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Part II

Books and Documents > The Medical Department of the United States Army from 1775 to 1873

PART II

FROM THE CLOSE OF THE REVOLUTION, TO THE REDUCTION OF THE ARMY IN 1821

The act of the second of June, 1784, practically left the United States without any army. The general sentiment both of Congress and the country was very strong against the maintenance of any military force whatever. The immense armaments of Europe were chiefly used to preserve the balance of power on the continent, or to overawe the people, and were considered unnecessary for the first and incongruous as regards the latter, in a republic separated from all possible enemies by a broad ocean, and having the will of the people as the supreme law. What trifling force might be required for the protection of the frontier could always be obtained by a call on the states most interested; no contingency was likely to arise which would render necessary any permanent establishment.

Hence it is found that the earlier acts providing for the employment of troops carefully avoid any reference to the appointment of officers by the general government, and only require that certain states to be named shall be called upon to furnish so many men for temporary service. Of this character was a resolution of the third of June, 1784, that "a body of troops, to consist of seven hundred men, are indispensably necessary for taking possession of the western posts as soon as evacuated by the troops of His Britannic Majesty; for the protection of the northwestern frontier, and the guarding of public stores." The states were called upon to furnish these men from their militia in the following proportion, viz: Connecticut, 165; New York, 165; New Jersey, 110; Pennsylvania, 260; and they were to be organized by the Secretary of War into a regiment of infantry and two companies of artillery, to serve twelve months. To the force thus raised was allowed one surgeon and four mates. This regiment was discharged in the following March, and on the seventh of April, 1785, a further draft ordered, to be made in the same manner as the last. To this new regiment one surgeon was allowed, at a monthly compensation of forty-five dollars, and four surgeon's mates, at thirty dollars each. This force was increased


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on the twentieth of October, 1786, to two thousand and forty officers and men, and on the third of October, 1787, a further increase of seven hundred was made, to take the place of those about to be discharged. All these were, however, militia and formed no part of the army of the United States, which at this time had no existence. By the report of a committee of the last Colonial Congress, appointed to examine into, and close up the Revolutionary Department of War, we find that the total number of troops in service in October, 1788, was but five hundred and ninety-five, who were distributed at West Point, Springfield and several block-houses in Western Pennsylvania and Ohio. There was no Medical Department recognized by the government, and what medical officers were required were employed by the states furnishing the troops.

Meanwhile, the Constitutional Convention had completed its work, and the first Congress commenced its sessions in New York. Their earlier labors were chiefly devoted to the organization of the new government. They created three executive departments; of War, of the Treasury and of Foreign Affairs. To the head of the former the President appointed Major General Henry Knox. The condition of affairs demanded that his first attention should be directed towards an increase of the military forces. Ever since the close of the war the Indians on the frontier had manifested a hostile attitude, inspired thereto it was asserted by the machinations of British agents. The western posts were still held by the British troops, and our small force of less than six hundred men was totally inadequate to keep the Indians in check. It was therefore enacted by Congress on the twenty-ninth of September, 1789, that a corps of seven hundred rank and file, should be organized, to be stationed on the frontier, and to constitute (together with two companies of artillery already in service) a regiment of infantry and a battalion of artillery. To the former were allowed one surgeon and three surgeon's mates; and to the latter one surgeon's mate.

Of the regiment of infantry thus organized, Josiah Harmar, of Pennsylvania, was appointed Lieutenant Colonel; and by virtue of a brevet of Brigadier General conferred on him by Congress, he was assigned to the command of the whole force. The medical officers of the regiment of infantry were: surgeon, Richard Allison, of Pennsylvania, (who had served as surgeon's mate during the Revolution); surgeon's mates, John F. Carmichæl, of New Jersey, John Elliot, of New York, and John M. Scott, of New Jersey; and of the battalion of artillery, surgeon's mate, Nathan Hayward, of Massachusetts. During the following spring this organization was supplanted by one formed by the act of the thirtieth of April, 1790.


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This provided for the immediate enlistment of twelve hundred and sixteen men, to be divided as before into infantry and cavalry; the regiments of infantry to be allowed two surgeon's mates instead of four. The pay of surgeon was fixed at thirty dollars per month, and of the mates at twenty-four dollars each per month. The surgeon was allowed subsistence at the rate of three rations a day, and each surgeon's mate at two rations; or they might at their option receive money by way of commutation for their subsistence, at the contract price of the ration at the posts where due. The surgeon was further allowed ten dollars per month, and each surgeon's mate six dollars per month instead of forage. It was further enacted, that the sum of ten cents should be deducted from the monthly pay of every enlisted man for the purpose of forming a fund for the purchase of hospital stores. The officers remained the same as before, except that the number of surgeon's mates of infantry being reduced, Doctor Carmichæl was discharged on the second of June. During the summer the Indians broke out into open hostilities, and Harmar marched with this force and some Pennsylvania and Kentucky militia into Ohio, but was defeated by the Indians on the nineteenth and twenty-second of October, on the Miami river. A congressional investigation acquitted the General of any blame, and it being evident that a larger force was needed to subdue the savages, an act was passed on the third of March, 1791, to raise and employ General and Staff Officers, and one additional regiment of infantry to be organized as the preceding one; and further, in lieu of the state militia previously called out, the President was authorized to employ troops "under the denomination of Levies, not exceeding two thousand rank and file, with a suitable number of commissioned officers, for a term not exceeding six months; and to organize such levies, and alone to appoint the commissioned officers." Section xiii of this act provided:

"That in case the nature of the service upon which the troops of the United States may be employed, should require a greater number of surgeon's mates, than are provided for in the before mentioned act, [April 30, 1790], the President of the United States may engage from time to time, such additional number of surgeon's mates, as he shall judge necessary.

Surgeon's mate John Elliot, of the first infantry, was promoted surgeon of the second infantry, and Joseph Waldo was appointed to the "Levies;" and the following mates: James Woodhouse, of Pennsylvania, Charles Brown, of Pennsylvania, John Hamill, of Pennsylvania, Victor Grasson, of France, Joseph Phillips, of New Jersey, and William McCoskry, of Pennsylvania, who were assigned to the different battalions of the levies; John F. Carmichael (late of the first infantry), and Elijah Tisdale to the second


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infantry. With this new force General St. Clair (who had succeeded Harmar as General-in-Chief) undertook an active campaign against the Indians, but was surprised near the source of the Maumee and defeated, losing upwards of six hundred killed and two hundred wounded. Among the former was Doctor Victor Grasson, surgeon's mate of Gaither's battalion of Darke's regiment of the levies; being the first officer of the Corps who lost his life in battle, and as such deserving of a respectful record in these pages, though unfortunately beyond this simple mention nothing is known of his history.

The term of service of the levies expired in the fall of 1791, and it became necessary for Congress to legislate further for the protection of the frontier. Consequently on the fifth of March. 1792, an act was passed entirely reorganizing the military force of the United States. This bill provided for the retention in service of the two regiments of infantry, and for the enlistment of three additional regiments, two to be organized as before, and the other to consist of two battalions of infantry and one squadron of light dragoons; all the additional troops to serve for three years. This force the President was authorized to organize in such manner as might appear most proper; "diminishing the number, or taking from one corps and adding to another." On the twenty-fourth of December, the Secretary of War communicated to the House of Representatives the following organization of the army, as directed by the President:

The whole force was formed into a "Legion," under command of a Major General, with the usual staff, among others a "Surgeon to the Legion" as chief medical officer. This legion was divided into four sub-legions, each of twelve hundred and eighty rank and file, to be commanded by Brigadier Generals. Each sub-legion was allowed a surgeon and three surgeon's mates, one to each battalion. By section vii of this act, the pay of surgeons of the General Staff was fixed at seventy dollars per month, and that of regimental surgeons or surgeon's mates at forty-five dollars.

Richard Allison, surgeon of the first infantry, was appointed surgeon on the General Staff, and the following to be surgeons of sub-legions: John Elliott, surgeon of the second infantry; John M. Scott, surgeon's mate first infantry; John F. Carmichæl, surgeon's mate second infantry, and N. Hayward, surgeon's mate of the battalion of artillery. The following were either retained or appointed surgeon's mates of the battalions: Charles Watrous, Joseph Phillips, William McCoskry, Joseph Strong, Elijah Tisdale, J. C. Wallace, Charles Brown, James Woodhouse, John Hammill, Joseph Andrews, Thomas A. Claiborne and Frederick Dalcho. Several


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garrison surgeon's mates were also appointed, to date from April 11, 1792, under the thirteenth section of the act of Congress of March 3, 1791. These were, John Sellman, of Maryland, James Clayton, of Delaware, Thomas Hutchins, of Pennsylvania, and Elihu Lyman, of Georgia.

Major General Anthony Wayne was appointed General-in-Chief under the new organization, and marched with the legion into the Indian country. The year 1793 was occupied in constructing forts and opening roads, and in several minor skirmishes. In August, 1794, he struck a decisive blow at the battle of Maumee Rapids, in which a force of over two thousand Indians were completely defeated, with but a loss of thirty-three killed and about one hundred wounded on our side. Soon after this the Indians commenced negotiations looking towards a permanent treaty of peace.

By an act passed May 9, 1794, a regiment of artillerists and engineers was organized. The medical officers of this regiment were one surgeon and four surgeon's mates. The following were appointed: Surgeon's mate Charles Brown to be surgeon, and John G. Coffin, of Massachusetts, Francis G. Brewster, of New Jersey, John R. Lynch, of New York, and Richard Griffith, of Delaware, to be surgeon's mates.

This year trouble arose with the British government which threatened to involve the country in another war. The Americans complained that no indemnification had been made for negro slaves which had been carried away on British ships at the close of the war; that contrary to the treaty of peace between the two countries, the English troops still garrisoned the frontier posts; and that British agents were living on friendly terms with the western Indians, and had incited them to hostilities.

Counter recriminations were made on the part of England, and John Jay was sent as a special envoy to the court of St. James; in the meantime the aspect of affairs was such as to render any reduction of the military force of the country extremely inadvisable. The terms of service of the troops composing the legion of 1792 was about expiring, and it was necessary to make further provision for a military force. This was attempted in the act of March 3, 1795, which repealed the previous laws establishing the military organization, and provided that the army should consist of the regiment of artillerists and engineers, and a legion of forty-eight hundred men to be organized by the President into sub-legions, as was previously the case. The medical officers of the new organization were essentially the same as in the old, and the only items of interest to the Medical Department related to the pay and emoluments of the staff. The pay of the surgeon was fixed at seventy dollars, with an allowance of twelve dollars per


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month for forage, and three rations. Regimental surgeons were to be paid forty-five dollars, ten dollars for forage per month, and three rations; and mates, thirty dollars pay, six dollars for forage and two rations; matrons and nurses in hospital, each eight dollars per month.  The force called for under this act could not have been enlisted, for on the third of February, 1796, Hon. Timothy Pickering, Secretary of War, addressed a letter to the chairman of the House Military Committee, in which he calls attention to the inadequacy of the force at the disposal of the department. Troops were needed to garrison a line of posts from Lake Champlain to Mackinac; to occupy the forts at Natchez and Chickasaw Bluffs, about to be evacuated by the Spanish troops; to establish new posts along the Indian frontier northwest of the Ohio; and to garrison the sea-coast fortifications. In consequence of this appeal Congress once more reorganized the army on the thirtieth of May, 1796. The regiment of artillerists and engineers was retained, and the infantry force fixed at four regiments, each to have one surgeon and two surgeon's mates; "provided always; that the President of the United States may at his discretion, appoint an additional number of surgeon's mates not exceeding two, and distribute the same, according to the necessity of the service." This act was to take effect on the last day of October.

On the twenty-seventh of April, 1798, a second regiment of artillerists and engineers was organized to serve for five years. The medical officers of this regiment were; surgeon, James Scanlan, of Maryland; surgeon's mates, Bur Harrison, of Kentucky, and Thomas Tillinghast, of Rhode Island.

War now became imminent with France, in consequence of troubles and differences between the two governments which had been agitated for over a year, and in May the President was authorized to raise a provisional army of ten thousand men, with the necessary general and staff officers. The seventh section of this act reads:

"And be it further enacted, That in case the President shall judge the employment of a quartermaster general, physician general and paymaster general, or either of them essential to public interest, he is hereby authorized by and with the advice and consent of the Senate, to appoint the same accordingly, who shall be entitled to the rank, pay and emoluments which follow, viz: quartermaster general, the rank, pay and emoluments of a Lieutenant Colonel; physician general, and paymaster general each the pay and emoluments of a Lieutenant Colonel. Provided, That in case the President shall judge it expedient to appoint a commander of the army, an inspector general, adjutant general, quartermaster general, physician general and paymaster general, or either of them in the recess of the Senate, he is hereby authorized to make any or all of said appointments, and grant commissions thereon, which shall expire at the end of the next session of the Senate thereafter.


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And be it further enacted, That the commander of the army, inspector general, adjutant general, quartermaster general, physician general, and paymaster general, who may be appointed by this act, shall respectively continue in commission during such time only as the President shall judge requisite for the public service, and that it shall be lawful for the President to discharge the whole or any part of the troops, which may be raised or accepted under this act, whenever he shall judge the measure consistent with the public safety."

On the sixteenth of July the regular army was further increased by twelve regiments of infantry and one of dragoons, with the usual number of medical officers, and with the previous proviso, that such additional surgeon's mates might be appointed as the good of the service might require.

Under the provisions of the act of March 3d, for the appointment of a physician general, James Craik, of Virginia, formerly physician to the Army of the Revolution, was at the earnest request of Washington selected.

Medical officers were selected for the new regiments, and vacancies filled in the old ones. Still Congress had made no provision for a Hospital Department proper, an omission of the greatest importance in the event of war.

In a report to the President, dated December 24, 1798, Hon. James McHenry, Secretary of War, calls his attention to this defect in the legislation of Congress. He had himself served as a surgeon during the Revolution, and well understood the importance of organization to procure efficiency. He says: "The Secretary does not discover in any of the acts the necessary provision for the appointment of hospital officers or a hospital establishment. As military hospitals are indispensable to an army, especially in time of war, it is respectfully suggested that provisions on the subject ought to be made by law, and that the regulations to be found in the resolutions of the old Congress, more particularly in those under date of September 30, 1780, and January 3, 1782, as certainly the faithful results of much experience, may afford some important lights respecting this Department. The certain consequences of disregarding so essential a measure in the event of war, and the encampment of an army, will be a train of diseases which must cut off a large proportion of our troops."  This was communicated to Congress on the thirty-first of December, and on the second of March, 1799, Congress passed the following "Act to regulate the Medical Establishment:"

"SECTION I.     Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

That in the Medical establishment of the United States there shall be the following officers: a physician general who shall be charged with the superintendence, and direction of all military hospitals, and generally of all medical and chirurgical


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practice, or service concerning the army or navy of the United States, and of all persons who shall be employed in and about the same, in camps, garrisons and hospitals. An apothecary general and one or more deputies, who shall be charged with the safe keeping and delivery of all medicines, instruments, dressings and other articles for the use of the hospital and the army. A purveyor or who shall be charged with providing medicines, stores, and whatsoever else may be necessary in relation to the said practice, or service. A competent number of hospital surgeons, who shall be liable to serve in the field, and who shall have the immediate charge and direction of such military hospitals, as may be committed to their care respectively. A suitable number of hospital mates, who are to observe the directions of the hospital surgeons, and shall diligently perform all reasonable duties required of them for the recovery of the sick and wounded.

