with Maj. Gen. Horatio Gates on 24 June, be brought with him a large chest of medicines that the Director General had supplied. Uncertain of the authority that Congress had granted to Dr. Potts and Dr. Stringer and of his own responsibility for supplying them with medicines, Dr. Morgan went to Philadelphia and conferred for three days with the Medical Committee. He returned to New York convinced that the entire Hospital Department was under his direction and that neither Potts nor Stringer had power to appoint surgeons to act under them. Morgan requested that the number of surgeons and other personnel in the Hospital Department be augmented, and when Congress authorized an increase on 17 July 1776, he sent sufficient medicines for six more regimental medicine chests to the
53. (1) F or the 1780 regulations, see below, "Elimination of the District Organization." (2) JCC, 18:908 (6 Oct 80). Cochran accepted his appointment by letter on 3 February; see 19:160 (19 Feb 81).
54. Ibid., 19:230 (3 Mar 81); 22:4-7 (3 Jan 82).
55. (1) Force, Am. Arch., 4th ser., 6:417-18 (Stringer to Washington, 10 May 76); 469-70 (reply, 15 May 76). (2) JCC, 5:424 (6 Jun 76).
Northern Department. Morgan also appointed a surgeon to assist in the care of the sick and an apothecary to dispense those medicines, although he wrote that later certain congressional delegates intimated that "those gentlemen who were appointed to the northward, by any other authority than of the Congress, might look for their pay where they could get it."56 Meanwhile, on 24 July Dr. Stringer at Fort George advised General Gates that he was faced with both a great increase in the number of sick and a lack of assistants and medicines. The only medicines that had arrived, he claimed, were the small amounts brought by Dr. Potts. He proposed to leave Potts in charge while he went to lay the situation before Congress in person.57
Congress was in session when Stringer arrived at Philadelphia to obtain the needed supplies and to strengthen his authority. It referred his petition to the Medical Committee. On the basis of the committee’s report, Congress resolved that Dr. Morgan was Director General and Physician of the hospital with the main Continental army while Dr. Stringer was director and physician of the hospital in the Northern Department. It added that every director of a hospital possessed the exclusive right of appointing surgeons and hospital officers of all kinds in his own department unless otherwise directed by Congress. While this resolution did not define the relationship between the two men in detail, it did settle the question of authority over appointments. Dr. Stringer at once refused to recognize the assignments made by Dr. Morgan and promptly dismissed Dr. James McHenry, whom the Director General had appointed as assistant to Dr. Potts with directions to proceed to Philadelphia to purchase supplies for the hospitals in the Northern Department.58
General Gates was under the impression that he had granted Dr. Stringer permission on 29 July to go to New York to procure medicines. He was incensed when he learned on 24 August that Stringer "is gone a preferment hunting to the Congress at Philadelphia" while the troops were still suffering greatly for lack of medicines. He wanted the matter brought to Washington's attention and medicines sent to Dr. Potts at Lake George. Dr- Morgan received a copy of this letter; he could do little, though he did send a large assortment of medicines. He wrote to Gates that on 17 July Congress had empowered the directors of hospitals, with the approval of the commander of their respective departments, to purchase medicines and surgical instruments, and the Northern Army therefore was not dependent on him for its supplies.59
56. Force, Am. Arch., 5th ser., 1:919-21 (Morgan to Pres of Cong, 12 Aug 76). (2) JCC, 5:568-71 (17 Jul 76). (3) See also RG 11, CC Papers, reel 5 1, item 4l, 6:3 (same to same, 18 Jun 76).
57. Force, Am. Arch., 5th ser., 1:651-53 (Stringer to Gates, 24 Jul 76).
58. (1) JCC, 5:661, 673 (16 and 20 Aug 76). Though Congress designated Morgan’s hospital as the "American hospital," it obviously meant that new title to mean the hospital serving the main Continental army. (2) Dr. Jonathan Potts Papers, 1:90 (James McHenry to Potts, 21 Aug 76), Pa. Hist. Society. Hereafter cited as Potts Papers. McHenry was left to wonder who was to pay the expenses he had incurred in providing medicines that Potts had requested him to procure.
59. Force, Am. Arch., 5th ser., 1: 1114 (Gates to Egbert Benson, 22 Aug 76); 2:106-07 (Morgan to Gates, 1 Sep 76).
Procurement of Hospital Stores
In establishing the Hospital Department in 1775, Congress made it the duty of the Director General to furnish and pay for all medicines, bedding, and other necessaries. He was responsible for providing not only the drugs and surgical instruments but also the various utensils, the bedticks (coarse linen sacks into which straw was stuffed to form a mattress), and the blankets needed in a hospital, as well as the items required in special diets that the regular ration did not provide. These special subsistence items-sometimes referred to as "necessaries" and more often as "hospital stores" included such supplies as tea, coffee, sugar, chocolate, milk, raisins, barley, oatmeal, and particularly wine, which was generally considered "a capital remedy in any stage of typhus."60 During the first two years of the war, the Commissary Department purchased these supplies for the Hospital Department. In 1775 Commissary General Joseph Trumbull included "30 pipes Teneriffe wine," 100 casks of raisins, and 100 barrels of oatmeal as hospital stores in an estimate he prepared for subsisting an army of 22,000 men for a 7-month period. In addition to providing hospital stores to the general hospital in the Cambridge area and to such hospitals when they were set up in New York, Trumbull and his deputies supplied various hospital stores to the general hospital in the Northern Department.61
If any procurement records were maintained by the Hospital Department during the Revolutionary War, they no longer exist. In consequence, one can gain only a general idea from various other sources of how procurement was handled. According to Commissary General Trumbull, for example, Col. Samuel H. Parsons initiated a practice in the summer of 1775 that resulted in his sick being well provided with appropriate subsistence stores. Under Parsons’ orders, when a soldier became sick, his regular ration was stopped and its monetary value was used to provide the special diet the soldier needed during his illness. Director General Morgan thought so well of this practice that he called it to Washington’s attention in February 1776.62
In July the Commander in Chief ordered that whenever a soldier became sick, he was not to be carried on the provision return. Instead, the value of his ration was to be paid to the Director General, who was to use the money to provide a suitable diet for the soldier if he was lodged in, a general hospital. For the sick soldier in a regimental hospital, the surgeon of the regiment was to draw appropriate supplies from the general hospital, in conformity with the rules of diet established there.63 The regimental surgeons, however, continued
60. Tilton, Economical Observations on Military Hospitals, p. 59.
61. (1) Force, Am. Arch., 4th set., 3:1045 (estimate, _ Oct 75). (2) Potts Papers, 1:0-58 (James Bates to Potts, 25 Jun 76); 71 (Walter Livingston to Potts, 9 Jul 76).
62. John Morgan, Vindication, p. 38.
63. Fitzpatrick, Writings of Washington, 5:345 (GO, 28 Jul 76).
to protest that they could not obtain the necessary stores for their sick.
When the Continental Congress enacted a regulatory measure for the Hospital Department in April 1777, it vested all procurement responsibility, including the provision of hospital stores, in the Director General. In his absence, the deputy director generals supervising hospitals in the Northern Department (Northern District) and those in the hospital district east of the Hudson were each responsible for providing such stores. At the same time, Congress provided for a commissary of hospitals in each district who procured, stored, and delivered provisions, forage, and other articles in accord with the orders of the Director General. Congress directed that in making his purchases, the commissary of hospitals was to consult frequently with the Commissary General and the Quartermaster General so that the prices he gave for supplies and transportation would be consistent with those given by the agents of those two departments.
The Director General retained these broad procurement powers for less than a year. Early in 1778 Congress divested him of all procurement authority.64 Thereafter the deputy director general in a district was responsible for supervising and directing procurement of hospital stores and all other medical supplies. Congress called Dr. Jonathan Potts from the Northern Department to take charge of procurement for the general hospitals in the Middle District. Subsequently, it applied the term "purveyor" to this office.
When Dr. Potts assumed his duties in the Middle Distfict in the winter of 1777-78, reserves of hospital stores were as depleted as rations for the troops. Since his hospital commissaries found themselves in competition with the purchasing commissaries of the Commissary General, Potts sought to develop a working arrangement with Ephraim Blaine, then deputy commissary general of purchases in the Middle Department. Blaine was quick to point out that the hospital commissaries were failing to provide the needed provisions. Though it was not his duty to furnish provisions for hospitals, he added, he had nevertheless helped to supply them. However, if Potts wanted his continued assistance, he would have to dismiss his purchasing agents, whose activities, Blaine charged, had only served to raise prices by 10 percent. Blaine wrote that he would undertake to work out with the Commissary General a method of providing the Hospital Department with a regular supply.65
In time the hospital commissaries adopted the procedure of applying to the issuing commissaries of the Commissary Department at their stores or magazines for rations or parts of rations. Some difficulties arose because hospitals could not always be located near an issuing commissary’s store. In the summer of 1779 Washington directed Commissary General Jeremiah
64. JCC, 10: 128 - 31 (6 Feb 78).
65. Potts Papers, 4:461 (Blaine to Potts, 2 May 78).
Wadsworth to make certain that he supplied such hospitals.66 By the beginning of 1780 hospital commissaries could obtain rations only by presenting a return to the issuing commissary countersigned by the principal physician or surgeon of the hospital for which the supplies were needed. The purveyor furnished funds to the hospital commissaries to procure locally such subsistence items as milk and vegetables.67 By 1780, however, the funds at the disposal of the Treasury Board were so limited that the procurement operations of the Hospital Department were as hampered as those of any other supply department. When subsistence supply was thrust upon the states under the system of specific supplies, the sick and wounded fared as badly as the regular troops. The congressional committee at headquarters in May 1780 advised the President of Congress that the hospitals were destitute of all necessaries for the sick. In March Dr. John Cochran, then chief physician with the main army in the field, had complained of the lack of stores, but he had been pessimistic about obtaining any relief. He wrote Purveyor Potts that he would lay the situation before Washington, but he doubted there would be any effect. "He may refer the matter to Congress, they to the Medical Committee who will probably pow-wow over it a While & no more be heard of it."68
In the closing months of the war the purveyor obtained rations for the sick from the contractors who had entered into agreements with the Superintendent of Finance to provide the required special subsistence items. Obtaining these supplies from the contractors’ issuing stores was often complicated by the latter’s great distance from the hospitals to be supplied. The contractors also apparently failed to understand that they had to provide an army in the field not only with regular rations but also with a portion of hospital stores, and that they had to establish a magazine of hospital stores in the vicinity of the army to accommodate the sick. Such shortcomings added to the complaints against the contractor system as the war drew to a close.69
Procurement of Medicines and Surgical Instruments
Congress did not vest procurement of medical. supplies solely in the Director General in 1775. The bulk of such supplies had to come from abroad, and the Secret Committee handled foreign procurement. Among the first military supplies that the Continental Congress authorized the committee to procure abroad in January 1776 were medicines, surgical instruments, lint,
66. Fitzpatrick, Writings of Washington, 15:345-46 (30 Jun 79).
67. (1) JCC, 16:100 (27 Jan 80). (2) Potts Papers, 4:509 (Thomas Bond to Potts, 18 Mar 80).
68. (1) Ibid., 4:508 (Cochran to Potts, 18 Mar 80). (2) Burnett, Letters, 5:134 (committee to Pres of Cong, 10 May 80).
69. (1) RG 93, Pickering Letters, 83:6-7 (Dr. Samuel Adams to Comfort Sands and Co, 26 Jan 82). (2) Fitzpatrick, Writings of Washington, 24:26 (to same, 16 May 82); 25:164 (to contractors, 16 Sep 82). (3) RG 93, Misc Numbered Does 31485 (contract, 29 Nov 82).
and bandages, to the amount of 2,200 pounds sterling. Two months later it empowered the Secret Committee to purchase, on the most reasonable terms obtainable, some medicines that had been privately imported. Early in May it directed that committee to send 200 pounds of Peruvian bark to the commanding officer in Virginia for use in the Southern Department. Such a delivery order proved to be an exception to the general rule that restricted the activities of the Secret Committee in reference to medical supplies to their foreign procurement and to the payment of, freight charges for medicines imported on the government's account.70
In addition to the medical supplies imported for the government, medicines were imported by private merchants, who offered them for sale in the larger port towns. Initially, the Medical Committee, under orders of Congress, procured such medicines. That committee began its domestic procurement on 23 September 1775 when it purchased "a parcel of drugs in the hands of Mr. Rape1je." Before the end of 1775 Congress directed that an order be drawn for 1,936 dollars in favor of Eliphalet Dyer, a member of the Medical Committee, for medicines that he had purchased for the Continental forces. At the direction of Congress, the Medical Committee sent medicines to the Northern and Southern Departments and also supplied the Director General with medicines.71
On 20 August 1776 Congress elected William Smith as Continental druggist at a salary of 30 dollars a month. He received and delivered all medicines and surgical instruments; in short, he functioned as a medical storekeeper, with Congress providing the funds to pay for medicines delivered to him by merchants.72 Early in 1777 Congress empowered the Medical Committee to employ a suitable person in each state to purchase medicines for the Continental Army at reasonable rates.73 The paucity of records, however, provides no information on these agents or on their effectiveness in procuring medicines.
During the first two years of the war the Director General of the Hospital Department shared with the Medical Committee responsibility for the domestic procurement of medicines. Attached to the headquarters staff and constantly with the main army in the field, the Director General had only limited opportunity to make purchases. That opportunity became even more restricted when Washington's army engaged in a campaign of movement. in New York and New Jersey in 1776. On the other hand, the Hospital Department encountered no problem in procuring native medicinal plants.
70. (I)JCC, 3:453 (23 Dec 75); 4:24- 25 (3 Jan 76); 180 (1 Mar76); 324 (3 May 76). (2) Congress, for example, advanced 755 42/90 dollars to the Commerce Committee to enable it to pay Andrew and James Caldwell for the freight charges due them on medicines they had imported from Martinique in their sloop on the government’s account. Ibid., 11:546 (28 May 78).