SECTION II.     And be it further enacted, That each military hospital shall have a steward, with a competent number of nurses and other attendants; which steward shall be charged with the procuring of such supplies, as may not otherwise be furnished, and with the safe keeping, and issuing of all supplies.

SECTION III.     And be it further enacted, That the said physician general, hospital surgeons, purveyor and apothecary, and apothecaries' deputy or deputies, shall be appointed as other officers of the United States; that the said mates, and steward shall be appointed by the authority, and at the direction of the said physician general, subject to the eventual approbation, and control of the President of the United States, and shall be removable by the authority of the said physician general; and that the surgeons of each hospital shall appoint, employ, and fix the compensation of the nurses, and other attendants of such hospital, subject to the control of the said physician general, or the hospital surgeon of senior appointment with a separate army, or in a separate district.

SECTION IV.     And be it further enacted, That as often as the regimental sick will not suffer by the employment of regimental surgeons, or mates, in the temporary or other hospitals of the United States, the physician general, or the hospital surgeon of senior appointment with a separate army, or in a separate district, with the consent of  the general and Commander-in-Chief, or the officer commanding a separate army, may require the attendance of such surgeons, or surgeon's mates, as in his opinion can be with safety so withdrawn from their regiments.

SECTION V.     And be it further enacted, That it shall be the duty of the physician general, with two or more hospital surgeons, to frame a system of directions relative to the description of patients to be admitted into the hospitals; to the means of promoting cleanliness in the hospital; to the prevention of idleness, skulking and gambling in the hospitals; to the prevention of the spread of infectious distempers in the camps, and hospitals, and the government of nurses, and all others charged with the care of the sick in camps or hospitals, subject in the first instance to the approbation and revision of the Commander-in-Chief, the commander of a separate army, or in a separate district as the case may be, and eventually to the approbation and control of the President of the United States; Provided always, That the said directions having received the sanction of the Commander-in-Chief, or the commander of a separate army shall be operative, and remain in full force unless altered or annulled by the President of the United States.

SECTION VI.     And be it further enacted, That the compensations of the several officers, shall be as follows: of the physician general, one hundred dollars pay per


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month, which shall be in full compensation for forage, rations, and traveling expenses; of the purveyor one hundred dollars pay per month, in full compensation for his services, and all expenses; of the apothecary general eighty dollars per month, and thirty dollars per month in full compensation for forage, rations and all expenses; of each of his deputies fifty dollars pay per month, and sixteen dollars per month in full compensation for forage, rations and all expenses; of each hospital surgeon eighty dollars pay per month, and forty dollars per month in full compensation for forage, rations, and all expenses; of each mate thirty dollars per month, and twenty dollars per month in full compensation for forage, rations, and all expenses; of each steward twenty-five dollars per month, and eight dollars per month in full compensation for forage, rations and all expenses. Provided, That none of the officers shall be entitled to any part of the pay, or emoluments aforesaid, until they shall respectively be called into actual service.

SECTION VII.     And be it further enacted, That for the accommodation of the sick of the army and navy of the United States, the physician general, and hospital surgeons of senior appointment, with the approbation of the general commanding the army within the district where he shall be, shall have power to provide temporary hospitals; and the physician general with the approbation of the President of the United States, shall have power to provide and establish permanent hospitals.

SECTION VIII.     And be it further enacted, That all the said officers, and others, shall as touching their several offices and duties, be liable to the rules and regulations for the government and discipline of the army; and shall be bound to obey, in conformity with law, and the usages and customs of armies, the orders and directions of the chief military officers of the respective armies, and within the respective districts, in which they shall respectively serve and be.

SECTION IX.     And be it further enacted, That the physician general or in his absence, the senior medical officer, with the approbation of the Commander-in-Chief, or commanding officer of a separate army be, and hereby is authorized and empowered, as often as may be judged necessary, to call a medical board which shall consist of the three senior medical officers then present, whose duty it shall be to examine all candidates for employment, or promotion in the hospital department, and certify to the Secretary at War, the qualifications of each."

Before the troops called for by these and other acts passed about this time could be brought into complete organization, envoys had been appointed to settle the questions in dispute between the two nations, and early in the year 1800 it became almost a matter of certainty that there would be no war, and consequently on the fourteenth of May, Congress passed a bill to discharge by the fifteenth of June, all the troops raised for the increase of the army, "except the general and other staff, the engineers, the inspector of artillery, the inspector of fortifications, two troops of dragoons, the two regiments of artillerists and engineers and the first four regiments of infantry." This disbanded all the medical officers except six surgeons and twelve surgeon's mates, and by December, 1801, this number of mates had been still further reduced to seven, existing vacancies not having been filled in view of a still greater reduction of the army. Under the provision of


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this act, Doctor James Craik was mustered out of service as Physician General. He returned to his home near Mount Vernon, Virginia, where he passed the remainder of his life. The medical officers who remained in service on the nineteenth of December, 1801, were: Surgeons Charles Brown, first artillerists and engineers, James Scanlan, second artillerists and engineers, John Elliot, first infantry, William McCoskry, second infantry, Joseph Phillips, third infantry, and John F. Carmichæl, fourth infantry; Surgeon's mates Prescott Barron and Samuel M. Griffith, first artillerists and engineers, Charles Blake and George Dill, second artillerists and engineers, and of the infantry regiments, Eben Lawrence, J. C. Wallace, Edward Reynolds and Reuben Everett.

The act of March 16, 1802, still further defined the Military Peace Establishment of the United States, by directing that after June 1st, the army should consist of but one regiment of artillery and two of infantry, besides the necessary staff and the engineers; all officers not retained in some of these organizations to be discharged. The number of small posts to be garrisoned, however, rendered a relatively large medical staff absolutely necessary, and the following section was included in the bill:

"SECTION III.     And be it further enacted, That there shall be *      *      *  two surgeons and twenty-five surgeon's mates to be attached to garrisons or posts and not to corps."

The provisions of this bill in respect to pay, subsistence and forage, were the same as existed in previous statutes on the subject. The garrison surgeons appointed under the above section were John F. Carmichæl, late surgeon of the fourth infantry, and David Davis, late regimental surgeon's mate. The surgeon's mates were Alexander A. Peters, Samuel M. Griffith, George Dill, Charles Blake, Prescott Barron, Edward Reynolds, Southworth Harlow, John Rippey, Thomas R. Jack, Philip Turner, Robert Stark, Fiducis Tuttle, Lyman Spalding, Henry Jackson, James Lee, Nathaniel Bradford, Samuel McKee, jr., Francis Le Barron, Thomas Van Dyke and John F. Heileman. Many of these had seen service, and one, Philip Turner, had been distinguished as a hospital surgeon during the Revolution, and it will be remembered attracted especial attention from his great skill as an operator.

Even with the small military force now in service the number of medical officers was found insufficient, and on the twenty-sixth of March, 1804, the following act was passed:

"SECTION I.     Be it enacted, etc., That there shall be appointed, in addition to the surgeon's mates provided for by the 'act fixing the military peace establishment of the


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United States,' as many surgeon's mates not exceeding six, as the President of the United States may judge necessary, to be added to garrisons or posts, agreeably to the provision of the said act."

The returns made to Congress by the Secretary of War in 1803 showed two surgeons and twenty-three mates attached to garrisons. In December, 1804, the number of mates was increased to twenty-nine, by the filling of original vacancies caused by the act just quoted. The new appointments were, George Hall, of South Carolina, Hanson Catlett and Richard Davidson, of Kentucky, Corneilius Baldwin, of Virginia, Hugh M. Hall, of Georgia, and Abraham Edwards, of New Jersey.

From 1806 to 1808, various events occurred of a hostile character on the part of the government of Great Britain, and in the latter year it was thought advisable to once more raise for a limited time an additional military force, which was done by the act of the twelfth of April. This added to the army for the term of five years, (unless sooner discharged) one regiment of light artillery, one regiment of riflemen, one of light dragoons, and five of infantry; each to be provided with one surgeon and one surgeon's mate. The third section of this bill provided:

"That when in the opinion of the President of the United States, a suitable proportion of the troops authorized by this act shall be raised, there may be appointed * * * * such a number of hospital surgeons and surgeon's mates, as the service may require, but not exceeding five surgeons and fifteen mates, with one steward and one wardmaster to each hospital."

The pay and allowances of the officers provided for by this act was fixed as follows:

"And be it further enacted, That the compensation of the officers * * * authorized by this act shall be, viz: * * * to each hospital surgeon seventy-five dollars per month, six rations per day or an equivalent in money, and twelve dollars per month for forage when not furnished as aforesaid; each hospital surgeon's mate, forty dollars per month, two rations per day or an equivalent in money, and six dollars per month for forage when not furnished as aforesaid; each hospital steward, twenty dollars per month, and two rations per day or an equivalent in money; each wardmaster sixteen dollars per month, and two rations per day or its equivalent in money; Provided, The officers furnish their own horses and accoutrements, and actually keep in service the aforesaid number of horses, to entitle them to the aforegoing allowance for forage, or its equivalent in money."

It would appear that the additional hospital officers provided for by this law were never appointed, for their names do not appear on the Army Register for 1809, and the general return of the army for 1810 shows but one hospital surgeon and one mate, two garrison surgeons and twenty-nine mates, and seven regimental surgeons and four mates; the garrison medical


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officers belonging to the permanent establishment, and the others to the additional military force.

It will be proper before proceeding to consider the events connected with the Corps during the war of 1812-15, to offer a few words of explanation as to the relative duties of the officers composing the rather complex organization, which seems to have found favor in all the enactments of this period. The early legislation for the army after the close of the Revolution, it has been seen, provided only for regimental medical officers. The first regiments were raised for active service against the Indians, and it was supposed that the regiment would always act as a unit, or at most broken up into not more than two or three battalions, so that there could always be a medical officer with each detachment. Afterwards, when the extension of our sea-coast fortifications, the acquirement of the frontier posts from Great Britain, and the necessity of keeping a force permanently at the West for the protection of settlers, largely increased the number of military posts, garrison surgeons and mates were appointed, who were generally though not always selected from that part of the country where they were expected to serve, and who were permanently stationed at the various military posts, not being assignable to any other duty. On the approach of war hospital officers were provided for, whose duties were to act as medical directors and inspectors of departments and armies; to have charge of general and depot hospitals, and to generally perform such service as is now assigned to the senior surgeons in the Corps. The regimental medical officers accompanied their regiments on the march and into action, and attended to the minor cases in their own hospitals, but as soon as a man became seriously ill or had a wound of such a character as to require a capital operation, the regulations required his transfer to a general hospital. It will be seen that in the point of corps organization, matters had advanced but very little since the Revolutionary period, and that no wisdom had been learned from the vexatious controversies of those days between the general and regimental staff. It is impossible to ascertain from any positive enactments on the subject, what was the relative rank of these different grades, but it would appear from the schedules of pay and allowances of each, that the hospital officers took precedence, next those attached to garrisons, and lastly the regimental surgeons and mates.

Very early in the year 1812 it became evident that the long pending troubles between the United States and Great Britain would result in war, and the sessions of the twelfth Congress were chiefly occupied with devising ways and means for carrying it on. On the eleventh of January an act was passed for the immediate enlistment of an additional military force, to 


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consist of ten regiments of infantry, two of artillery and one of light dragoons; each regiment to be allowed one surgeon and two surgeon's mates. The fourth section of this act provides, "That there shall also be appointed * * * such a number of hospital surgeons and mates as the service may require, with one steward to each hospital." This force was increased by the act of June 26th to twenty-five regiments of infantry, with the same organization as before.

The country was at this time illy provided in all the essentials necessary for the formation of an efficient army. A long period of peace had caused all the experience of the war of the Revolution to be forgotten. Most of those who had served in that struggle, and whose experience would at this time have been of the greatest value, were either dead or superannuated. No efficient army organization had been kept up, all the various staff departments were such as would be required for a force of but two or three regiments, and were without executive chiefs or any regulations by which they could be systematized. Especially was this true of the Medical Department, which for many years only had an existence in the persons of a few garrison and regimental surgeons and their mates, who were stationed at various isolated posts, seldom or never having communication with each other and having no official head other than the commanding officer of the post or regiment to which they were attached. The surgeons of the Revolutionary Army had left behind them no records of their experience; and the management of military hospitals, the police and hygiene of camps, the diseases peculiar to troops and the surgical conduct of a campaign were topics of which the profession of the country were entirely ignorant, the only American work on these subjects having a general circulation being a volume of "Observations on the means of preserving the health of soldiers and sailors," written in 1807, by Dr. Edward Cutbush, a naval surgeon. Under these circumstances the army provided for by the acts last mentioned assembled at Greenbush, New York. Doctor James Mann, of Massachusetts, who had just been appointed hospital surgeon, was ordered to superintend the Medical Department for this Northern Army. Speaking of the difficulties which he had to encounter, he says:

"The mere organization of hospitals was the least perplexing part of duty. The illy defined powers with which the hospital surgeons were invested, even in their own department, subjected them to many disagreeable interferences of the officers of the line. Collisions will always exist between officers of different departments of an army, when their several powers and duties are not explicitly pointed out. Officers tenacious of authority, assume as much as may be implied by rules and regulations. In addition to multiplied embarrassments, the various duties


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attached to the office of hospital surgeon with those merely professional, was always so pressing, that little time was allowed to record particularly the diseases and medical transactions of the army, as they occurred."

The average number of men at Greenbush, during the summer and fall of 1812, was from fifteen hundred to three thousand, varying between these numbers as troops were organized and marched to the northern frontier. The average on sick report was from one hundred to one hundred and thirty, the diseases being chiefly dysentery and diarrhoa, due to want of cleanliness, bad cooking and intemperance. No hospital accommodations having been provided, the sick were treated in tents. As the troops marched to the frontier general hospitals were established at Burlington, Vermont, and Plattsburgh, New York, and a little later at Malone, New York. The hospital at Burlington was placed in charge of Doctor Joseph Lovell, surgeon of the ninth infantry, (afterwards the Surgeon General of the army). That at Plattsburgh was organized and conducted by Doctor William H. Wilson, hospital surgeon's mate, of New York. At Buffalo there was also a hospital for the troops on the Niagara frontier, which in December, 1812, was in charge of Surgeon Silas Fuller, of the twenty-third infantry.