71. Ibid., 3:261, 419 (23 Sep and 9 Dec 75); 5:622, 633 (31 Jul and 6 Aug 76).
72. Ibid., 5:673; see also p. 748 (9 Sep 76).
73. Ibid., 7:91-92 (4 Feb 77).
Under orders of the Director General, military hospital stewards advertised for them. Thus Thomas Carries, steward of the general hospital in New York in 1776, advertised for dry herbs to be brought to him. He offered good prices particularly for balm, hyssop, wormwood, and mallow for use in "baths and fomentations."74
Director General Morgan’s purchases of medicines were made from local drug shops, which were owned largely by physicians. In colonial times they generally dispensed their own medicines, prepared by their apprentices. When the British evacuated Boston, Dr. Morgan enjoyed a windfall. At Washington’s orders, he took possession of the drugs left behind in two shops when their Loyalist owners fled the City.75 These drugs were sufficient to enable him to prepare forty regimental medicine chests and to meet the initial needs of the Hospital Department when the main Continental army moved to New York. In addition, he was able to provide a proper medicine chest for each of the surgeons of the four regiments left in garrison at Boston under’ the command of Maj. Gen. Artemas Ward and for the surgeon of the regiment on command at Beverly. Dr. Morgan also directed the collection at Boston of old linen sheets and rags for bandages and tourniquets, and after his arrival in New York, he had his hospital steward advertise and promise good prices for these materials.76
To meet the large demands being made upon him by both the main army and the Northern Army, Dr. Morgan applied for and obtained, half the medicines that had been purchased by Dr. Malachi Treat for the use of the inhabitants of New York.77 By the fall of 1776 Dr. Morgan had purchased all the medicines that could be obtained at shops at Boston, Salem, Newport, Norwich, and New York, and as the demands upon him increased, he turned to the Continental druggist to obtain a further supply of "capital" drugs. Instead of the ten pounds of tartar emetic that he had requested, he received four ounces, and his requisitions for other drugs were filled in similar proportions. This supply, he wrote, was "like a drop lost in the Ocean."78 Congress had further diluted his procurement authority in July when it had ruled that the directors of hospitals also had authority to procure medical supplies, thereby paving the way for a competitive pursuit of the few drugs available in the states.79
74. Force, Am. Arch., 5th set., 1:647-48 (29 Jul 76).
75. (1) Ibid., 4th set., 1:1257 (Mass. Council, 30 Mar 76). (2) Washington Papers, reel 35 (Morgan to Washington, 22 Apr 76).
76. (1) Morgan, Vindication, p. 4 (memorial to Washington, 1 Feb 77). (2) Force, Am. Arch., 5th ser., 1:647-48 (advertisement, 29 Jul 76).
77. Ibid., 4th set., 6:1365, 1384 (N.Y. Prov Cong, 15 May and 8 Jun 76); 5th set., 2:1272 (Morgan to John Jay, 28 Oct 76).
78. (1) Pennsylvania Packet, 19 Jun 79 (Morgan to Sam Adams, - Jul 76). (2) RG 11, CC Papers, reel 51, item 41, 6:51-64 (memorial, Morgan to Cong, 18 Sep 78). (3) Morgan, Vindication, pp. 13-14.
79. JCC, 5:570-71 (18 Jul 76).
When the Continental Congress appointed Dr. William Shippen Director General in the spring of 1777, it vested in him all procurement authority. He followed the same procedures as Morgan had to procure medicines for the main army in the Middle Department. Dr. Jonathan Potts, Shippen’s deputy in the Northern Department, directed procurement there. Potts dispatched Dr. Andrew Craigie, who was assigned to his department, to the New England area to procure whatever medicines and surgical instruments he could from private shipments arriving there or from the state store at Boston.80 Subsequently, when Congress appointed Dr. Potts as purveyor in the Middle Department, Craigie continued to function as his purchasing agent. With considerable satisfaction he wrote Potts of his success in procuring the whole invoice of valuable medicines consigned to Lux and Bowley at Baltimore. Unfortunately, as in the procurement of all supplies, there was a considerable gap between procurement and actual possession. In this instance, the shipment was landed first in Virginia, and all but two of the packages of medicine were seized near Williamsburg for the use of that state.81
Purveyor Potts introduced more regularity and system into the procurement and delivery of medical supplies. He sent Craigie to Carlisle to build what became the Hospital Department’s principal store supporting the main army. There Craigie prepared all medicines and completed the assembling of all hospital and regimental medical chests. He suggested the establishment of an issuing store near the army where such chests could be replenished
80. Potts Papers, 3:305, 331 (Craigie to Potts, 29 Aug and 1Sep 77).
81. Ibid., 4:429, 437 (same to same, 27 Mar and 4 Apr 78).
occasionally, and such a store was set up at the Yellow Springs hospital in the fall of 1778. Dr. John Brown Cutting, who administered the issuing store, labored under handicaps. He was unable to obtain a return of the number of regiments in the area to use as a guide in his operations, but he estimated there were at least eighty, including Artillery.82 As available supplies and funds dwindled, the procedures for procuring, receiving, preparing, and delivering medical supplies to Washington’s army that Potts and Craigie introduced met with varying success. These procedures were continued by the purveyor's successor, Dr. Thomas Bond, elected by Congress on 7 October 1780.83
Procurement of Other Hospital Supplies
Hospitals needed shirts, sheets, pillows, blankets, beds, and various utensils such as kettles, ladles, buckets, bedpans, and weights and scales. Many of these articles that the Continental troops had at Cambridge had been furnished by the Massachusetts Committee of Safety, which had gained them largely by impressment. When Congress appointed a Director General in 1775 to head the Hospital Department, he became responsible for providing such items. Beds used in a hospital, whether a house or a tent, were bunks or cradles built by carpenters under direction of the Quartermaster’s Department or by the troops themselves; the bedding consisted of a tick of coarse linen filled with straw and one or two blankets.84 Even these minimal necessities were not always available. General Wayne wrote from Ticonderoga in 1776 that there were "neither beds nor bedding for our sick to lay on or under other than their own clothing."85 It was late in the war before the Hospital Department included pillowcases and sheets in its estimates of needed supplies.86 Hospital clothing apparently was whatever the soldier happened to be wearing on arrival.
When the British evacuated Boston, Dr. Morgan had his hospital steward collect almost 2,000 blankets and rugs and about the same number of bedsacks and pillows that the British had left in their hospitals and barracks and on the docks. These were washed, aired, made fit for use, and sent in wagons with other supplies to New York in accordance with Washington’s instructions.87 There is nothing to indicate that Dr. Morgan procured
82. Ibid., 4:458 (Craigie to Potts, 1 May 78); 441 (Cutting to Potts, 16 Oct 78).
83. JCC, 18:909.
84. Tilton, Economical Observations on Military Hospitals, p. 54.
85. Force, Am. Arch., 5th set., 3:1359 (to Pa. Committee of Safety, 4 Dec 76).
86. See Washington Papers, reel 86, set. 4 (Cochran to Washington, 6 Aug 82).
87. (1) Fitzpatrick, Writings of Washington, 4:464-65 (to Morgan, 3 Apr 76). (2) RG 11, CC Papers, reel 51, item 41, 6:3 (Morgan to Cong, 18 Jun 76). (3) Morgan, Vindication, pp. 3-4 (memorial to Washington, 1 Feb 77).
any additional bedding or clothing while he administered the Hospital Department.
As far as can be determined from available records, the Clothier General furnished clothing and blankets to men in the hospitals. In the fall of 1777 Congress directed the Clothier General to deliver to the Director General or his deputies in the several military departments a "proportionable share" of the blankets, shirts, shoes, and stockings that he procured.88 The Clothier General could not understand, however, why every soldier sent to a hospital was "under the necessity of being clothed before he can join the Army notwithstanding they may have been clothed before." At least a partial answer was provided by Dr. Benjamin Rush at the Princeton hospital, who discovered that the sick were exchanging their clothing for liquor.89
Clothing had such a way of disappearing that Washington instructed the physician general of the hospital in the Northern Department in 1779 to deliver it to the men in the hospital only as it was needed, "which will be chiefly, when they are about to leave you."90 The demand for blankets was so great in the winter of 1777-78 that Congress tried to obtain them by soliciting private donations and by appealing to the states for assistance. In the spring of 1777 Dr. Shiplien had felt that sheets might be obtained by assessment, a procedure that had been used earlier to obtain blankets.91 When the office of the purveyor was established, Congress instructed Dr. Potts to assign an assistant solely to the business of providing bedding, furniture, utensils, and hospital clothing. Since the supply of blankets and clothing was dependent upon importations from Europe, it is unlikely that the purveyor or his assistant was ever entirely, engaged in their procurement. They undoubtedly continued to fill their needs, insofar as they could, by sharing in distributions made by the Clothier General and by resorting to assessment.