The diseases of the troops composing the eastern division of the army were as at Greenbush, intestinal disorders, to which was added in October the measles, which prevailed with such severity that nearly one-third of the total strength of the command was sick in November. As the winter advanced, pneumonias of a sthenic type became prevalent along the whole frontier, and there were upwards of four hundred deaths from this disease alone, during the winter in the two hospitals at Plattsburgh and Burlington. It was especially noticed by the surgeons that those regiments suffered the most in which discipline was lax; the light artillery regiments had fewer sick than any other. "Their quarters and encampments were generally in the best state; the men were mostly neat and clean in their dress and appearance." Of another case Doctor Mann remarks: "There was one regiment on the frontier, which at one time counted nine hundred strong; but was reduced by a total want of good police to less than two hundred fit for duty in the course of two months. This regiment in its appearance was at that time dirty in the extreme. * * * At one period more than three hundred and forty of this regiment were in hospital; in addition to these a large number were reported sick in camp. At the close of the war this regiment had established a high reputation. Its good discipline and bravery were excelled by none."


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The troops on this frontier did not suffer, as did their predecessors in this locality during the Revolution, from want of supplies. On the contrary, the hospitals were abundantly provided with every thing necessary for the comfort of the sick, both in the shape of medical officers and stores. The obstacles to a proper administration were due to the want of any executive head of the bureau, for which Congress had strangely neglected to provide, and to the fact that the hospital officers had no rank even of an assimilated character to protect them in the performance of their duties. The following extract from an official report of the Medical Inspector of the Northern Department is of interest, as showing the condition of the hospitals at the close of 1812:

"The hospital department at Plattsburgh has not been destitute of the common supplies, which are usually furnished the sick of an army; while every requisition made for hospital stores has been promptly answered. During the month of November, ample supplies of stores as wine, spirits, sugar, molasses, rice, tea, and chocolate were ordered by General Dearborn to be forwarded to Plattsburgh, under the charge of Doctor Wilson, hospital surgeon's mate. In December an additional quantity was by orders, directed to the same post, and to Burlington. * * * * The hospital under direction of Doctor Wilson, [at Plattsburgh] is found in the best state. The beds are amply furnished, the wards clean, the kitchen neat. No less credit is due to Doctor Lovell, surgeon of the 9th regiment, under whose charge the hospital at Burlington is placed, on account of its good condition and the unremitted attention bestowed on the sick. The hospital at Greenbush is in good order and the patients comfortable."

The experience of the campaign during the fall of 1812 and the winter of 1812-13, convinced Congress of the necessity of a more thorough organization of the staff departments, and on the third of March an act was passed for "the better organization of the General Staff of the Army of the United States," which is given herewith, in so far as it referred to the Medical Department:

"SECTION VII.     And be it further enacted, That for the better superintendence and management of the hospital and medical establishment of the army of the United States, there shall be a physician and surgeon general, with an annual salary of two thousand five hundred dollars, and an apothecary general, with an annual salary of eighteen hundred dollars; whose respective duties and powers shall be prescribed by the President of the United States.

* * *****

SECTION XI.     And be it further enacted, That all letters and packages to and from *    *    *    *   the physician and surgeon general, and apothecary general, which relate to their official duties, shall be free from postage."

For the position of Physician and Surgeon General created by this act, Doctor James Tilton, of Delaware, was selected. We have already seen that this


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gentleman had distinguished himself greatly by his abilities as a hospital surgeon during the Revolution. Since that time he had represented his native state in the National Congress, and had been for many years living in retirement in the vicinity of Wilmington, devoting his attention chiefly to agriculture. He had on the outbreak of the war given to the world a work entitled "Economical Observations on Military Hospitals, and the prevention and cure of diseases incident to the army," in which he elaborated the plan for hospital organization presented by him to Congress in 1781. In this work he condemns the practice which had hitherto prevailed of conforming to the organization which obtained in the various European armies. The book is now very rare, but from a review of it which may be found in the Medical Repository for 1813, the following summary of its contents is extracted. It is of value historically, because it was the first publication in reference to this subject which had been written in this country as the result of personal experience:

"Doctor Tilton does not distinguish medical officers into physicians and surgeons, but considers them one or the other as circumstances may require. He proposes to establish a medical board in each military district or separate army, to be composed of two or more hospital surgeons and several regimental surgeons. This board is to have a field officer to sit as chairman, and meet monthly or oftener if necessary, by general order, to regulate the concerns of that department. This board is to examine and appoint all vacancies of hospital and regimental mates, with the consent of the commanding officer; to examine candidates for hospital surgeons, and recommend them to the physician and surgeon general for appointment, and establish rules for the medical department. The oldest hospital surgeon is to be the director of general or regimental hospitals in the army or district where stationed, and to act as prescribing surgeon only, without interfering in commissarial duties. His attention will thus be drawn to visit the several establishments for the sick within his charge, and as director to superintend their concerns. Such an arrangement is to prevent impositions on the government, and hereafter to procure surgeons adequate to their respective duties.

Instead of establishing extensive and costly buildings for hospitals, Doctor Tilton proposes to extend the circle of regimental practice, and diminish the scale of hospital practice; thus if possible to prevent disease and ward off infection. His object is to have a harmonious understanding between the surgeons of the army, and by a proper regulation of the medical board, keep in check any disposition to throw the sick into general hospitals beyond moderation and propriety, whereby they must become crowded, producing the inevitable consequences of camp, jail, typhus, or hospital fevers, from which armies have suffered more than from their enemies."

The enunciation of these advanced views doubtless led to his appointment. On account of his age he was very adverse to accepting the position, but being assured that his duties would be chiefly of an executive character, and that he would not be required to take the field he consented, and was


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confirmed by the Senate, to date from June 13th. At the same time Doctor Francis Le Barron, of Massachusetts, was appointed Apothecary General. He had already had a long experience in the army. His original entry into service was in December, 1800, as surgeon's mate of the navy; was transferred to the army as surgeon's mate, March 26, 1802, and promoted surgeon in 1808, and had been continuously on duty as such up to the date of his present appointment.

Immediately after the passage of the before mentioned act, the President caused to be issued "Rules and Regulations for the Army, May 1, 1813." The duties of the Physician and Surgeon General are thus defined:

"It shall be the duty of the Physician and Surgeon General to prescribe rules for the government of the hospitals of the army, to see these enforced, to appoint stewards and nurses, to call for and receive returns of medicines, surgical instruments and hospital stores, to authorize and regulate the supply of regimental medical chests, to make out general half yearly returns of these, and of the sick in hospital to the War Department, and yearly estimates of what may be wanted for the supply of the army.

The apothecary general shall assist the Physician and Surgeon General in the discharge of the above mentioned duties, and shall receive and obey his orders in relation thereto."

There are no regulations in reference to the duties of hospital surgeons or the management of the sick, which may be accounted for by the fact that the above gave special authority to the Physician and Surgeon General to prescribe all such rules. These regulations, however, define for the first time the uniform and dress of the army, and now that a new uniform has just been adopted, it will be interesting to quote the clauses relative to the equipments of the Medical Corps, and compare them with our own:

"The uniform of the physician and surgeon, and apothecary generals, and hospital surgeons and mates shall be black; the coats with standing collars, and on each side of the collar, a star of embroidery within half an inch of the front edge.

The coat to be single breasted with ten buttons, and button holes worked in blue twist in front five inches long at the top and three at the bottom. The standing collar to rise to the tip of the ear, which will determine its width. The cuffs not less than three and a half, nor more than four inches wide. The length of the skirt to reach to the bend of the knee. The bottom of the breast and the two hip buttons to range. On the collar there shall be one blind hole five inches long with a button on each side.

Breeches or pantaloons to be worn, with four buttons on the knee and gilt knee buckles.

High military boots and gilt spurs.

The stock to be black of leather or silk.

Chapeaux with button and loop black, and black cockade four and a half inches in diameter, with a gold eagle in the center.


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The sword to be straight, yellow mounted, with black or yellow gripe. The waist belt to be of black leather, and no sashes to be worn.

The epaulettes to be of gold.

The dress of the hospital staff will conform as to fashion to the uniform of the staff, except that they will wear pocket flaps, and buttons placed across the cuffs, four to each, and covered buttons in all instances of the colour of the coat."

Notwithstanding that Doctor Tilton had been informed that no active service would be required of him, he considered it his duty on acceptance of his appointment to visit and inspect the hospitals along the northern frontier. The troops under General Dearborn had been concentrated during the spring at Sackett's Harbor, preparatory to the expedition against Little York in Upper Canada. This post had been occupied during the previous winter by militia troops, among whom the winter epidemic had been very fatal, and the Surgeon General found the hospital in such a filthy and neglected condition that he immediately convened a Medical Board to prepare additional regulations for the management of the hospitals, and to examine all incompetent officers. He also directed that a general hospital should be established at Watertown, twelve miles distant; where the village academy was secured for the purpose and fitted up for the accommodation of one hundred persons. There was a temporary hospital at this place, which had been established two months before on the departure of the troops for Canada. This was in charge of Hospital Surgeon's mate David March, U. S. A. On the twenty-seventh of April the attack on Little York took place, and after four days occupation of the town, the army with the wounded and sick were moved to Fort Niagara, where a tent hospital was organized two miles from the river. The ground was wet and low, and many of the wounded died from camp diarrhoa and typhus fever, and in June, after the capture of Fort George, a general hospital was established at Lewistown, eight miles up the river, by advice of Surgeon Mann, Medical Director. This hospital consisted of two barns, besides a large number of hospital tents, and was well supplied with every thing necessary for the comfort of the sick and wounded; which by the first of August had increased to nearly seven hundred. Here the patients improved very rapidly, the position of the hospital being salubrious, the tents policed with great care, and the diet being generous. In the army at Fort George, however, a most lamentable degree of sickness prevailed. Doctor Mann writes:

"During the month of August an uncommon proportion of the army were sick or unfit for duty. More than one-third of the soldiers were on the sick reports. The officers shared with the privates in the prevailing diseases. Half of the medical staff attached to regiments were also unable to perform their duty. Of seven


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surgeon's mates attached to the hospital department, one died and three had leave of absence by reason of indisposition; the other three were for a short period sick. So general was the sickness, the few remaining surgeons could not do full justice to their patients. At the time when the returns of the sick in the general hospital counted between six and seven hundred, there were only three surgeons of this department present for duty. At this period of General Boyd's command, the troops were under excellent dicipline, the encampment in good condition, and the men neat in their apparel. The general and regimental hospitals were reported during the summer months by the inspectors of the army, 'in the best possible order.'"

The following account of the condition of the army at this time is taken from an official report of Hospital Surgeon Joseph Lovell, U. S. A., and may be found in Mann's Medical Sketches:

"The division of the army stationed at Fort George from the beginning of June to the beginning of October, 1813, was encamped on the bank of the Niagara extending from the fort to the village nearly on the lake shore. The surrounding country is flat, and the camp was deprived of the lake breezes, from the position of Newark. During the month of June it rained almost incessantly; while the latter part of July, and the whole of August were extremely hot; the whole of September was however remarkably mild and pleasant. Thus after having been wet for nearly a month, the troops were exposed for six or seven weeks to intense heat during the day, and at night to a cold and chilly atmosphere, in consequence of the fog arising from the lake and river. The enemies' advance being within a short distance of the camp, the details for duty were large, and skirmishes taking place at the picquets every morning; the soldiers were for a length of time stationed at the several works for several hours before daylight; and thus exposed to the influence of a cold damp atmosphere, at the time the system is most susceptible of morbid impressions. The diseases consequent to this alternate exposure to a dry hot, and cold damp atmosphere, were such as might have been expected; typhus and intermittent fevers, diarrhoa and dysentery. A detachment of artillery, stationed at the right wing near the lake, was particularly exposed to the heat of the day, and the dampness of the night, and suffered much from typhus and intermittents. * * * * These diseases however though severe, bore but a small proportion to the usual pestilences of our army, diarrhoa and dysentery. During two years and a half, I was on the frontiers, at every post from Buffalo to Burlington, Vermont, these complaints almost invariably absorbed all others. They were the only ones which could be called our camp diseases. All others arose from obvious or local causes, and were as common to the citizen as soldier." 

From the establishment of the hospital at Lewistown until the end of the year, the number of patients admitted was between nine hundred and fifty and one thousand, and there were fifty-nine deaths.

In the fall of 1813 General Wilkinson, who had succeeded Dearborn in the command of the army, organized an expedition down the lake, and ordered all convalescents to the hospital at Lewistown, with orders that they should be furnished with winter quarters out of reach of the enemy. In


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November, Doctor Mann determined to break up this hospital, its exposed situation rendering it less suitable for winter quarters than some place would be more removed from the lake. With this view, he selected about a hundred of those who were subjects for discharge, and sent them to Greenbush, under charge of a young surgeon's mate, Doctor William E. Horner, (afterwards the well known Professor of Anatomy at the University of Pennsylvania). The remainder, numbering about two hundred and fifty, were moved to Williamsville, about forty miles from Lewistown. The barracks at this place were repaired, well supplied with stores, and placed in charge of Hospital Surgeon's mate Joshua B. Whiteridge, a young man who had gained a high reputation as executive officer of the hospital at Lewistown, and who "for assiduous attention to duty was exceeded by no physician in the army."

Meanwhile, General Wilkinson had located his head-quarters at Malone, and in December a general hospital was established in that village. The academy, the arsenal and some private houses were selected, and accommodations for two hundred and fifty men thus afforded. The regimental hospitals of the division were at French's Mills, sixteen miles distant, where the sick suffered greatly from the severity of the weather and the effects of unwholesome diet, insufficient accommodations and want of stores, many of which had been lost during the open boat passage down the lake. These were causes over which the Medical Staff had no control; nevertheless they were very severely criticized, and most unjustly made responsible for the great mortality which took place at this time.

At the commencement of the year 1814 the chief general hospitals were those already mentioned, at Greenbush, Plattsburgh, Malone, Williamsville and Burlington. The latter had acquired the reputation of being a model hospital. It was originally established in 1812 by Surgeon Joseph Lovell, ninth infantry, who was succeeded in charge by Hospital Surgeon Walter V. Wheaton, (long a distinguished ornament to the Corps). He in turn was relieved by Hospital Surgeon James Mann, who turned over the charge of the hospital to Hospital Surgeon Henry Hunt in 1814. All of these gentlemen had labored faithfully to bring the institution to the highest state of efficiency, and one of them has fortunately left on record an account of the regulations adopted therein and its general management, which is of sufficient interest to be given in detail:

"The following regulations were adopted in the General Hospital at Burlington; where in no instance from its first establishment, even when the monthly reports counted from six to nine hundred men, was an infectious disease generated or propagated:


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The washing of the walls and floors with soap and water or lime water was of the first importance. This was frequently repeated especially during hot weather. In cold weather when the wards were occupied by the sick, washing them was not only inconvenient, but hazarded the health of the patients. A coat of sand half an inch thick or more, renewed on the floors every day, was never attended with ill consequences, but was refreshing to the sick, while it superceded the necessity of washing. Whitewashing the walls with lime and water never incommoded the sick; it sweetened the rooms, and corrected infectious principles. By daily sanding the floors, they were kept not only clean but perfectly white. The opportunity of washing them was improved, when the number of sick was reduced so as to admit their removal from one ward to others. The wards were thus alternately washed and thoroughly repaired. Bunks as soon as they were unoccupied were removed from the wards, and after cleansing returned. The straw of the sacks was burned as soon as the bed was vacated. The sacks were washed once in two weeks, and the straw changed. Blankets were always clean and frequently changed. During hot seasons the windows and doors of the wards were continually open. In cold seasons the windows were opened for a short time, repeatedly in the day; care being taken that the sick in their beds were not exposed to the direct currents of air. No person was permitted to spit on the floors of the wards. Spit boxes were furnished every bed, and filled with sand twice a day, sometimes oftener where the patients expectorated largely. Close stools, bed pans, and urinaries were removed as soon as employed. No culinary process was performed at the hearth of the sick wards. Attached to each ward was a closet where the table furniture after washing was deposited in neat order. Each ward was furnished with a large table, constantly covered with a clean cloth of linen the better to ensure its cleanliness; on which was placed a box with a number of little apartments, wherein were set in order, the vials and medicine for the patients, each vial and parcel labelled with directions, so as to obviate mistakes.

Attention was paid to the distribution of the sick. The wards appropriated to infectious or contagious diseases were less crowded than those occupied by patients with less important complaints. Surgical cases had rooms separate from the febrile. Venereal and itch patients were assigned to their separate wards, and not intermixed with men of different diseases.

Personal cleanliness was also a mean which promoted health, and obviated the generation of new diseases. The sick previous to admittance were washed in tepid water, in an apartment appropriated to this use; then placed in a clean bed with a clean shirt. Daily ablutions of the hands and face were ordered. The sick with febrile diseases under the immediate direction of a surgeon, were occasionally washed or spunged with vinegar and water at some seasons. The patients in hospital were shaved every other day, and shirted twice a week.

The beds throughout the hospital were always in order whether occupied or not. If a patient left his bed ever so frequently in the day, if only for five minutes, it was immediately put in order; so that the wards were always in a condition to be visited or inspected by officers of the army. *     *     *    *

The Hospital at Burlington, during five months in succession when under my immediate direction was not one hour in a state so bad that it would not meet the approbation of an inspecting officer who knew his duty. This hospital was visited repeatedly by officers of the line when under the direction of Doctors Wheaton and Hunt, and during every period after August, 1813, was always seen in the best


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possible order, and deservedly merited the high encomiums it received, not only from inspectors of the army, but private citizens. *     *     *     *

During the winter of 1813-14, there were at one period between seven and eight hundred patients, distributed in forty wards, nearly equally divided among eight hospital surgeons and mates. These young gentlemen felt themselves highly responsible for the state of their respective wards, and condition of the sick; who were not a little benefitted by a competition excited to excel each other in their duty; which was manifested by daily improvements, in respect to cleanliness and accommodations of their patients. *     *     *     *

The location of this military hospital is most eligible, situated on the highest bank, elevated sixty or seventy feet above the water. The soil of this spot is sand mixed with gravel, dry and hard at all seasons of the year.

During the campaign, 1814, a convenient garden was laid out, under the direction of Doctor Hunt, hospital surgeon, for the benefit of the convalescents and invalids, which by their labor was kept neat and in good order.

The interior of this hospital has been already noticed, its exterior was not less attended to. In an adjoining house, the surgeons were accommodated with comfortable rooms, where one or more always remained.

The wards of this hospital were regularly swept and put in order by sunrise through the year. The wards were visited by their several surgeons, in the summer months at eight o'clock in the morning, in the winter at nine. Previous to these hours, the patients had breakfasted. The rooms were not only in perfect order, but every patient was found in his own lodging. While the surgeons were making their prescriptions silence was preserved. The prescriptions were taken by the attendants to the dispensary, where they were immediately made up by the apothecaries. During the winter, 1813-14, four apothecaries were constantly employed in their appropriate duty."

The general hospital at Malone was broken up in February, 1814, by reason of movements of the army, and the sick, some four hundred and fifty in number, removed in sleighs to Plattsburgh and Burlington. This formidable undertaking was successfully accomplished under the direction of Hospital Surgeon Mann, with a loss of but six men, while a large number of the patients decidedly improved in health. The diseases from which the men suffered were chiefly pneumonia, rheumatism and dropsy, besides a great many cases of frost-bite, and mortification of the lower extremities from exposure in boat service on the lakes. From the first of January to the ninth of February, at Malone, there had been admitted three hundred and eighty, of whom twenty died. At Burlington, during the first four months of 1814, the admissions were two thousand four hundred and twelve, and there were seventy-five deaths. Remaining on hand April 30th, one hundred and sixty-one, most of whom were convalescent.

In the summer of 1814 the general hospital for the troops operating on the Niagara frontier was established at Buffalo. A plat of ground was selected near the present site of the Central Railroad depot, and a large


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number of hospital tents erected, which were amply provided with bunks and straw and hospital stores, and placed under charge of Hospital Surgeon William Thomas. Hither the wounded were brought after the battle of Chippewa. Doctor Horner gives the following account of their transportation from the field of battle to the hospital:

"The battle being fought on the banks of the Niagara river, the wounded were brought up in boats to the general hospital at Buffalo. They were conveyed from the boats on Buffalo creek to the hospital, a distance of three or four hundred yards, on blankets the sides of which were nailed to poles nine or ten feet long. This formed an easy and convenient litter by which four strong men could safely convey one wounded, without exposing him to the unspeakable pain from jolts, etc., which would be the inevitable consequence of transportation by wheel carriages. Besides this advantage of the litter, when the wounded soldier was to be placed on it., it was spread smoothly on the ground, and he slipped gently on. It was then taken up carefully by the assistants, and carried to the hospital, when the patient was either assigned at once to his tent, or placed on the hospital parade ground, as the convenience of dressing required. A litter thus constructed can be easily pulled away from under the patient without pain, and is in that respect, much better than the brancard, or the wheelbarrow."

The battle of Bridgewater, on the twenty-fifth of July, crowded the hospital to excess. On the first of August it contained nearly eleven hundred patients. On the fourth of that month the enemy made a sudden attack at Black Rock, and Buffalo being threatened with capture it was thought advisable to remove the hospital to Williamsville, where one had existed the previous winter. Accordingly all who were able to be moved were sent to the latter place, and a general hospital established under charge of Hospital Surgeon Ezekiah Bull, assisted by Hospital Surgeons Thomas and Lovell. The more severe cases, to the number of eighty or ninety, were left at Buffalo, under charge of Surgeon's mate W. E. Horner. The latter was constituted the receiving hospital for the army, then at Fort Erie, and Doctor Horner was directed to retain the worst cases and send all the rest to Williamsville. These hospitals were kept filled to their utmost capacity by the operations of the army, but on the termination of the campaign by the evacuation of Fort Erie in November, that at Buffalo was closed, and the remaining sick transferred to Williamsville.

The interest of the fall campaign at the east centered at Plattsburgh. On the first of September, the sick in the general hospital numbered seven hundred and twenty men; and as these could not be protected within the lines of works, they were, in view of the approaching fight, transferred to Crab Island, two miles distant, and placed under charge of Hospital Surgeon's mate Edward Purcell. No accommodations had been provided


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for them on the island, and they remained for three days exposed to the wet and cold, when Doctor Purcell determined to transport them to Burlington, which he did in open batteaux across the lake. This crowded the hospital at Burlington to such an extent, that the ill effects of crowd poisoning were soon perceived in the increased number of deaths and the slow convalescence of many. Typhus, dysentery and diarrhoa became very prevalent.

The wounded in the battle of Plattsburg and in the naval action on the lake were transferred to Crab Island, where they were placed under charge of Doctor Mann.

The legislation of the year 1814 embraced but one bill which was of any interest to the Medical Corps. This was passed on the thirtieth of March, and was entitled, "An act for the better organizing, paying and supplying the army of the United States." The sections having any reference to the Hospital Department were as follows:

"SECTION IX.     And be it further enacted, That from the first day of June next, the officers of the army shall be entitled to waiters agreeably to grades, as follows, *      *      *      *  the physician and surgeon general two, *     *     *     * hospital surgeons, one.

 

SECTION XI.     And be it further enacted, That the President of the United States be authorized to appoint as many assistant apothecaries as the service may in his judgment require, each of whom shall receive the same pay and emoluments as a regimental surgeon's mate.

          

SECTION XVIII.     And be it further enacted, That the physician and surgeon general of the army be entitled to two rations per day and forage for two horses; and that in addition to their pay as at present established by law, the regimental surgeons, and surgeon's mates be entitled to fifteen dollars per month each."

This last section was inserted in consequence of the numerous complaints that had come from the army of the inadequacy of the pay of the regimental medical officers. In fact their status throughout the war had been very low. They were without rank of any kind, were hardly more respected officially than the non-commissioned officers and did not really have as much authority, and though constantly performing the most arduous duties, their pay was far less than the hospital officers. Surgeon Mann writing to Doctor Tilton in the name of the medical officers of his department says, in a letter dated Malone, February 14, 1814:

"This is a fact and a serious one too, that the surgeons and mates of regiments, under existing encouragements have no inducements to continue long in service. Curiosity alone, will induce them to sacrifice the term of one year in service. This being gratified its exciting powers lose their effects. The pay and emoluments of surgeons and mates of regiments do not give them a support, especially on the frontiers of Canada, where the articles of life are procured at the most extravagant prices."


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In December, 1814, a general order was issued from the War Office establishing Regulations for the Army of the United States. In this document the duties of medical officers are for the first time clearly defined. The paragraphs relating to the Medical Department are as follows:

REGULATIONS FOR THE MEDICAL DEPARTMENT.


HOSPITAL SURGEONS AND MATES.

The senior hospital surgeon shall be ex officio director of the medical staff, in the army or department to which he may be attached. It shall be his duty to examine, and (if he approves) countersign all requisitions for hospital stores, medicines and surgical instruments, of the surgeons or mates in his department; to inspect the hospitals or infirmaries, under his direction as often as he may deem it necessary, and as often as he shall be required by the commanding general; to correct all abuses, and to prescribe and enforce such rules and regulations for the government of the attending surgeons and mates, as may be considered most conducive to the comfort of the sick and the interest of the service, with the approbation of the general commanding the army or department.

It shall be his duty to consolidate the reports of the surgeons and mates in his department, and to transmit a copy thereof quarterly, to the commanding officer of the department; to keep a book in which shall be registered all the reports transmitted by him; and to make from time to time such remarks on meteorological phenomena, and the appearance of epidemicks, as may be deemed useful in promoting medical science.

It shall be the duty of the hospital mates, to observe the directions of the medical director; to have the police rules of the hospital or infirmary, written in a legible hand, and hung up in some conspicuous part thereof, for the information and government of the patients; to assign to each patient an appropriate ward; to keep a register of all patients admitted, and a diary, in which shall be recorded the history of every important or interesting case of disease.

It shall be the duty of the senior attending surgeon at every hospital, infirmary, or post, to make requisitions for such medicines, hospital stores, etc., as may be considered necessary for the comfort of the sick, and to submit the same to the director for his approval.

They shall make monthly and quarterly reports to the director agreeably to the forms prescribed.

It shall also be their duty to communicate frequently and freely with the director, and to consult him in all cases, wherein his advice may be deemed necessary.

There shall be kept at every hospital and infirmary under the direction of the senior surgeon, a book in which shall be entered the name and description of every patient, to be taken from his descriptive list, when admitted, and his disease. To which will be added the date of his discharge from the hospital, and the disposition made of him. When a soldier is returned to his corps, furloughed, or furnished with a certificate to obtain a discharge for inability, his descriptive list shall be returned with him, having been carefully kept in the hospital for that purpose, noting on the same the payments which have been made at the hospital.


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Under the direction of the commanding officer of the army or department, the senior attending surgeon shall make out regular muster rolls of the stewards, wardmasters, nurses, attendants, and patients attached to his hospital or infirmary, and deliver them to the inspector, who shall correct and sign the same for the guidance of the paymaster, as in all other cases of musters and inspections for payment.

HOSPITAL STEWARDS AND WARDMASTERS.

It shall be the duty of the steward, under the direction of the surgeon, to provide for the hospital, to receive and take charge of all hospital stores, furniture, utensils, etc., to keep an accurate account of all issues, and specify not only for whom but by whom ordered. The surgeon's certificate shall be his voucher.

The stewards are authorized to draw from contractors any of the component parts of the ration which may be necessary to the supply of hospitals, and which the said contractors are obliged to furnish. The component parts of the ration not actually employed as food in the hospital, may be sold, and the avails applied to the purchase of vegetables, etc., etc., as directed by the superintending surgeon. 

The wardmaster shall be under the direction of the steward. He shall receive the arms, accoutrements and clothing of every patient, admitted into the hospital. 

He shall see that the clothes are immediately washed, numbered and labelled with the name, regiment, and company of the patient, and put away in a place provided for that purpose. If the arms and accoutrements are not brought with the patient, the wardmaster shall so report. He shall be responsible for the cleanliness of the patients and the wards; shall call the roll every morning and evening and report all absentees.

He shall be particularly careful in the proper construction of the close stools, and see that that they have always a proper quantity of water, or charcoal in them, and that they are cleansed at least three times a day. He shall see that the beds and bed clothes are properly aired and exposed every fair day to the sun, and that the straw in each bed sack is changed at least once in every month, and that each patient is washed and his hair combed every morning.  When a patient has died, or been discharged, he shall see that the bed and bed clothes are properly cleaned, and the straw burned, and that the nurses and attendants are kind and attentive to the sick and wounded.  All the attendants shall be considered as under his immediate direction, and he shall be held responsible for the faithful performance of the duties assigned them.

No non-commissioned officer or private shall be removed from the situation of nurse or attendant, without the consent of the senior attending surgeon.

REGIMENTAL SURGEONS AND MATES.

The surgeon shall be responsible for the order, regularity and cleanliness of the regimental hospital, or infirmary, as well as for the comfort and convenience of all other sick men confided to his care.

He shall send as few patients as possible to the general hospital, and these shall be confined to the wounded, and chronic cases; excepting when the sick are ordered to be left behind on a march. In that event all cases may be sent to the general hospital, unless otherwise provided for by the director. When a patient is to be sent to the general hospital, the surgeon shall send with him a descriptive


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list, together with a certificate containing the name, regiment, and company of the patient; the symptoms and duration of his disease, with some general remarks on the mode of treatment pursued. He shall likewise send with him, his clothing, arms and accoutrements. He shall keep a strict record of all cases sent to general hospital.

When the troops are in permanent encampments or cantonments, he shall provide some suitable place for the reception of the sick. In this regimental infirmary, the common camp diseases, such as inflammatory and typhus fevers, diarrhoas and dysenteries, shall be attended. He shall be careful to have the infirmary well ventilated, and shall not crowd his patients.

 He shall use every precaution to prevent the origin of contagion, and should it appear, he shall immediately report to the commanding officer, and make every exertion to counteract it, by paying a strict attention to personal cleanliness, and frequent changes of the bedding and linen of the sick, etc., etc.