The Rising Tide of Complaints
In 1775 the cost of operating the Hospital Department for a year was estimated to be 10,000 pounds. Dr. Morgan thought this estimate was too low, but he tried, to keep his expenses within the limits set.92 No particular supply problems arose while the Hospital Department remained at Cambridge, where Dr. Morgan attempted to bring it under systematic management. That situation changed rapidly, however, when Washington’s army
88. JCC, 9:941 (19 Nov 77); see also 10:23-24 (6 Jan 78).
89. (1) Washington Papers, 59:132 (Mease to Washington, 4 Nov 77). (2) RG 11, CC Papers, reel 101, item 78, 19:181 (Rush to William Duer. 13 Dec 77).
90. Fitzpatrick, Writings of Washington, 14:25 (to Dr. Malachi Treat, 19 Jan 79).
91. (1) JCC, 9:1011-12 (9 Dec 77); 10:23-24 (6 Jan 78). (2) RG 11, CC Papers, item 78, 20:103 (Shippen to Cong, 10 May 77).
92. Morgan, Vindication, p. 5.
moved to New York. Before proceeding there, Morgan carried out Washington’s orders to forward the department’s medicines and stores, to attend to the needs of the troops remaining in the Boston area, to care for and discharge the 300 sick who were in the several hospitals in April, and to break up the hospitals. In New York he established his hospitals at King's College, City Hospital, the barracks, and in houses appropriated by the New York Convention.93
While the troops remained in New York City and camped near Harlem, they were very sickly. Washington could not pinpoint the causes though he later attributed this condition "to the rawness of the troops, unused to Camp life, want of necessaries and the extreme fatigue they were obliged to undergo during the Heat of the Summer."94 When the army moved to White Plains and then to New Jersey, its lack of sufficient transport added to the hardships experienced by the sick. Complaints against the Hospital Department under Morgan’s direction increased. The conflict between the regimental surgeons and the Director General further fueled the clamor.
On 24 September a congressional committee arrived at camp. It found that the sick had been much neglected and that many had died from a lack of suitable diet and care. When the troops had moved, all the sick in the regimental hospitals had been suddenly delivered to the Director General, who did not have sufficient surgeons and nurses to care for them. In addition, the committee noted, the adjutants had frequently neglected to make returns to the Director General and the Commissary General of the number of sick in their regiments. The sick consequently could not receive the value of their rations in those subsistence items provided by the Director General for use in special diets.95
Stirred into opposition to Dr. Morgan by the complaints that had reached it, Congress in October took the unusual step of dividing authority between Dr. Morgan and Dr. Shippen, whom it had appointed chief physician for the flying camp in New Jersey on 15 July 1776. Under, this indefensible plan, Congress directed Morgan to provide and superintend a hospital on the east side of the Hudson, At the same time, it directed Shippen to provide and superintend a hospital for the troops in New Jersey. Congress authorized each doctor to appoint a sufficient number of surgeons, mates, apothecaries, and other assistants in his hospital and to supply such quantities of medicines, bedding, and other necessaries as each judged expedient.96
In the midst of the current military operations, it was impossible for Dr. Morgan to establish a hospital as directed. In addition, almost all hospital
93. (1) Ibid., pp. 2-4 (Morgan to Washington, 1 Feb 77). (2) Force, Am. Arch., 4th ser., 5:1024-25 (same to same, 22 Apr76).
94. (1) Fitzpatrick, Writings of Washington, 13:480-82 (to Morgan, 6 Jan 79). (2) See also Pennsylvania Magazine of History and Biography, 43:77-80 (Greene to Morgan, 10 Jan 79).
95. Force, Am. Arch., 5th set., 2:1385 (committee to Cong, 3 Oct 76).
96. JCC, 6:857-58 (9 Oct 76); for Shippen’s earlier appointment, see 5:562.
stores and medicines were deposited west of the Hudson, and nearly half of the Hospital Department’s surgeons and mates were also there. Moreover, the sick and wounded from Long Island and the general hospital at New York had been conveyed to New Jersey where, at Washington’s orders, Morgan had established hospitals for them. Washington did not suppose that Congress’ order was intended to prevent either doctor from establishing hospitals wherever they were most needed. This interpretation precipitated a clash between the two doctors. On 9 November Dr. Shippen complained to the Continental Congress that he was unable to carry out its orders because Dr. Morgan "differs in opinion with me concerning the meaning of Congress and because Gen. Washington desires they [the hospitals in New Jersey] remain under his care." He felt that the Commander in Chief, was not recognizing his authority under the October order of Congress. He added that on a practical level Dr. Morgan would be unable to care for the sick in New Jersey since he was busy establishing hospitals far to the other side of the Hudson.97 At Washington’s orders, for example, Morgan was setting up a hospital at Peekskill. Congress referred Shippen’s letter to the Medical Committee, and on the basis of its report, Congress repeated its previous resolution that Dr. Morgan was to care for the sick and wounded on the east side of the Hudson and Dr. Shippen on the west side.98
As Washington’s army retreated through New Jersey, the sick and wounded were hurriedly sent ahead of the army to temporary hospitals set up at Hackensack, Perth Amboy, Newark, Elizabethtown, Morristown, Brunswick, and Trenton. In December, after Washington had crossed the Delaware, Dr. Shippen moved them to more permanent hospitals in Pennsylvania at Easton, Bethlehem, and Allentown. Dr. Morgan had direction of the hospitals at Philadelphia. Complaints against the latter multiplied in the course of these operations. In December Shippen proposed a reorganization of the Hospital Department.99
Dismissal of Morgan and Stringer
On 9 January 1777 Samuel Adams wrote that "great and heavy complaints have been made of abuse in the Director-General’s department in both our armies; some, I suppose, without grounds, others with too much reason." As he anticipated, the Continental Congress on that day bowed to the clamor and dismissed Dr. Morgan and Dr. Stringer, without assigning
97. (1) Force, Am. Arch., 5th ser., 3:618 (Shippen to Cong, 9 Nov 76). (2) See Fitzpatrick, Writings of Washington, 6:239 (to Shippen, 3 Nov 76).
98. JCC, 6:989 (28 Nov 76).
99. Force, Am. Arch., 5th ser., 3:1258-59 (to Richard Henry Lee, 17 Dec 76).
any reason for its action.100 Early in February Morgan requested a court of inquiry and submitted a vindication of his conduct to Washington, who sent it to Congress with a plan for the better regulation of the Hospital Department that the former Director General had formulated. Failing to obtain satisfaction, the latter submitted another letter and a voluminous memorial to Congress on 31 July.101 Congress referred these to the Medical Committee, which reported the following month that there had been no particular charge against Dr. Morgan but that there were general complaints from all ranks of the Continental Army. It was necessary for the public good and the safety of the United States that he should be replaced. Although the doctor’s memorial appeared to be "a hasty and intemperate production," the. Medical Committee nevertheless felt that he was entitled to an inquiry into his conduct, and it recommended the appointment of a committee for that purpose. Congress concurred in the report but did not appoint a committee until 18 September 1778 after Dr. Morgan had sent another letter. This committee did not submit its report until 13 March 1779. Congress ordered its report to lie on the table for consideration the following Thursday, and it did not review the report until 12 June 1779. The report vindicated Morgan’s conduct as Director General in every respect, and Congress thereupon exonerated him from all charges. The disgrace of his dismissal, however, had left him embittered.102
Reorganization of the Hospital Department
On 20 January 1777 Washington ordered Dr. John Cochran to Philadelphia to consult with Dr. Shippen about reorganizing the Hospital Department. The two men were to submit a list of the number of officers and of the quantity of stores necessary for efficient operation of the department. They were also to include in their plan fixed hospitals in various areas as well as a flying hospital for the army in the field.103 About the same time, Washington received Shippen’s reorganization plan, but he deferred sending it to Congress until Dr. Cochran had consulted with Shippen. The latter, who hoped to be made director of the Middle Department under his proposed reorganization plan, also set forth a pay scale, but Washington judged it to be too high, since the pay of a director would exceed considerably that of a major general. Shippen and Cochran agreed that there should be one superintending power
100. (1) Burnett, Letters, 2:211 (to John Adams). (2) JCC, 7:24-25. (3) Fitzpatrick, Writings of Washington, 7:28 (to Morgan and to Stringer, 18 Jan 77).
101. (1) Ibid., 7:149-51 (to Cong, 14 Feb 77). (2) RG 11, CC Papers, item 53, fol. 113; item 41, 6:19.
102. (1) JCC, 12:925 (18 Sep 78); 13:313 (13 Mar 79); 14:724 (12 Jun 79). (2) RG 11, CC Papers, reel 51, item 41, 6:51-54 (Morgan to Cong, 17 Sep 78); see also reel 77, item 63, fol. 125 (same to same, 5 Jun 79).
103. Fitzpatrick, Writings of Washington, 7:44-45.
in the department. On 14 February 1777 Washington sent Congress the plan drawn up by the two doctors. He enclosed Dr. Morgan’s proposed plan, commenting, "I think all his hints are included in Shippen’s plan."104 By mid-March, having heard nothing on the subject, Washington warned Congress of the importance of getting the organization of the Hospital Department settled before the opening of the approaching campaign. He added that a revision of the pay of regimental surgeons and mates was also necessary; these appointments were essential, but the pay was so low that men of ability would not accept them.105
In the meantime, on 27 February the Medical Committee had brought in a report on the Hospital Department. Congress ordered it to lie on the table. Three weeks later it recommitted the report, together with the Shippen-Cochran plan. The great spirit of reform that swept through Congress in 1777 finally resulted in the passage of a new plan of organization, adapted from that used in the British Army, on 7 April.106 In contrast to the simplicity of the regulation establishing the Hospital Department, the plan was complex and detailed, particularly in its provisions for staffing the department. As in the case of the other supply services, the Hospital Department’s organization was shaped to operate in the various military departments, although the latter were called districts in the organizational framework. At the head of the department was the Director General. He established and regulated a sufficient number of hospitals to receive the sick and wounded of the Continental Army; provided medicines, surgical instruments, dressings, bedding, items of diet, and everything else requisite for the sick and wounded; paid the salaries of all departmental personnel; and generally controlled the department. In addition, he particularly superintended all hospitals between the Hudson and Potomac Rivers, that is, in the Middle District. Certainly, these extensive and diversified duties were a great deal of responsibility for one man.
In each district-middle, eastern, northern, and southern-Congress made provision for a deputy director general, and for an assistant deputy director, who superintended hospitals committed to his care and assisted in providing medical supplies under the orders of the Director General or the deputy director of his district. The plan provided for an apothecary general in each district, with as many mates as necessary, who received, prepared, and delivered medicines and other articles to the hospitals on the orders of the Director General or the deputy directors. Each district also had a commissary of hospitals, who employed assistants and storekeepers. There was to be a steward for every 100 sick or wounded, who received
104. (1) Ibid., 7:149-51 (to Cong, 14 Feb 77). (2) Washington Papers, reel 39 (Shippen and Cochran to Washington, 31 Jan 77).
105. Fitzpatrick, Writings of Washington, 7:287-88 (to Pres of Cong, 14 Mar 77).
106. JCC, 7:161 - 62 (27 Feb 77); 193, 197 - 200, 206 (22, 24, and 27 Mar 77); 219, 225, 227, 231-37 (2, 4, 5, and 7 Apr 77).
provisions from the commissary, distributed them according to the orders of the Director General, physician general, or surgeon general, and was accountable for them to the commissary. The plan also provided a matron for every 100 sick or wounded to see that provisions were properly prepared, that wards, beds, and utensils were kept in order, and that economy was observed. Under the matron’s direction, a nurse attended to every 10 sick or wounded. Each hospital was allowed a hostler or stabler to receive horses from the commissary and to take care of the wagon horses and other horses belonging to the hospital. Each district had a clerk with a sufficient number of assistants to keep the accounts of the hospitals and to receive and deliver funds according to the orders of the Director General or the deputy director. Congress authorized the Director General and his deputies to appoint and discharge the assistant deputy directors and the other officers and attendants of the hospitals.
Under the reorganization plan, Congress appointed one physician general and one surgeon general in each district to superintend, respectively, the practice of physic and of surgery in all the hospitals of the district. In the absence of the Director General or the deputy, they could order the physicians, surgeons, and other officers of the hospitals to perform such duties as they thought proper. They also made weekly reports to the Director General or, in his absence, to the deputy director general or his assistant on the condition and number of the sick and wounded in the hospitals. The plan also provided for senior physicians and senior surgeons to attend, prescribe for, and operate upon the sick and wounded placed under their care. Second surgeons and mates assisted the senior surgeons. The Director General or the deputies determined the number of senior physicians, senior surgeons, and second surgeons, but the physician general and surgeon general in the district made the appointments. The plan set up a system of returns culminating in a monthly consolidated return for all hospitals that the Director General prepared and sent to the Medical Committee. All of the personnel thus far mentioned staffed the Hospital Department; they were separate and distinct from those appointed at the same time to staff the flying hospitals in the field.107
Three days after Congress reorganized the Hospital Department, it elected its officers. Congress unanimously elected Dr. William Shippen Director General of all military hospitals. It appointed Dr. Walter Jones physician general of the Middle District and designated Dr. Benjamin Rush its surgeon general. Dr. Jones declined to serve, and on 1 July Congress appointed Dr. Rush to that vacancy, electing Dr. William Brown the following day to the surgeon general’s post vacated by Rush. For the Eastern District Congress elected Dr. Issac Foster deputy director general; Dr. Ammi Ruhamah Cutter, physician general; and Dr. Philip Turner, surgeon
107. For the field organization under the 1777 regulation, see above, pp. 388-89.
general. For the Northern District Congress retained the services of Dr. Jonathan Potts, designating him deputy director general, and it appointed Dr. Malachi Treat and Dr. Francis Forgue, respectively, as physician general and surgeon general.108 When Dr. William Rickman, director of the hospital in Virginia, protested the inclusion of that state in the new plan of organization, the Medical Committee concluded that his hospital was distinct from, and independent of, the general establishment of hospitals in the other states and that the resolution of 7 April 1777 did not apply to it. Congress agreed with this interpretation, and Dr. Rickman retained his independence from the control of the Director General.109
Rush -Morgan-Shippen Feud
Eight months after Shippen’s appointment, Dr. Benjamin Rush criticized the entire hospital system.110 Initially, he made no serious charge against any official; instead, he compared American and British methods and recommended certain changes. He thought it desirable to have an inspector general and chief physician whose only duties would be to visit the hospitals, examine the quantity and quality of medicines, stores, and instruments, and forward reports of the number of sick and wounded to the Commander in Chief. In addition, the department, he felt, ought to have a purveyor general