The surgeon shall with the consent of the commanding officer of the regiment or corps, select a capable and careful non-commissioned officer, who shall act as steward and wardmaster; and such number of men as may be necessary to attend upon the sick, who are to be considered as attached to the medical staff, and not to be removed but by the consent of the surgeon.

The surgeon shall frequently inspect the provisions furnished to the troops, and report the same when unsound, to the commanding officer, as well as every thing in diet, dress, or situation, which can affect the health of the troops.

He shall require of the orderly sergeant of each company a written and daily report of the sick, and shall report all cases of feigned sickness to the commanding officers of the companies to which they belong.

He shall examine each case reported at least once a day, and all dangerous cases more frequently.

He shall attend at the commencement of a march, and designate such men as should be permitted to ride or have their knapsacks transported in the wagons.

He shall attend all musters and inspections, and report such men as are unfit for service, assigning the cause of their inability.

He shall have on hand a sufficient supply of medicines, instruments, dressings and hospital stores, and be always ready to render services in case of an engagement. 

He shall see that the mates are attentive to their duties, and endeavor to afford them every opportunity of improvement.

He shall keep a daily journal and prescription book, wherein shall be recorded an account of all cases of sickness, the nature of the complaints, and the means used to effect a cure, together with the result.

He shall make out a morning report of the sick and convalescent, and deliver it to the commandant of the regiment or corps. He shall make out monthly and quarterly reports, agreeably to the forms prescribed, which he shall forward to the medical director of the department.

In the absence of the surgeon, the mate oldest in commission shall act as surgeon. When the surgeon is present, it shall be the duty of the mate or mates to prepare his prescriptions, see that they are regularly taken, and to attend to the directions of the surgeons in all cases. They shall have charge of all medicines and instruments, and be held responsible to the surgeon for their good condition. They shall be attentive to the order and cleanliness of the regimental infirmary, and see that the patients are kept clean in their persons, linen and bedding.


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POST SURGEONS.

The duties of these officers are the same as those prescribed for the hospital and regimental surgeons and mates, and have their rank with the mates when serving together.

APOTHECARY GENERAL, AND HIS ASSISTANTS.

The apothecary general and his assistants will receive and take charge of all hospital stores, medicines, surgical instruments, and dressings, bought by the commissary general of purchases, or by his deputies, or by any other person under the direction of the said commissary or deputies, and shall account to the superintendent general of military supplies for all expenditures of the same.

The apothecary general and his assistants, will compound and prepare all officinals, and put up and issue medicines, &c., in chests or otherwise, conformably to requisitions signed by the director, or senior surgeon of the department.

Returns are to be made to the apothecary general quarterly, by the assistant apothecaries, surgeons, and mates, or any one having charge of instruments, medicines, hospital stores, or hospital equipments of any description.

The forms of these returns will be regulated by the apothecary general, under the direction of the superintendent general of military supplies, to whom one copy of the returns will be sent.

MISCELLANEOUS.

No surgeon of the army shall be engaged in private practice.

When medical or surgical aid is required, if no surgeon or mate of the army be at or near the post or place, the senior officer shall have authority to obtain such by special agreement in writing, under the following rules, viz:

When the number of sick does not exceed twenty, the compensation shall not exceed two hundred dollars per annum; for more than twenty and less than thirty, three hundred dollars; for any number of sick more than thirty, the rate of compensation shall not exceed the pay and emoluments of a surgeon's mate of the army. 

Whenever it becomes necessary to employ a citizen surgeon, the circumstances of the case will be immediately reported to the commanding officer of the department, and to the Adjutant and Inspector General.

No candidate will hereafter be appointed in the medical department of the army, who shall not have received a diploma from a respectable medical school or college, without first passing the examination of an army medical board.

Whenever a body of troops shall arrive at any military station, accommodation for the sick will be first provided, and subsequently those for officers and privates who are well, and to accomplish this, all artificers and mechanics shall be instantaneously put in requisition.

Every hospital and infirmary shall be supplied with one or more female attendants, at the discretion of the senior surgeon. It shall be the business of these to scour and cleanse the bunks and floors, to wash the blankets, bed-sacks, and clothes of the patients, to cook the victuals of the sick, and to keep clean and in good order the cooking utensils.

The pay of nurses shall not exceed six dollars per month, and one ration per day, to be established by the senior attending surgeon, and made up and certified by him in the hospital muster rolls.


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Women infected by the venereal disease shall in no case, nor on any pretense, be allowed to remain with the army, nor to draw rations.

ALLOWANCE OF QUARTERS AND FUEL.

To each hospital surgeon, regimental surgeon, post surgeon, and to two hospital surgeon's mates, or two regimental surgeon's mates, one room, one half cord of wood, from May 1st to October 31st, and one and one-half cords, from November lst to April 30th.

When the army went into winter quarters in the winter of 1814-15, the commissioners had been for some time in session at Ghent endeavoring to arrange terms of peace. The original demands of Great Britain were such as rendered a concurrence on the part of the United States impossible, and Congress prepared to carry on the campaign with increased vigor, and for this purpose proposed to raise one hundred thousand fresh troops by means of a draft. This was, however, rendered unnecessary, as the commissioners on the part of Great Britain withdrew their extravagant demands, and peace being an accomplished fact, the first military legislation of the session was (instead of an increase of the army), an "Act fixing the Military Peace Establishment of the United States." This reduced the army to ten thousand men, to be divided into infantry, artillery and riflemen, in such proportions as the President might direct; each regiment to be provided with one surgeon and two surgeon's mates. It also contained the following section relative to the general Medical Staff:

SECTION III.     And be it further enacted, That there shall be * * * such a number of hospital surgeons and surgeon's mates as the service may require, not exceeding five surgeons and fifteen mates, with one steward and one wardmaster to each hospital. * * *  Approved, March 3d, 1815."

By the provisions of this bill a large proportion of the medical officers who had performed faithful service throughout the war retired to private life. Among them was the Physician and Surgeon General, James Tilton. He had been compelled, in consequence of a malignant tumor of the knee, to submit to an amputation of the thigh the year before, and was incapacitated by his age and this disability from any further service. He carried with him into his retirement the admiration and good will of all his subordinates in the Medical Corps, and the respect of his superiors in the War Department. The remainder of his life was spent on his farm near Wilmington, his time being occupied in the preparation of a number of articles on agricultural subjects, some of which attracted considerable attention at the period. He died on the fourteenth of May, 1822, at the age of seventy-seven.


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By a general order issued May 15, 1815, from the Adjutant and Inspector General's Office, defining the Military Peace Establishment of the United States in accordance with the foregoing legislation, the President directed that the following officers should be provisionally retained in service, until further legislation by Congress, viz: the Apothecary General, two assistant apothecaries, five hospital surgeons, fifteen hospital surgeon's mates, two garrison surgeons, and ten garrison surgeon's mates.

The duties of a medical officer are of such an unassuming character that it is but seldom that his name is mentioned in general orders, or found in the official reports of a campaign. It will, therefore, be but a just tribute to those who distinguished themselves in the war of which we have just treated to give a few extracts from orders and reports in which praise is awarded to members of the Corps for their conduct.

Lieutenant Colonel George Mac Feely of the twenty-second infantry, in his report of the bombardment of Fort Niagara on the twenty-first of November, 1812, says:

"To Doctor West of the garrison, Doctor Hugan of the 14th Regiment, U. S. Infantry, and Doctor Craig of the 22nd Regiment, U. S. Infantry, I offer my thanks; they were employed during the entire day in the most critical duties of their profession."

Brigadier General E. W. Ripley, commanding the second brigade of the Northern Army, closes his report of the action at Fort Erie, Upper Canada, on the fifteenth of August, 1814, as follows:

"I close this long report by stating to you in the highest terms of approbation, the skillfulness exhibited by Doctor Fuller, Surgeon of the 23rd, and Doctor Trowbridge, Surgeon of the 21st Infantry, with their mates Doctor Gale of the 23rd, and Doctors Everett and Allen of the 21st; their active, humane, and judicious treatment of the wounded both of the enemy, and of our own, together with their steady and constant attention to the duties of their station, must have attracted your personal observation, and I am confident will receive your approbation."

General Gaines, in forwarding this report to the Hon. John Armstrong, Secretary of War, reiterates the above praise in the following words:

"The surgeons, Doctors Fuller, 23rd, Trowbridge, 21st, with their mates, Doctors Gale of the 23rd and Everett and Allen of the 21st, deserve the warmest approbation for their indefatigable exertions and humane attention to the wounded of our army, as well as to the prisoners who fell into our hands."

Hospital Surgeon Mann, Medical Director at Plattsburgh, reports from that place in November, 1814, to Surgeon General Tilton:

"In events of high importance it is seldom the medical staff are noticed. This is discouraging to the ambitious young surgeon of the army. It may be alleged,


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the surgeons being non-combatants are out of danger. This, however, is not always the case. During the investment of Plattsburgh by the enemy, the surgeons were constantly passing from fort to fort, or block-houses to dress the wounded, exposed to a cross fire of round and grape shot; while the greater part of the army were covered by fortifications. The cool bravery of the surgeons, was in private conversation noticed by the Commander-in-Chief; had half as much been reported to the War Department respecting them, they would have felt themselves amply compensated. While making this observation I do not include myself; because I was snug on duty at Crab Island, out of much danger while our fleet continued master of the lake. If reports honorable to officers, are founded upon good conduct and cool bravery, who more deserving than the non-combatants? They have fewer motives to excite them, and are equally exposed to danger as officers of the line, whose minds as well as bodies, are constantly exercised by their commands. If any officer has hardships attached to his office, it is the surgeon who executes his duty with fidelity and assiduity.

I feel myself bound to report with much respect, the conduct of all the medical gentlemen attached to this army, who have at all times during this campaign performed their duty; and who for their particular services, during and after the investment of Plattsburgh by the enemy, merit the applauses of the country.

To discriminate would be an act of injustice. Doctors Lawson and Mason, surgeons of regiments, Warmsley, Beaumont and Hugo, surgeon's mates, have all deserved well of their government. I would particularly mention Russell, hospital surgeon's mate, and Low, Assistant Apothecary General, who volunteered his services, for their attention and professional abilities at a time when the wounded of both fleets and army were placed under my charge; on whom were performed immediately after the action, more than thirty capital operations. It is with much pride this opportunity is improved to state, that the medical gentlemen of our army and navy, were not inferior, but superior to the medical gentlemen of the British navy; several of whom were made prisoners of war, and assisted to dress the wounded of their own fleet. This circumstance in very flattering to our infant medical institutions; and is good evidence, they are not less respectable than the ancient schools of Europe.

With the highest respect, etc.,

JAMES MANN, 
    Hospital Surgeon."

It is much to be regretted that we have no medical reports of the campaign of 1814-15 on the Gulf, but we have the high authority of General Jackson that the Medical Staff did their duty with their usual fidelity. In his general order of congratulation to the army after the victory at Chalmette, dated January 21, 1815, he says:

"The medical staff has merited well of the country, and the General would not do justice to his own feelings, were he to withhold from Doctor Ker, hospital surgeon, who volunteered his services, and Doctor Flood, the just tribute of applause, deserved by them for their medical skill and personal bravery."

The act before quoted, "Fixing the Military Peace Establishment," reduced the staff to too great an extent. So serious were the evils likely to


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result, that the Hon. William H. Crawford, Secretary of War, addressed a communication on the subject on the twenty-seventh of December, 1815, to the chairman of the House Military Committee. Among other recommendations he advises the permanent retention of the Apothecary General and four assistant apothecaries, and an increase in the number of hospital surgeons and mates, together with the appointment of a sufficient number of post surgeons to meet the requirements of the army. His recommendations were taken into consideration, and a bill passed on the twenty-fourth of April, 1816, "For organizing the General Staff, and making further provisions for the Army of the United States." The items of this act which are pertinent to the subject under discussion are as follows:

"Be it enacted, etc., That in addition to the act providing for a military peace establishment, the provisions of the act of March the third, one thousand eight hundred and thirteen, for the better organization of the general staff, be, and the same are hereby so far established that the general staff shall consist of one adjutant and inspector general, etc., * * * and that the apothecary general as heretofore authorized, be allowed two assistant apothecaries.

SECTION II.     And be it further enacted, That the medical staff shall be so extended, that there shall be four hospital surgeons, and eight hospital surgeon's mates to each division, with as many post surgeons as the service may require, not exceeding twelve to each division, who shall receive the same pay and emoluments as hospital surgeon's mates. * * * *

SECTION X.     And be it further enacted, That the officers of the staff, provisionally retained by the President, and in this act enumerated and made permanent, be recognized in service under this act, and that the garrison surgeons and mates be hereafter considered as post surgeons; and hereafter the staff of the army may be taken from the line of the army, or from citizens.

SECTION XII.     And be it further enacted, That when forage is not drawn in kind by officers of the army, entitled thereto, eight dollars per month for each horse, not. exceeding the number authorized by existing regulations, shall be allowed in lieu thereof: Provided, That neither forage nor money, shall be drawn by officers, but for horses actually kept by them in service."

This patch-work kind of legislation year after year, had anything but a beneficial effect both on the officers of the Corps and on the health of the army. The wiser heads saw that the Medical Department needed a more complete organization and a more systematic code of regulations to render it efficient. Doctor Mann had urged reform in these respects repeatedly in various ways during the war, and had always asserted that the great obstacle in the way of the medical officer was the indefinite character of his military position. In 1817 Doctor Joseph Lovell, then chief medical officer of the Northern Department, addressed to Major General Brown an able paper on the causes of disease in the army, in which he detailed at length his views on the duties of surgeons, and their responsibility for the sickness occurring


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among the troops. This report is intrinsically so valuable, as well as of interest from the distinguished official position of the writer, that it merits an insertion in these pages without abridgement:

"REMARKS ON THE SICK REPORT OF THE NORTHERN DIVISION FOR THE YEAR ENDING 
JUNE 30, 1817.

By the reports received from the different posts, it appears the troops have been remarkably healthy during the past year; for of the whole number of cases (2138) very nearly one-half (1051) are slight accidents and transcient complaints, which detain the soldier but a few days from duty;-193 from wounds;-and 55 venereal;-leaving but 838 of fevers and other important complaints.

Of these 266 consist of the different kinds of inflammatory fever; as colds, pleurisy, &c.; which are the almost inevitable consequence of a cold and changeable climate, and which no ordinary care can prevent. As they must always be incident to the inhabitants of the Northern section of the Union, and particularly to the soldier, ought not the most efficient means be taken to enable him to obviate as far as possible, these injurious effects of climate, by the quantity and quality of his clothing?

Next on the lists to inflammations comes diarrhoa and its attendant dysentery (diarrhoa 246, dysentery 94). As these, particularly diarrhoa, were the pests of our army during the war, constituting with inflammations, nearly the only complaints; and as they appear to be the chief cause of disease even in peace, it must be a matter of the highest importance accurately to ascertain their causes; and the best means of removing them, or obviating their deleterious effects.