108. JCC, 7:253-54 (11 Apr 77); 8:518 (1 Jul 77).
109. Ibid., 8:626 (9 Aug 77).
110. RG 11, CC Papers, reel 101, item 78, 19:173, 181 (Rush to William Duer, 8 and 13 Dec 77).
to provide the hospitals with all necessities; the physician general and the surgeon general in each district would inform the purveyor general of what they needed and then forward the stores provided to the hospitals. These suggestions were constructive, but Rush later went on to attack Dr. Shippen. He resigned his post as physician general in the Middle District in January 1778. To fill the vacancy, Congress elected Dr. William Brown physician general in the Middle District and appointed Dr. Charles McKnight to the post of surgeon general vacated by Dr. Brown.111
Complaints multiplied and conditions in the hospitals were as bad as ever. In the winter of 1777-78 hospital stores were as deficient as regular rations at Valley Forge, and the sick were naked. Distressed by the "unhappy Condition of our Poor Fellows in the Hospitals," Washington, in replying to criticism by Gov. William Livingston of New Jersey, wished his "powers to relieve them [the sick] were equal to my inclination."112 In an effort to eliminate some of the disorders and irregularities at the hospitals, Washington ordered a field officer to visit each hospital. This officer prepared a list of the names and regiments of all the sick and transmitted it to the Adjutant General. He took charge of any arms, accouterments, or ammunition that he found at the hospital contrary to orders and made exact lists of clothing belonging to the patients. Furthermore, he sent to camp, under the care of a commissioned officer, all soldiers who had recovered and were judged fit for duty by the hospital officers, as well as all stragglers from Washington’s army in the vicinity of the hospital.113
In the meantime, Congress read Rush’s proposals on the organization of the Hospital Department and referred them to a committee of five. It authorized that committee to take every measure necessary for the relief of the sick and to report on what alterations in the Hospital Department’s organization were necessary. Congress referred other letters to this committee, including one from Dr. William Brown to the Medical Committee in which he submitted his views on modifications needed by the Hospital Department. Like Rush, he believed the duties of a purveyor general should be separated from those of a director general.114 On the basis of the committee’s report, Congress on 6 February 1778 relieved the Director General of his purchasing responsibility. It was at this time that it appointed Dr. Potts deputy director general for the hospitals in the Middle District. Thereafter, the deputies in all the districts procured all the supplies needed by their respective districts through assistants they appointed. Though not so designated at that time, the deputies were nonetheless now viewed as purveyors. The
111. JCC, 10: 131, 186 (6 and 21 Feb 78).
112. Fitzpatrick, Writings of Washington, 10: 233 - 34 (31 Dec 77).
113. Ibid., 10:405-07 (to officers visiting hospitals, - Jan 78).
114. (1) JCC, 10:9 (1 Jan 78); 93 (27 Jan 78). (2) RG 11, CC Papers, item 78, roll 91 (Dr. Brown to Medical Committee, 20 Jan 78).
main supply depot for the Hospital Department in the Middle District was established at Reading, Pennsylvania, where Potts maintained his headquarters.115
Congress ordered the Director General to visit the hospitals in each district frequently and to see that regulations were enforced. He was to examine the number and qualifications of hospital officers, report any abuses to Congress, and discharge any supernumerary officers. To further the efforts Washington was making to correct irregularities, Congress also authorized the Director General or, in his absence from a district, the physician general or the surgeon general to appoint a ward master for each hospital to receive the arms, accouterments, and clothing of each soldier admitted, keeping a record of, and giving receipts for, these articles. On the recovery and discharge of the soldier, these items were returned to him. If he died, the arms and accouterments were delivered to the commissary or deputy commissary of military stores, who gave a receipt for them. The ward master received, and was accountable for, hospital clothing, and he performed such other services as the physician general or the surgeon general directed.
Many dedicated and patriotic doctors provided service to the soldiers in the Revolutionary War. Unfortunately, the top echelon of the Hospital Department until 1781 was rent by bickering, jealousy, and vengefulness, at the expense of the department and of the sick and wounded. Dr. Rush, for example, was an irascible man who quarreled with friend and foe alike. As physician general in the Middle District, he was stationed at the hospital in Princeton in 1777, but his duties required him to visit all the hospitals in the district and to superintend all the hospital physicians. Dr. Shippen later contended that Rush’s opposition to him was motivated by jealousy and a conviction that the Director General had prevented his obtaining preferment in the Continental Army.116
In any case, before the end of the year Rush complained of disorders and overcrowding in the hospital at Princeton. Dr. Shippen flatly contradicted him. He wrote to Congress that he had heard of Rush’s complaints, but the hospital was not crowded; there were no fatal diseases, and few men had died.117 This view does not agree with the recollections of Dr. James Tilton, a surgeon at the Princeton hospital at that time, who was not inimical to Dr. Shippen. He wrote in 1781 that he had found the sick and wounded so indiscriminately mixed in the hospital that infection had spread and great mortality had resulted. He himself had caught "jail fever." On his way home to recuperate, he had stopped at the hospital at Bethlehem, where the mortality rate was even greater than at Princeton.118 Dr. Rush followed up his initial
115. Burnett, Letters, 3:77 (James Lovell to John Langdon, 8 Feb 78).
116. Gibson, Bodo Otto, p. 192.
117. RG 11, CC Papers, reel 101, item 78, 19:181 (Rush to Duer, 13 Dec 77); reel 98, item 78, 20:171-73 (Shippen to Cong, 18 Jan 78).
118. Tilton, Economical Observations on Military Hospitals, p. 29.
criticism by sending a letter to Washington in which he charged Shippen with malpractice and neglect. The Commander in Chief felt obliged to lay these "heinous" charges before Congress. The latter referred the letters to a committee of three, directing it to inquire into the charges and the conduct of Dr. Shippen as Director General. To support his charges, Dr. Rush began collecting affidavits from personnel in the Hospital Department.119
No further action was taken, and there the matter rested until 15 June 1779 when Dr. Morgan joined Rush in his charges against Shippen and called for a court-martial.120 Only three days earlier Congress had finally expressed its satisfaction with Morgan’s own conduct as Director General. Morgan was likely motivated by a desire for revenge, for he felt, perhaps with some justification, that Shippen had schemed with friends in Congress to have him removed as Director General so that Shippen could succeed to, the post. Impatient when Congress did not immediately respond, Morgan wrote again and again, reiterating charges and pressing for the court-martial. In the meantime, Dr. Shippen himself appealed to Washington for a court-martial in July 1779 to clear his name. The court-martial was not ordered until December, and it was later postponed until mid-May 1780. Because the arrest of Shippen caused difficulties in the Hospital Department, Congress authorized the Medical Committee to take proper measures for carrying on the department’s business and directed all medical personnel to obey its orders.121
When the court-martial met, it cleared Shippen of all charges.122 Washington transmitted the proceedings to Congress on 15 July for its approbation or disapprobation. In view of the length of time that had passed during the controversy and trial, it is not surprising that the Hospital Department fell into considerable disorder. Washington thought the affair ought to be concluded as soon as possible. When a month had passed without congressional action, Dr. Shippen appealed to Congress "to be relieved of the distressing state of suspense." He called attention to the "deranged" state of the Hospital Department and to the suffering the soldiers were enduring because no person was directing the department’s activities.123 Congress considered the court-martial proceedings on 18 August 1780. Although the courtmartial had acquitted Shippen of the charges of speculation and sale of
119. (1) RG 11, CC Papers, reel 101, item 78, 19:211-13 (Rush to Washington, 25 Feb 78); 215 - 22 (affidavits). (2) Fitzpatrick, Writings of Washington, 11: 125 (to Pres of Cong, 21 Mar 78). (3) JCC, 10:303 (3 Apr 78).
120. RG 11, CC Papers, reel 77, item 63, fol. 129 (Morgan to Cong, 15 Jun 79).
121. (1) Ibid., reel 77, item 63, fols. 137 - 38 (25 Oct 79); 143 - 50 (22 Nov 79); reel 98, item 78, 20:435-36 (Shippen to Cong, 28 Jul 79). (2) JCC, 17:561-62 (26 Jun 80).
122. These charges included fraudulent sale of hospital stores for his own profit and use of public wagons to transport them; speculation in and adulteration of hospital wines at Bethlehem; neglect of duty; and scandalous practices unbecoming an officer.
123. (1) Fitzpatrick, Writings of Washington, 19:182 (to Pres of Cong, 15 Jul 80). (2) RG 11, CC Papers, reel 98, item 78, 20:541-42 (Shippen to same, 15 Aug 80).
hospital stores for lack of evidence, it nevertheless had clearly believed that he had engaged in those activities and had thus acted in a highly improper and reprehensible manner. Efforts to include this criticism as an amendment to the motion before Congress on the court-martial proceedings failed. Congress instead passed a motion which simply read, "The court martial having acquitted the said Doctor W. Shippen, Ordered, that he be discharged from arrest."124
The case against Dr. Shippen was closed, but the publicity did not end, and the Hospital Department continued to be damaged by it. To bring about a public moral condemnation of Shippen, Dr. Morgan resorted to the press. The Pennsylvania Packet carried his appeal to the citizens of the United States and his opposition to Shippen’s reelection as Director General, which occurred on 6 October 1780. Inevitably, Morgan’s appeal was followed by Dr. Shippen’s "vindication," in which he frankly admitted speculation in hospital stores but contended that neither law nor regulations prohibited his purchase and sale for profit of articles of common trade. Moreover, he claimed, his transactions had been so small-4 ½ pipes of wine and 3 tierces of sugar-that they in no way could have affected market prices. This distressing exchange continued to be published in the Pennsylvania Packet until the end of 1780.125
Elimination of the District Organization
The elaborate organization of the Hospital Department established in 1777 caused considerable dissatisfaction by 1779. Congress took steps to meet some of the objections early in January of that year. When changes in the position of the troops or other circumstances necessitated it, Congress authorized the Director General to send deputy directors, physicians, and surgeons to any post despite the fact that by regulation they were attached to a particular military department (hospital district). If a dispute over seniority followed, the Director General was to settle it, though the aggrieved party had a right to appeal to the Medical Committee for redress. Even before Congress took this action, Washington had expressed his dissatisfaction with the district organization of the Hospital Department to a congressional committee. He favored eliminating it and giving the Director General authority to send surgeons and stores wherever they were required, proportioned among the various particular needs of the time.126 Congress, however, made no other changes in the Hospital Department’s organization that year, though criticism continued. Early in 1780 Dr. Philip Turner, surgeon general in the Eastern District, charged that the department was
124. JCC, 17:744-46 (18 Aug 80).
125. Pennsylvania Packet, 2 Sep-23 Dec 80.
126. (1) JCC, 13:110-11 (23 Jan 79). (2) Washington Papers, reel 55, ser. 4 (8 Jan 79).
"too large, too Expensive, and ought to be curtailed, our Numbers are more than are Needed."127
Inflation and the lack of money that plagued all supply services in the summer of 1780 brought acute distress to the Hospital Department. "There is no supply of milk, meal, or any other vegetable-of wine, sugar, tea or coffee there is not a sufficiency for the ordinary expenditure of another week," a senior surgeon wrote Maj. Gen. Benedict Arnold. The purveyors had neither cash nor credit, and unless something was done, he warned, the sick and wounded officers and soldiers would suffer and might die for lack of a suitable diet.128 Aware of the situation, Washington sent Dr. John Cochran, physician and surgeon general of the army in the Middle District, to Philadelphia to solicit the aid of Congress. As a result, the Medical Committee prepared an estimate of needs, and Congress ordered a warrant for 200,000 dollars issued in favor of Purveyor Potts, who was to expend the money as directed by the Medical Committee.129
When Dr. Cochran returned from Philadelphia, he applied to John Mathews, a member of the congressional committee at headquarters, for assistance in obtaining more surgeons. The four surgeons and one mate with the flying hospital in the Middle District were barely sufficient to care for the troops. The increasing number of the sick required the establishment of more hospitals. No doubt Mathews, in writing to the Medical Committee, was passing along the observations of Dr. Cochran when he noted that there
were five, doctors in Philadelphia "who have no visible employment there" and urged that they be ordered to the main army. In addition, six doctors ought to be ordered to the Middle District from the Northern District. Mathews noted also that Dr. Cutting, the apothecary general, resided in Philadelphia; his distance from the main Continental army was thus too great for supplies to be rea 'dily procured from his store. Mathews suggested that a magazine should be established in New Jersey, and he noted that the delay in
determining the court-martial proceedings against Shippen had disrupted the operations of the Hospital Department. No one directed matters, he wrote, and everybody did as he pleased.130
By this time Congress itself was moving in the direction of reform. On 7 August 1780 it ordered the Medical Committee to report specifically on the state of the military hospitals in Pennsylvania. The committee proposed a general system of regulations for the Hospital Department on 13 September that brought together various rulings and changes made by Congress since
127. (1) Ibid., reel 56, ser. 4 (to Washington, 3 Feb 80). (2) Fitzpatrick, Writings of Washington, 18:49-50 (to Turner, 24 Feb 80).
128. Washington Papers, reel 69, ser. 4 (William Eustis to Arnold, 7 Aug 80).
129. (1) Fitzpatrick, Writings of Washington, 19:181-82 (to Pres of Cong, 15 Jul 80). (2) JCC, 17:648 (21 Jul 80). (3) Burnett, Letters, 5:287-88 (Medical Committee to Potts, 22 Jul 80).
130. Ibid., 5:320-21 (to Medical Committee, 10 Aug 80).
the adoption of the 1777 regulation. After consideration, Congress adopted these regulations on 30 September.131 In the interest of economy, it reduced the number of officers in the department and eliminated the district organization. It provided for one Director to supervise all hospitals north of North Carolina. Having finally realized that American physicians, unlike their European counterparts, were also surgeons, Congress now provided three chief hospital physician and surgeons for the same area above North Carolina. It also allowed one chief physician and surgeon for each separate army. The department’s organization further included 15 hospital physicians who were also surgeons, 20 surgeon’s mates for the hospitals, one purveyor with an assistant, one apothecary with an assistant, plus a steward and matron, as well as orderlies and nurses, for each hospital.
Dr. Shippen had been ordered to make a return of the personnel in the Hospital Department. Relying on his reply, the Medical Committee on 2 October submitted to Congress a return of the general officers and senior and junior surgeons, together with the dates of their commissions. Four days later Congress proceeded to elect officers for the reorganized department.132 It reelected Dr. Shippen as Director, fixing his salary at 150 dollars a month and allowing him two rations per day for himself, one ration for his servant, and forage for two horses. It designated James Craik, Malachi Treat, and Charles McKnight as his three chief hospital physician and surgeons.
In the midst of the suspicions generated by the Morgan-Rush-Shippen controversy, Dr. Potts, like almost every supply officer who handled money in the Revolution, had learned of disquieting rumors attributing various abuses to him and insinuating that he had made a fortune out of his position as purveyor in the Middle District. These rumors were unfounded, his associates were quick to point out. Impaired health and his inability to support his family on his pay led Dr. Potts to submit his resignation in the spring of 1780. In October Congress filled the post by electing his former assistant, Dr. Thomas Bond. At the same time, it designated Dr. Andrew Craigie as apothecary, and elected an assistant purveyor and an assistant apothecary. It completed the staffing of the department by appointing the fifteen hospital physicians and surgeons.133
Prerogatives of Qjricers
Although personnel of the Hospital Department were subject to courtmartial, since 1775 they had been treated more like civilians, without any of the rights and privileges of officers. Yet doctors, Shippen wrote the Medical
131. JCC, 18:876-88 (30 Sep 80).
132. Ibid., 18:889 (2 Oct 80); 908-10 (6 and 7 Oct 80).
133. (1) Gibson, Bodo Otto, pp. 256, 258-59 (letter of resignation, and letter, Craik to Potts, 1 Mar 80). (2) See also Potts Papers, 4:517 (Thomas Bond to Potts, 16 Aug 80). (3) JCC, 18:909-10 (9 Oct 80).