It required but little ingenuity to surmise that bad food and worse water would produce more or less disturbance in a man's stomach and bowels; especially when he had been used to much better fare. It was therefore a very easy matter to account for all the diseases of the soldier by accusing the contractor of furnishing unhealthy provisions, and the water of containing deleterious ingredients. This mode of explaining the difficulty rendered police duty vastly easier to the officers of the line, and furnished the surgeon with a brief and satisfactory mode of accounting for the death of his patients. The consequence was that much time and some talent were wasted in talking and writing against contractors and lake water, which might have been much better employed in rendering the soldier comfortable, and protecting him against the inclemencies of the climate.

For the fact is, that neither of these accusations were in general just. The provisions were not commonly bad; nor did experiment show any ingredients in the water, at all adequate to the effect supposed. Nor was it true, that the food or the water were peculiarly bad, whenever and wherever these complaints prevailed and proved most fatal. Nor is it believed, there is cause of complaint against the provisions furnished at present.

It is moreover, exceedingly doubtful whether bad food alone would produce the effects that have been ascribed to it. For in prisons and on ship board, where numbers are frequently confined for a length of time to far worse fare than is even pretended in these cases, complaints of this nature are by no means the general consequence; while many a prisoner and slave condemned to the hardest labour, have proved by experience how very soon the digestive organs will become accustomed to food of a much worse quality than contractors would dare to issue, or the


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soldier's senses permit him to receive; and that even the deleterious effects upon the constitution were very gradual, though aided by many contingents to which the soldier, in this country at least., is seldom exposed.

It is by no means intended to assert, that bad food or coarse food badly cooked would not produce disease; much less that it would not peculiarly aggravate complaints of the stomach and bowels, or even act as an exciting cause of them. But it is meant to say, that this alone does not necessarily or even generally produce such complaints;-that the food of the soldier was not during the war, and certainly is not now, of a quality calculated to produce them;-that the prevalence of these complaints at any particular time bore no proportion to the good or bad quality of the provisions; nor were those places, where they were almost always committing ravages, worse supplied in this respect, than any others; and therefore-that we are to look to some other cause for the production of these military plagues.

And this it is apprehended will be found to arise from an undue exposure to cold and moisture. For the recruit is immediately confined to his rations, and experiences no bad effects from the change. It is not until he begins to feel the want of dry and comfortable lodging and clothing, and to be exposed to the changes of weather without sufficient clothing or exercise, that he suffers from diseases of the lungs and bowels. It is not a fact that those stations which became famous as the graveyards of the army, were worse supplied with provisions or abounded with worse water than any others; while it is well known that at these places, the soldier was peculiarly exposed to the above-mentioned noxious agents. It could not be owing to the state of the provisions or water that these complaints were so destructive in the spring and fall, rather than in the summer and winter; but it must be attributed to the unwholesome combination of cold and moisture peculiar to the frontier at these seasons; and it must be from this exposure that even now in time of peace, these complaints continue at some posts to occupy so large a share in the sick reports.

In proof of what is here advanced, we need only to refer to the mortality at Sackett's Harbor during nearly the whole war, and to the state of the army in that vicinity during the fall of 1813. In both cases it must have been the climate-the weather-that produced the mischief; as there is not the least ground for supposing there was anything peculiarly bad in the provisions or water at that particular time, and at that particular place.

Besides it is well known that among the inhabitants of the Northern section of the States, the greater proportion are under the necessity of guarding themselves by great attention to clothing from the bad effects of the climate, in order to prevent or remove the very diseases in question; and every practicing physician depends almost entirely upon this circumstance for curing, and altogether for preventing complaints of this nature.

In confirmation of what has been advanced it may also be added, that the only medicines which have any permanent effect upon these complaints are those which act upon the pores of the skin; and thus in some measure counteract the effects of cold and moisture; and these require every assistance from warm bathing, warm clothing, lodging, etc.; simply cleansing the stomach and bowels does very little towards removing the complaints when fully formed. A coarse diet indeed is injurious, but it is in consequence of debility induced by the disease itself. It aggravates but does not produce it; and of course change of diet will not cure it.


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And even in the state of convalescence, it is very common after a cold and rainy night when the sick are in tents, to find several who appeared fast recovering dead within twenty-four hours; and some even before the morning visit of the surgeon. And this was in a greater or less degree so constantly the consequence on the whole of this frontier, that after a stormy night, the attending surgeon could calculate very certainly upon finding some dead, and many very much reduced.

If then we are to attribute not only the great waste of life during the war, but the majority of the complaints at present to the want of adequate means of guarding against the effects of climate, it ought most certainly to be represented to those whose province it is, to make such alterations and additions to the allowance of clothing as will be consistent with true economy, by being best calculated to remedy the evil. To this end no soldier in this Division, at least none north of Philadelphia, should be allowed to wear any other than a woolen shirt. This point has been often insisted on by the surgeons of the army; and in confirmation of it, we need only refer to the number of those enjoying every comfort., who find it necessary in order to avoid complaints of the lungs and bowels, not only to wear flannel next the skin, but to follow the advice of Doctor Franklin in not taking it off until midsummer and putting it on again the next day. A second article equally necessary to the end proposed is an outer coat. Indeed there are few citizens of any grade in this climate, who do not feel the necessity of this, and who do not at any rate provide for it or a substitute, though most generally comfortably housed at those times when the soldier is most exposed. And lastly the most important circumstance perhaps of all is to enable the soldier to keep his feet warm and dry by a liberal allowance of woolen socks and laced shoes, reaching at least to the ankle. Almost every one has at times felt the uncomfortable consequences of wet and cold long applied to the feet, and many know but too well their deleterious effects upon the constitution through the lungs and bowels; so that it is scarcely necessary to insist upon this point. In fact there can be little doubt that due attention to these things, and to such circumstances of the soldiers quarters as may tend to the same end would materially lessen the number of sick at present, and be of most essential benefit in the event of war. It is well known how much attention was bestowed upon this subject by the British upon this frontier; so that their soldiers were even supplied with fur caps and socks and gloves in addition to the articles above recommended; and the consequence was that the complaints which destroyed the greater part of our army were scarcely known among them, though they were often near neighbors for months.

The cases of rheumatism are few, for the troops are mostly young and healthy men; and this is a mode of inflammation which generally attacks those of debilitated constitutions, or who are somewhat advanced in life. It renders many unfit for service, who but for this would be efficient men, and was at times very troublesome during the war. Very few if any diseases require greater attention to comfortable clothing and lodging than this; they are the ground requisites for preventing the complaint in those predisposed to it, and absolutely necessary to removing it when induced. The cases of intermittent fever have not been numerous except in the 5th Department and particularly at Detroit. This complaint always prevails more or less among the troops; and though it depend altogether upon local causes for its origin, much may be done to lessen the susceptibility of the system to it; and therefore wherever it occurs it becomes fully as important a part of the surgeon's duty to explain and recommend the means of preventing it, as to admin-


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ister the remedies calculated to cure it. The whole number of cases reported is 164; of these 141 were in the 5th Department, and 120 at Detroit. How far this prevalence of the complaint is to be attributed to the effect of climate, and how far to accidental or predisposing causes; or whether the last year has been in this respect peculiarly unhealthy, can of course be known only by the inquiries, observations and reports of the surgeons stationed there. But it is much to be regretted that one of the most important duties of an army surgeon, that of investigating the causes of disease at the different posts in order to remove them when possible, or obviate their noxious effects when practicable, should not be required by our regulations; and of course not attended to by the surgeons. Nor has the order requiring every surgeon to keep a record of the cases under his care been attended to as its importance demands. A strict attention to these points would not only be of the greatest benefit in preventing disease, but necessarily render the surgeon better acquainted with the nature of the complaints that occur, and at the same time ensure a degree of industry and attention to duty which is suspected to be much required.

As connected with this subject may be also mentioned the want of a proper system of Medical Police, and of due attention to existing regulations in relation to it. This is one of the most important duties of the Medical Staff, is most carefully attended to in other services; and can only be introduced into ours by long practice. Like many minute duties of officers of the line, particularly those connected with police and the interior economy of a camp, they are only to be gradually acquired; and so incorporated into the regular routine of duty as to be considered as indispensable as the mere prescription of medicine. An officer of the line may soon learn the duties of the field, and a surgeon be amply qualified for his profession, and both of them be worse than useless to an army. It is from a knowledge of minutiæ which depend neither upon General Regulations, nor specific orders, that the experienced officer and surgeon becomes so much superior to the undisciplined recruit. It is almost entirely in order to acquire this kind of knowledge, that a military establishment is kept up in time of peace, and it is an undoubted fact that in no department of the army is it so slowly acquired and therefore so deficient as the medical. How severely this was felt during a great part of the last war is too well and too publickly known to need comment.

It is therefore suggested whether such alterations be not required in the regulations, as are calculated to produce a system of medical police, which will not only ensure attention to every point of duty at present, but also in case of war enable the newly appointed surgeon to learn what he ought to do, without the necessity of trusting to his own ingenuity and suggestions and after all his industry finding himself disbanded just as he begins to understand the most important duties of his station. Not to mention the many serious disadvantages of being obliged to allow each to adopt his own imperfect system; or the waste of time and men and money while he is making his experiments. For there can be little doubt that where one man has died from improper medical treatment, ten have been destroyed from want of a knowledge of the many duties peculiar to an army surgeon.

To effect this purpose it should be made the duty of every surgeon and mate having the charge of a hospital, together with his quarterly report to the head-quarters of the division, to transmit an account of the local situation of his station, of the climate, the diseases most prevalent in the vicinity, and their probable causes, the state of the weather during the time reported with respect to temperature;


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winds, rain, etc.; to state at large the general symptoms of the complaints among the troops, as well as every peculiarity of disease; to investigate and as far as possible report their causes; the means employed to obviate them, with the success; as well as the practice adopted and the result.

To this end he should not only keep a prescription book containing a daily account of the symptoms and circumstances of each patient in every important case; the medicines prescribed and the result of his practice; but also one in which should be stated everything directed to the diet and regimen; as the quality and quantity of food allowed, the mode in which it is prepared, etc. By the former the mate or apothecary should prepare the medicines; and it would also be a correct voucher for their proper expenditure; and by the latter the stewards deliver the allowance of hospital stores, etc.; and this would be a voucher for what he had expended. The surgeon should also keep a diary of the weather; noting in it whatever may be supposed to produce or vary the forms of disease. By a reference to these, the surgeon in his quarterly reports, instead of a mere list of names usually made out by the steward, would be enabled to give such an account of the diseases that had occurred, their causes and his treatment, as would be the best possible criterion not only of his medical abilities, but also of his industry and attention to duty. And besides this, an abstract of these reports would soon enable the surgeon at head-quarters to furnish what is much wanted at present, and what can only be effectually supplied in this way, viz: a system of medical police and army practice suited to the diseases incident to the troops at the several posts in the division; and at the same time of suggesting such means of preventing these complaints as the experience of the different surgeons may have found most beneficial, under different circumstances of time and place. It is in this way that the most useful practical works have been produced.

In order to insure attention to these things and also to the manner in which the inferior but not less important offices of the hospital are performed, it is also proposed that the surgeon attached to the head-quarters of the division be made "Inspector of Hospitals." It has long been observed that none but one of the medical staff can be competent to this duty. The Inspector General and commanding officer can only determine whether the hospital and its furniture appear neat and clean, and the surgeon make his regular visits. But in every thing relating to the duties peculiar to his station, the surgeon is at present left entirely to his own sense of propriety. He is the only officer who is not in some way or other responsible for the mode in which his various duties are performed, and strictly accountable for the public property entrusted to his care. To this cause is no doubt to be attributed the many complaints continually, and too often justly, made against the medical department, particularly in active service, both on account of neglect of duty and waste of property.

In addition therefore to the duties assigned a Medical Director, the surgeon attached to the head-quarters of a division should be authorized to call for and receive from the respective surgeons and mates such returns and reports relative to the situation, climate, weather, etc., at the different posts, as may be calculated to ascertain the causes of disease, and the best practical means of preventing it. And also such an account of the symptoms in every important case, the remedies prescribed, and regimen observed as may be requisite to elucidate the nature of the prevailing complaints, and the most efficient mode of treating them.

He should consolidate the quarterly reports; and make such remarks and sug-


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gest such improvements both in practice and police, as may appear to be required for the benefit and comfort of the sick. He should from time to time inspect the hospital; examine the books and accounts of the steward and wardmaster; enquire into the manner in which every duty is performed; and see that all the regulations, both professional and those relating to police are properly attended to; by a strict examination of the prescription book, judge of the medical abilities of the attending surgeon, and ascertain that there has been a proper expenditure of medicine; from the diet book which should contain the quantity and quality of the food and liquor daily allowed to each patient, see that there has been a proper application of the hospital stores; and make such communications to the Apothecary General on the subject as may appear necessary and proper. And finally from his own observations, and from the reports and accompanying remarks of the surgeons, to form a manual of medical police and practice suited to the circumstances of the soldier; and to make such reports to the commanding general of the medical abilities, industry, fidelity, etc., of the respective surgeons, as his information from all these sources might warrant.

Were some plan of this nature adopted, and the above-mentioned duties faithfully attended to, it is believed the good effects would soon be apparent; and that they would be as permanent as they were obvious.

JOSEPH LOVELL,
                 Hospital Surgeon, U. S. Army."

The winter and spring of 1818 were passed by Congress in perfecting a bill for regulating the General Staff of the army. The Quartermaster's and Commissary Departments were completely reorganized, and many changes suggested in the Medical Corps. After much debate and several recommittals to the Military Committee, the bill was at length passed on the fourteenth of May, 1818. The following sections related to the Hospital Department:

"Be it enacted, etc., That so much of the act 'Fixing the military peace establishment of the United States,' passed the 3rd of March, 1815, as relates to hospital stewards and wardmasters, and of the 'Act for organizing the General Staff, and making further provision for the Army of the United States,' passed April 24, 1816, as relates to hospital surgeons and hospital surgeon's mates, *   *   *   * be, and the same is hereby repealed.

SECTION II.     And be it further enacted, That there shall be one Surgeon General, with a salary of two thousand five hundred dollars per annum, one assistant surgeon general with the emoluments of a hospital surgeon  *    *   *    * and that the number of post surgeons be increased not to exceed eight to each division." 

The Corps establishment after the passage of this act consisted of one surgeon general, two assistant surgeons general (for although the bill only provided for one, there appear two, one for each division of the army, on the Register for 1818,) one apothecary general, two assistant apothecaries, forty post surgeons, and one regimental surgeon and two mates to each regiment. Hospital surgeons under the old organization were transferred to the list of post surgeons. In default of any positive information as to the


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reasons for this action, it seems to have been very unjust towards the hospital surgeons, for during the war they had ranked all other medical officers, and now by the provisions of the second section of the act of April 24, 1816, they only ranked with regimental surgeon's mates, and thus some (Doctor James Mann for instance) who had conducted large hospitals during the war, were subordinated to regimental surgeons who were appointed after they were hospital surgeons. This anomalous procedure was more strongly marked in the subsequent reorganization in 1821, when all the regimental surgeons were transferred to the General Staff as surgeons, and the post surgeons as assistant surgeons, thus making them permanently subordinate in their own Corps to those whom they had formerly ranked. The existence of the Medical Staff as a distinct organization is usually estimated to date from this time, owing to the fact that a permanent head of the Department was now for the first time appointed; those who had previously exercised such executive functions, being designated only to meet temporary exigencies. Nevertheless, although this was a great step in the direction of an efficient administration of the Department, the construction of the Corps was greatly different from that it assumed under subsequent legislation and which it has retained essentially to the present day. The unnecessary distinction between post and regimental medical officers was still retained, and no provision was made granting them either assimilated or actual rank that would definitely have fixed their status in relation to officers of the line.

For the position of Surgeon General, Hospital Surgeon JOSEPH LOVELL was selected, to date from April 18th, and Hospital Surgeons Tobias Watkins and James C. Bronaugh were appointed Assistant Surgeons General, the former for the northern and the latter for the southern division of the army. Apothecary General Francis Le Barron, and Assistant Apothecaries James Cutbush and Christopher Backus, who had been provisionally retained by War Department General Orders of May 15, 1815, were recognized as permanently in service in accordance with the act of April 24, 1816. 

Joseph Lovell was born in Boston, Massachusetts, on the twenty-second of December, 1788. His grandfather was a leading member of the "Sons of Liberty," and when the British evacuated Boston in 1776, he was taken to Halifax as a hostage. He afterwards served the country in the Continental Congress, and was chairman of the Committee on Foreign Affairs. His son James S. Lovell married Deborah Gorham, a noted Boston belle. Joseph, their eldest son, was educated in Boston, and graduated at Harvard University in 1807. He studied medicine with Doctor Ingalls, of Boston, and soon after being licensed to practice entered the service (as has been mentioned) as


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surgeon of the ninth infantry. Although not yet thirty years old, the ability he had shown in charge of the general hospital at Burlington, and when serving with Generals Scott and Brown on the northern frontier, and his appreciation of the wants of the army, evinced by his able reports on various subjects connected therewith, designated him as the fittest person to assume the organization of the new department, and his appointment gave great satisfaction both to the army at large and the Medical Staff. Immediately after the appointment of Surgeon General Lovell, the following order was issued by the War Department:

"ADJUTANT AND INSPECTOR GENERAL'S OFFICE,
                April 21, 1818.

GENERAL ORDERS.

All reports, returns and communications connected with the Medical Department will hereafter be made to the Surgeon General's Office at Washington.

All orders and instructions relative to the duties of the several officers of the Medical Staff, will be issued through the Surgeon General, who will be obeyed and respected accordingly.

The Assistant Surgeons General will forthwith commence the inspections of the Medical Department in their respective divisions, agreeably to the instructions they may receive from the Surgeon General.

BY ORDER:

               D. PARKER,
      Adjutant and Inspector General."

The first point which attracted the attention of Doctor Lovell on reporting for duty was the necessity for a revision of the Medical Regulations. Those of April 24, 1816, which were a copy of those which we have just given, issued in 1814, were not only very defective in many respects, but were not adapted to the new organization of the Corps, and to the provisions of the general order just quoted. Moreover, the nomenclature of diseases on the quarterly reports was so vague as to afford no reliable data upon which to base opinions as to the health of the army, or to afford deductions for future reference. The duties of medical officers in their relations with the new bureau and especially with reference to their requisitions on the Apothecary General for supplies, required to be clearly expressed; the appointment of the Assistant Surgeons General as the inspecting officers of the Corps demanded attention to the subject of medical inspection, which had hitherto been to a great measure left optional with the directors of departments and divisions; and the abolition of the office of commissary general of purchases, and consequent transfer of that portion of his duties which pertained to the Medical Department, to the Apothecary General and


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his assistants, called for additional regulations for the purveying department. Doctor Lovell also, now that his position gave him the power to do so, determined to carry out the views in reference to the duties of medical officers which he had expressed in his letter to General Jacob Brown, while Medical Director of the Northern Division. These regulations which are given in full herewith, were issued in general orders from the War Department in September, 1818, and distributed to the army in the following winter. Their good effect was speedily seen in the improved character of the reports forwarded by medical officers, and the testimony received as to the increased efficiency of the Department.

"REGULATIONS OF THE MEDICAL DEPARTMENT, SEPTEMBER, 1818.

SURGEON GENERAL.

The Surgeon General shall be the director and immediate accounting officer of the Medical Department. He shall issue all orders and instructions relating to the professional duties of the officers of the Medical Staff; and call for and receive such reports and returns from them as may be requisite for the performance of his several duties.

He shall receive from the Assistant Surgeons General and the Medical Directors of armies, districts, and departments confidential reports relative to the condition of the hospitals and infirmaries, the character and conduct of the surgeons and mates, the state of their books and accounts, the medical topography of the several posts and stations, the nature of the prevailing complaints, their probable causes and the treatment adopted.

He shall receive from every surgeon, and mate performing the duties of surgeon, quarterly reports of sick, with such remarks as may be necessary to explain the nature of the diseases of the troops, the practice adopted and the kinds of medicines and stores required; together with a copy of the entries made for the quarter in the book kept for the diary of the weather, accompanied with suitable observations.

He shall receive from every surgeon and mate, having charge of public property of any description for the use of the sick, duplicate semi-annual returns of the same in the form and manner prescribed; and also annual requisitions for the supplies required for each hospital, regiment, post or garrison for the ensuing year; and transmit them with his remarks and instructions to the Apothecary General; accompanied with a statement, to be obtained from the office of the Adjutant and Inspector General, of the probable number of troops to be stationed at the several posts, &c., for which they are made.

He shall examine the annual estimate of supplies furnished by the Apothecary General, making such remarks and alterations as the good of the service may appear to require; and receive from him and his assistants detailed returns of all supplies put up for and delivered or forwarded to, the several surgeons and mates.

He shall examine the returns and accounts of the several surgeons and mates; see that proper vouchers are sent for articles issued, and that the quantities expended with the sick are agreeable to the numbers on the sick reports, and the nature of their complaints; if so, he shall certify it, and at the end of each year, and oftener if


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necessary, send the returns and accounts thus certified to the office of the Second Auditor for final settlement. If he does not receive proper vouchers for issues, and satisfactory evidence that articles so reported have been lost or destroyed by unavoidable accident, he shall forthwith obtain the necessary documents from the person making the return, or transmit the amount to the office of the Second Auditor to be charged to his account.

If upon comparing the returns with the reports of sick, there appears to have been any improper expenditures of medicines or stores either in quantity or quality, he will require an explanation thereof from the person making the return; and if necessary direct the Assistant Surgeon General, or the Medical Director to examine the books and accounts of said person, and to ascertain how and why such expenditures have been made; and the amount of any articles proven to have been improperly applied will be charged in the office of the Second Auditor to the account of the person who has thus misapplied them.

He shall keep a register of all the medical officers in service, in which shall be recorded the dates of their appointments, promotions or transfers, the posts and stations at which they have been on duty and for what length of time at each place, the furloughs they may receive, by whom and for what length of time they were granted and the time of their return to duty; he shall also enter in this register his remarks on the several reports and returns made to him, together with the substance of the confidential reports of the Assistant Surgeons General and Medical Directors, as well as of all other communications he may receive relating to the character, conduct and professional qualifications of the surgeons and mates, keeping a regular file of the original documents, and submitting the whole from time to time to the examination of the Secretary of War.

He shall from time to time make to the Secretary of War such reports and returns as may be necessary to explain all the concerns of the department under his charge; with such remarks relative to improvements in practice and police, and to the clothing, subsistence, &c., of the army, as may seem to be required for the preservation of health, the comfort and recovery of the sick, and the good of the public service.

ASSISTANT SURGEONS GENERAL.

The Assistant Surgeon General shall be the medical inspector for the division, district, department or army to which he is attached. It shall be his duty to inspect the hospitals and infirmaries under his charge, according to the instructions he may receive from the Surgeon General; to ascertain the manner in which each officer performs his duties; to see that the necessary supplies are received for the sick; that they are of a good quality, and that they are properly expended.

He shall strictly examine the case books, prescription books and diet books of the surgeons and mates, and from them ascertain the nature of the diseases that have prevailed, their symptoms, the practice adopted and the result; and hence judge of the professional abilities of the attending surgeon, and ascertain that the quantity and quality of the stores and medicines used are conformable to the nature and duration of the complaints.

From an examination of the book containing the diary of the weather, medical topography of the station or hospital, account of the climate, complaints prevalent in the vicinity, &c., and from suitable inquiries concerning the clothing, subsistence, quarters, &c., of the soldiers, he will discover as far as practicable the probable causes


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of disease, and recommend the best means of preventing them; and also make such suggestions relative to the situation, construction and economy of the hospitals and infirmaries, as may appear necessary for the benefit and comfort of the sick and the good of the service.

He shall examine the books and accounts of the steward; see that his issues of hospital stores and furniture agree with the diet books and written orders of the surgeons and mates, and that he has kept a correct account of the number of rations drawn, agreeably to the register and muster rolls of the hospital; of the parts commuted or sold; and of his disposal of the proceeds.

Ascertain also that the wardmaster keeps a strict account of the bedding, furniture, cooking utensils, &c., received for the use of the hospital; of the articles lost, worn out or destroyed by order; and also of the clothing, arms and equipments of every patient admitted, and that they are disposed of agreeably to the regulations on that subject; and that he pays due attention to enforcing the police prescribed, and to the order and cleanliness of the patients, wards and kitchens.

He shall make to the Surgeon General, in October, annually, and at such other times as he may direct, confidential reports, containing all the information he may obtain concerning the character, conduct and attention to duty, of the several surgeons and mates; the order and condition of their hospitals and infirmaries, and the state of their books and accounts; with such remarks relative to the causes of diseases, the best means of preventing them, their symptoms, and the treatment adopted, as appertain to the report of a medical inspecting officer; which report shall be submitted to the commanding officer of the division, district or army to which he is attached, for his examination, remarks and signature.

APOTHECARY GENERAL AND HIS ASSISTANTS.

The Apothecary General shall, agreeably to the returns and requisitions of the several surgeons and mates received from the Surgeon General's Office, and to a standard supply table, make an annual estimate of the supplies of medicines, instruments, hospital stores, &c., required for the ensuing year, which shall be submitted to the Surgeon General for his examination and approval.

The Apothecary General and his assistants shall purchase, according to this estimate, all medicines, hospital stores, surgical and other instruments, books and dressings, required for the public service of the army. The articles so purchased shall be carefully packed under their directions, and by them delivered either to the surgeons or to a military storekeeper, or to a quartermaster, for transportation to the places of their destination and use; and all parcels so packed shall be legibly marked with the name of the place to which they are to be sent, or of the regiment or corps for which they are intended, and accompanied with an invoice of the articles contained in them.

They shall compound and prepare such medicines as may be thought necessary for the good of the service; cause suitable medicine chests to be constructed, according to the directions of the Surgeon General, and furnished to the several hospitals, posts and garrisons; and supply printed forms of the reports and returns required by the regulations.

They shall make quarterly returns of their purchases to the Second Auditor accompanied with invoices of the articles purchased, for which they shall be charged; and nothing will exonerate them from such charge, but the receipt of a surgeon,


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military storekeeper, quartermaster, or other person authorized to receive supplies of this nature, or a certificate on honor for what may have been expended in the apothecary's department, stating for what purpose. If articles become damaged or unfit for use, they will not be taken off the books of the Second Auditor to their credit until sold by order of the War Department. 

They shall make to the Surgeon General returns in detail, of the medicines, stores, &c., put up for, and delivered or forwarded to, the several surgeons and mates stating the numbers and marks of each chest, package, &c., and to whom they were delivered.

The Apothecary General will make in October, annually, an estimate of the expenses of the Medical Department for the information of the War Department.

The Assistant Apothecaries General will purchase and issue whatever articles composing the yearly supply the Apothecary General may deem necessary to have purchased in their respective districts, making returns of the same to him.

SURGEONS ATTENDING GENERAL HOSPITALS.

The senior surgeon shall be ex-officio medical director and inspector of hospitals for the army or district to which he is attached. He shall enforce the rules and regulations given for the government and direction of the surgeons and mates; examine and if he approve, countersign all requisitions upon the Apothecary General or his Assistants, except that made on the 30th of September for the ensuing year; and as inspector of hospitals he shall perform all the duties required of the Assistant Surgeon General.

The surgeon attending a general hospital shall observe the instructions of the Assistant Surgeon General and of the Medical Director in every thing relating to the hospital under his charge; superintend its construction, government and police, and be held responsible for the manner and in which the subordinate officers perform their respective duties.

He shall keep a register of all patients admitted into his hospital, in the form and manner prescribed.

He shall receive, and carefully preserve, the descriptive list of each individual, noting on it any payments made, or clothing issued to him while in hospital. Should any surgeon or mate send patients to his hospital without the report required by the regulations, and certified copies of their descriptive lists, or should they be sent by any officer of the line without their descriptive lists, it shall be his duty forthwith to demand them, and if they be not sent within a reasonable time, or some good cause given for the neglect, he shall immediately apply to the commanding officer for the arrest of such delinquent on the charge of disobedience of orders.

He shall keep a case book, prescription book and diet book, in which shall be daily recorded the symptoms in every important case, together with the medicines and diet prescribed; and these shall serve as a guide to the assistant surgeon or apothecary in delivering the medicines, to the steward in distributing the stores, and for the information of the medical inspector. He shall keep a diary of the weather in the form and manner prescribed, noting everything of importance relating to the medical topography of his station, the climate, complaints prevalent in the vicinity, &c., and also an orderly book, in which shall be transcribed all orders concerning, or any ways relating to the Medical Department.

He shall divide his hospital into as many wards as he may have medical attendants, and every morning, at as early an hour as practicable, visit each ward, prescribe


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himself in all important cases, and consult with the attending surgeon; and in the evening enquire of the resident surgeon the state of the sick, and again visit such as may require particular attention.

He shall as far as practicable, assign appropriate wards to the patients according to the nature of their complaints; be careful that the wards are well ventilated, and the patients not too much crowded; by a rigid attention to police, prevent, if possible, the origin of contagion, and should it appear, make every exertion to counteract it by enforcing personal cleanliness, and by frequent changes of linen, bedding, &c.

He shall prescribe such rules and regulations as he may think necessary for the direction of the attendants, and the order, cleanliness, and convenience of his patients; and cause them to be printed or written in a legible hand, and hung up in some conspicuous place in each ward.

He shall from the descriptive lists in his possession, make regular muster rolls of the patients in his hospital, and also of his steward, wardmaster, cooks, nurses and matrons, in the form prescribed, for the examination and certificate of the Inspector General, or officer acting as such, as in other cases of muster and inspection for payment.

He shall see that his steward makes out correct returns for rations, agreeably to the number of patients and attendants present; direct what part of the ration shall be sold or commuted, and sign the requisitions: and from the proceeds of the parts thus commuted or sold, he shall cause such articles to be purchased as he may judge necessary and proper for the use of the sick.