Committee on their behalf in the summer of 1778, ran "as great, if not a greater risque of losing their lives than any officers in the Army," exposed as they were to the infectious fevers that, swept through hospitals. Personnel of the Hospital Department were allowed to draw rations as part of their compensation after the department was reorganized in April 1777. They were not included, however, in the congressional provision of 26 November 1777which entitled line officers to draw clothing annually from the stores of the Clothier General.134 The omission was not corrected for two years. On 20 November 1779 Congress then provided that all Hospital Department personnel who had been in the service for at least one year were entitled to draw clothing annually from the stores of the Clothier General in the same manner as officers of the line under the 1777 resolution. Oddly enough, only five days later Congress laid down rules for the delivery and payment of the officers’ clothing which implemented more effectively its earlier resolution, but Hospital personnel were again omitted, an oversight that was not corrected until 30 September 1780.135
Early in January 1780 the Medical Committee had presented a report which proposed extending to medical officers the benefits of land grants and half pay at retirement that had been granted to line officers in 1776 and 1778. The proposal was lost, but it was revived in September. Medical officers had never been given military rank, but on 22 September Congress established equivalent ranks which entitled them to land. The Director was allowed the same quantity of land as a brigadier general; the chief physicians and purveyor, the same as a colonel; physicians, surgeons, and apothecary, the same as a lieutenant colonel; regimental surgeons and assistants to the purveyor and the apothecary, the same as a major; the hospital and regimental mates, the same as a captain. At the same time, Congress resolved that medical officers would be given half pay in the same manner and under the same restrictions as line officers.136
Eight days later Congress passed a new regulation for the Hospital Department which retained the land grant benefits for medical officers but omitted the retirement pay. It was January of the following year before Congress corrected this omission. It then authorized the Director to receive, during life, an allowance equal to the half pay of a lieutenant colonel, provided he continued in service to the end of the war or was reduced before that time as supernumerary. Under similar restrictions, chief physician and surgeons, hospital physicians and surgeons, regimental surgeons, and the purveyor and apothecary were each to receive the half pay of a captain.137
134. (1) RG 11, CC Papers, reel 98, item 78, 20:303-04 (1 Aug 78). (2) JCC, 9:968-69 (26 Nov 77).
135. Ibid., 15:1294-96 (20 Nov 79); 1214, 1216 (27 and 28 Oct 78); 1304-06 (25 Nov 79); 18:887 (30 Sep 80).
136. Ibid., 5:763 (16 Sep 76); 11:502 (15 May 78); 18:847-48 (22 Sep,80).
137. Ibid., 18:887-88 (30 Sep 80); 19:68-70 (17 Jan 81).
These arrangements were in accord with what Washington had recommended. He had observed that in the British Army the pay of a regimental surgeon and of a lieutenant were the same or nearly so. In contrast, at the beginning of the war the pay of a lieutenant in the Continental Army was 13 1/3 dollars per month while that of a surgeon was 25 dollars. The difference arose from the fact that surgeons in the Continental Army drew no perquisites and few men of ability would have served for a lieutenant's pay. In the British Army the pay of the hospital surgeon was equal to that of a captain; in the Continental Army it was double that amount. Washington thought that paying these surgeons half their present pay at retirement was unreasonable. He considered that the half pay allowance of medical officers should be proportioned to that of line officers; this practice would be consistent with that of other armies and with the principles of justice and policy.138
Appointment of Dr. John Cochran
Within three months after being reelected Director, Dr. Shippen submitted his resignation, believing that he could be more useful in training young men to be surgeons than in continuing at his post. On hearing of his resignation, Washington wrote that although there might have been particular instances of disorder or neglect, on the whole, insofar as the maintenance of order and the treatment and accommodation of the sick were concerned, "no hospitals could have been better administered."139 When Dr. John Cochran succeeded Shippen, one immediate change was that the charges and countercharges that had whirled about the Hospital Department and its chief for the past three years came to a stop. In 1781, however, conditions in the department were wretched. Like all other supply officers, the purveyor had neither cash nor credit for obtaining supplies. The department suffered also from a growing scarcity of doctors, for as salaries went unpaid, posts fell vacant and remained so as doctors resigned their commissions. Dr. Cochran wrote, "Neither myself, nor any of the Gentlemen who have served with me, has received a shilling from the Public, in twenty-three months, which has, as you may reasonably suppose, reduced me to some difficulties."140
In the midst of the preparations for the campaign of 1781, Congress directed the Board of War, which had now assumed the duties of the Medical Committee, to prepare a plan for filling vacancies in "the hospital and medical
138. Fitzpatrick, Writings of Washington, 20:293-94 (5 Nov 80).
139. (1) RG 11, CC Papers, reel 102, item 78, 21:1 - 2 (Shippen to Cong, 3 Jan 81). (2) Washington Papers, reel 73, ser. 4 (Shippen to Washington, 4 Jan 81). (3) JCC, 19:15 (3 Jan 8 1). (4) Fitzpatrick, Writings of Washington, 21:218 (to Shippen, 13 Feb 81).
140. Walter Biddle, "Doctor John Cochran," Pennsylvania Magazine of History and Biography 3 (1879): 246 (6 Apr 81).
lines of the army. The board sent three plans to Washington for his comments, and on 20 September Congress adopted a plan which provided for filling future vacancies on the basis of seniority.141
Economy having become the order of the day, Congress was interested in reducing the staff of the Hospital Department. With this objective in view, it adopted a new regulation on 3 January 1782 which abolished the offices of chief physician and surgeon and chief hospital physician and surgeon. It retained in service under the title of physician the chief physician and surgeon of the army who had the greatest seniority. It reduced the number of surgeons in all military hospitals to no more than fifteen, and it made the Director responsible for superintending and directing all military hospitals, including those in camp. When necessary, the Director called a medical board of three senior medical officers to appoint all surgeon’s mates, examine all candidates for promotion in the department, recommend the best qualified to the Secretary at War, and give advice on departmental matters as requested. No regulation, plan, or order of this board was valid until approved by the Commander in Chief or the commanding general of a separate army and issued in General Orders. Congress authorized the Secretary at War to implement these resolutions.142
Examination and placement of candidates, however, were no longer problems of major importance in 1782. Instead, in the summer of that year
141. (1) JCC, 20:668 (18 Jun 81); 21:979, 980 (20 Sep 81). (2) Bumett, Letters, 6:123, 146-47 (Bd of War, 19 Jun and 14 Jul 81). (3) Fitzpatrick, Writings of Washington, 22:441 (to Heath, 1 Aug 81).
142. JCC, 22:4-7 (3 Jan 82).
Congress and the Secretary at War were primarily concerned with developing a system of accountability for all medicines, instruments, and property of the Hospital Department.143 Long overdue, this development came much too late to have any significant impact in the Revolutionary War. Before the end of the year, as salaries were reduced and doctors left the service, the Hospital Department contracted in size. Following the acceptance of preliminary peace arrangements, demobilization demanded the attention of Congress. On 17 April 1783 it passed a resolution applicable to the Hospital Department as well as to all other supply departments. It directed that immediate measures be taken for the sale of all articles in the military departments that would not be needed for the Continental Army before its reduction or for the formation of magazines for a peacetime establishment. On 16 May Congress substituted five years’ pay for the half pay for life it had granted doctors in 1781. When the doctors accepted this offer, Congress, by the summer of 1783, had made provision for the disposition of both personnel and supplies, and it could terminate the Hospital Department as a staff agency.144
143. Ibid., 22:408-12 (23 Jul 82). 144. Ibid., 23:254, 346.
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