He shall once a month examine the books and accounts of his steward and wardmaster; see that the hospital stores have been properly applied, and that the money received for parts of ration commuted or sold, has been expended agreeably to his instructions; that the arms, clothing and equipments of the patients are cleansed, numbered, marked, registered and deposited in the wardmaster's room, and that a regular account is kept of the furniture, bedding, &c., in use in the hospital; and if any attendant or patient shall be convicted of wilfully destroying or purloining any article of public property, the amount of its value shall be charged to him by the surgeon on his descriptive list, and deducted from his pay at the next payment; and it shall be the duty of the surgeon to prosecute any citizen who may buy or receive public property of any description from any one attached to the army, agreeably to the law on that subject.

ASSISTANT SURGEONS TO GENERAL HOSPITALS.

The assistant surgeons shall obey the orders and instructions of the senior surgeon; see that subordinate officers attend strictly to their duties, and aid in enforcing the regulations of the hospital.

Each assistant shall accompany the surgeon in his morning visit to the ward assigned to his particular charge, make the proper entries in the case book, prescription book, and diet book, and from the latter fill up the diet table for the day; in the evening he shall again visit his ward, and, if necessary report to the surgeon.

He shall be responsible for the proper distribution and administration of the medicines prescribed, for the manner in which the wardmaster and nurses perform their duties in his own division, and that the patients conform to the prescribed regulations.

One of the assistant surgeons shall be detailed daily to reside within or near the hospital, at all hours of the day or night; he shall prescribe in urgent cases, examine


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such patients as may be sent to the hospital, see that they are regularly entered in the register, that their descriptive lists are filed, and if they do not bring them, report it forthwith to the surgeon, that the wardmaster takes charge of their clothing, arms and equipments, that they are washed, furnished with clean garments, and placed in their appropriate wards, and report to the surgeon the next morning, and immediately in important cases. He shall make the proper entries in the book containing the diary of the weather, and as police officer of the day see that all the orders and regulations are duly attended to.

One of the assistant surgeons shall take charge of the books of the hospital, viz: the register, case book, prescription book and diet book, that containing the diary of the weather and the orderly book; and shall call at the office of the adjutant general every day or as often as may be convenient, and transcribe all orders relating to the Medical Department. He shall also take charge of the descriptive lists of the patients, and have them regularly filed according to their companies and regiments or corps.

One assistant surgeon shall take particular charge of the dispensary, instruments and medicines; keep an account of expenditures, agreeably to the prescription book; make out the regular semi-annual returns of medicines, instruments, stores, &c., and present them to the surgeon for his examination and signature.

HOSPITAL STEWARDS.

It shall be the duty of the steward to receive and take charge of all hospital stores, furniture of every description, and supplies purchased for the use of the sick; to keep a roster of the nurses and attendants, and from this and the register to make out returns for rations agreeably to the number in hospital and present them to the surgeon for his examination and signature; to receive and distribute the rations, and to commute or sell such parts, and employ the proceeds in such manner as the surgeon may direct. He shall keep an account of the number of rations drawn, the articles commuted or sold, and the amount received for them; take proper vouchers for all expenditures, and present the whole to the surgeon for examination at the end of each month.

He shall issue the hospital stores and other supplies to the cooks and nurses, and enter in a book daily the amount of each article delivered; for which the diet book and written orders of the surgeons and assistant surgeons shall be his vouchers. He shall deliver to the wardmaster such articles of bedding, furniture, cooking utensils, &c., as shall by written orders be directed for the use of the hospital; be responsible for the order and neatness of the storeroom; and on no account allow any of the patients or attendants to enter it in his absence, or to remain there longer than may be necessary to obtain their supplies.

WARDMASTER.

The wardmaster shall receive from the steward all the furniture, bedding, cooking utensils, &c., required for the use of the hospital, and be held responsible for them. He shall keep a book in which shall be recorded the articles distributed to the several wards and kitchens, holding the nurses and cooks responsible for whatever he may deliver them. He shall once a week take an inventory of everything in use, and report to the surgeon whatever is missing, worn out, or destroyed by order; and also the name of any patient or attendant whom he may suspect of wilfully destroying or purloining any species of public property.


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On the admission of a patient he shall take charge of his clothing, arms and equipments; see that they are made perfectly clean; that they are registered in a book, which he shall keep for the purpose, numbered, labeled with the name, rank, company and regiments or corps of the owner, and deposited in an appropriate apartment; and in case of his death, he shall deliver the surgeon an inventory of the above-named articles, together with any money, &c., left by him.

The cooks, nurses and attendants, shall be under his immediate direction and subject to his orders. He is responsible for the cleanliness of the patients and attendants of the kitchen, wards, furniture and cooking utensils. He shall call the roll of the wards at sunrise and sunset, and report absentees; see that every patient is washed and his hair combed every morning, and shaved, when his case will permit,  at least thrice a week; that the wards are swept and sanded, and the beds made before the time of the morning visit of the surgeon; that the close-stools and spit-boxes are made perfectly clean every morning, and the pans emptied and washed immediately after being used, and partly filled with powdered charcoal and water; that the beds and bedding are frequently aired and exposed to the sun, and the straw changed once a month, and oftener if necessary; and when a patient dies, that the straw is burned, the bunk, bed-sack and bedding, cleansed and returned to the steward, if not wanted in the hospital.

REGIMENTAL SURGEONS.

The regimental surgeon shall obey the instructions of the Assistant Surgeon General and the Medical Director; be responsible for the order and neatness of his hospital or infirmary, for the manner in which his mates and attendants perform their respective duties, and for the comfort and convenience of those sick in quarters.

He shall observe all the regulations given for the surgeon attending a general hospital in relation to the register, case book, prescription book, diet book, orderly book, and that containing a diary of the weather, the medical topography of his post or station, &c.; and also all those respecting the ventilation of his hospital, preventing or obviating the effects of contagion; prescribing suitable police regulations; making out muster rolls of his nurses and attendants; signing requisitions for rations; directing what parts shall be commuted or sold, and in what manner the proceeds shall be disposed of; examining the returns, books and accounts of his steward and wardmaster; and punishing those who wilfully destroy or purloin public property, or receive any property thus purloined.

He shall receive written morning reports of sick from the orderly sergeant of each company, who shall see that those reported present themselves at the place appointed by the surgeon, and to be present himself at their examination; he shall immediately report all cases of feigned sickness to the commanding officers of companies, prescribe for those who are able to remain in their quarters, and send those who require it to the hospital; he shall then visit his hospital, prescribe himself in all important cases, and in the evening again see those who require particular attention.

Unless when specially directed or in uncommon cases he will send no patients to the general hospital, except his own be crowded, or he be ordered to march; when he will send all whom he may judge unable to accompany the regiment; and with them a report, in the form prescribed, stating their names, rank, &c., together with a general account of the symptoms and duration of their complaints, and the treatment adopted; and he shall on no account neglect to obtain from the commanding officers of companies certified copies of their descriptive lists, and to transmit them, together with their clothing, arms and equipments, to the surgeon having charge of the hospital.


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He shall designate to the commanding officer those who should be allowed to ride, or have their knapsacks, &c., carried in the wagons; accompany the regiment; be within call in case of accident, and at all times have his instruments and dressings ready and at hand to attend to the wounded.

He shall accompany the officer appointed to select ground for an encampment, and, as far as consistent with other arrangements, recommend such places, and that the tents be pitched in such manner, as may be best calculated to protect the soldier from the inclemencies of the weather; and, when necessary, advise that the floors be raised, or other means taken to prevent the bad consequences of low and uneven positions.

When his regiment is in quarters or permanent encampments, he shall immediately point out, and the quartermaster shall furnish, a suitable place for the reception of the sick, and whenever it is practicable he shall procure for this purpose some building in the vicinity, only putting his patients in tents when absolutely necessary. He shall frequently visit the tents, see whether they are kept as dry as the nature of of the ground will permit, and whether they are clean, and occasionally aired and struck. When in quarters he shall from time to time inspect the rooms and kitchens, and so far direct the manner of preparing the food as he may think necessary for the health of the soldiers; examine the quality of the various parts of the ration, and immediately report to the commanding officer any defects he may discover; see that the vaults are dug at a proper distance from the camp, and frequently covered with fresh earth; and either by special reports, or in his remarks in his morning reports, make such observations and suggest such improvements upon all these points as he may think necessary to preserve the health of the troops, and for the comfort, convenience and recovery of the sick; and the commanding officer of his regiment shall issue such orders as he may think necessary and proper to remedy the evils and supply the defects thus reported to him.

He shall report to the commanding officers of companies such men as are unfit for service; furnish a certificate of the cause, the time when, and place where, it arose, the degree of disability, &c., and accompany the inspecting officer on muster and inspection days, and see they are mustered accordingly.

REGIMENTAL MATES.

When the number of patients permits, and both mates are present, the hospital shall be divided into equal wards, which shall be under the immediate direction of the respective mates. They shall accompany the surgeon in his morning visit; make the proper entries in the case book, prescription book and diet book; frequently visit the hospital during the day, and report to the surgeon in the evening, and oftener in urgent cases; attend to the preparation and distribution of the medicines; assist in making out the proper reports and returns; see that the nurses are attentive to the sick, and regularly administer the medicines prescribed; and that the regulations of the hospital are strictly attended to.

If both mates be present, the senior shall take charge of the register, and see that each patient be regularly entered therein; that the diary of the weather be properly kept; and that the steward and wardmaster attend to all the duties required by the regulations. The junior shall have particular charge of the medicines and instruments, and be responsible to the surgeon for their good condition; and see that all orders relating to the Medical Department are transcribed in the orderly book.

In the absence of the surgeon the senior mate present shall perform his duties.


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POST SURGEONS.

The post surgeon shall obey the instructions of the Assistant Surgeon General and Medical Director; be responsible for the order and cleanliness of his hospital, the manner in which his attendants perform their duties, and for the comfort and convenience of the sick.

He shall observe all the regulations given for a surgeon attending a general hospital, in respect to the books and accounts to be kept; the ventilation of his hospital; preventing and obviating the effects of contagion; prescribing suitable police regulations; making out muster rolls of his nurses and attendants, signing requisitions for rations, and directing what parts shall be commuted or sold, and in what manner the proceeds shall be disposed of; examining the books and accounts of the steward and wardmaster; and punishing those who destroy or purloin public property, or who receive any property thus purloined.

He shall also observe all the regulations given for the regimental surgeon in respect to receiving morning reports; reporting cases of feigned sickness; visiting his hospital and prescribing for his patients; selecting a suitable place for their reception; inspecting the tents, or quarters and kitchens, and directing the manner of preparing the food; examining the quality of the rations: making special reports to the commanding officer, or suitable remarks on his morning reports upon whatever may conduce to the health of the troops or the recovery of the sick; reporting those unfit for service. attending the inspecting officer, and seeing them mustered accordingly.

STEWARDS AND WARDMASTERS OF REGIMENTS, POSTS OR GARRISONS.

Every regimental surgeon may, with the consent of the commanding officer, select an active, intelligent, non-commissioned officer, and every post surgeon, a private, who shall be permanently attached to the hospital, and act as steward and wardmaster; and who shall observe all the regulations above given for the direction of the steward and the wardmaster of a general hospital. Citizens may be employed in lieu of soldiers, at the option of the surgeon; if engaged for the hospital or infirmary of a regiment, they will be allowed sixteen dollars per month, and one ration per day; if employed at a post or garrison, they will receive ten dollars per month and one ration per day.

OF REPORTS, RETURNS, REQUISITIONS, &C.

Every surgeon, and mate acting as surgeon, shall make a quarterly report of sick to the Surgeon General in the form and manner prescribed, with remarks relative to the nature and symptoms of the complaints reported, the treatment adopted, and the medicines and stores most in demand; and also transmit therewith a correct copy of the entries for the quarter in the book kept for the diary of the weather, with his observations upon the medical topography of the post, station or hospital; the climate, prevalent diseases, and their probable causes.

Every surgeon and mate, having charge of sick, shall make a monthly report to the Medical Director of the army, or district to which he belongs; and every one attending the sick of a regiment, post or garrison, shall make a morning report to the commanding officer in the form prescribed.

Every surgeon and mate, on being ordered to a new station, shall immediately inform the Surgeon General thereof, and also from whom he received the order; on receiving a furlough he shall also report it, stating by whom and for what length of time it was granted and report himself once a month until his return to duty.


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Post surgeons making application for change of station shall report to the Surgeon General, with the reasons assigned therefor.

Every surgeon and mate having charge of public property of any description for the use of the sick, shall make duplicate returns of the same to the Surgeon General on the 31st of March and 30th of September, annually; and on the 30th of September make also duplicate requisitions or estimates of the supplies required for the ensuing year, noting the number of troops for which they are made.

All requisitions made upon the Apothecary General or his assistants, in active service, except that on the 30th of September, shall be examined and countersigned by the Medical Director of the army, department or district to which the surgeon belongs.

Requisitions for cooking utensils and other articles of hospital furniture as cannot be conveniently obtained from a commissary of purchases, or a military storekeeper, will be made upon an officer of the Quartermaster's Department, who will furnish the articles required, the requisitions being countersigned by the commanding officer of the department or post.

When a surgeon is ordered away from the medical supplies under his charge, he shall immediately make to the Surgeon General a return of all articles received, expended and issued since his last regular return, accompanied with a receipt in detail for the remainder, if he be relieved by a surgeon; but if he deliver it to the quartermaster of a regiment or post, a military storekeeper, or other person than a surgeon, he shall, with the returns and one of the receipts given him, transmit an invoice of the articles delivered certified on honor; a copy of which invoice, signed by him, shall be left with the medicines, stores, &c. And when any surgeon or apothecary receives the articles thus left with a quartermaster, military storekeeper, &c., he shall in his next return state by whom they were left, as well as from whom they were received.

Surgeons receiving a furlough will be held responsible for all public property under their charge; they will therefore take duplicate receipts for the same; and if they be absent three months, they will be required to submit to the Surgeon General returns, receipts and invoices, as directed in the preceding regulation.

Whenever any instruments, stores, &c., put up for and directed to, one post, garrison, regiment or hospital, are by the orders of any officer taken for the use of another, it shall be the duty of the surgeon receiving them to report the circumstances immediately to the Surgeon General, and to transmit to him a certified copy of the order, the reasons for which it was given and a receipt for the articles; and also when practicable, to notify the surgeon for whom they were intended, and on the receipt of his own supplies to furnish him with the same amount.

MISCELLANEOUS.

Every person having charge of a general hospital, shall appoint his own steward, wardmaster, cooks and nurses; and if they be taken from the line of the army, it must be with consent of the commanding officer of the army, district or department. Every surgeon of a regiment, post or garrison, shall also, with the consent of his immediate commanding officer, select his attendants. They shall be permanently attached to the hospital or infirmary, and exclusively under the orders of the surgeons and mates; and shall not be removed except for misdemeanor, unless in cases of urgent necessity, and then only by the order of the commanding officer of the district, department, army, regiment, post or garrison, to which they belong.

The following will be the allowance of attendants on a hospital or infirmary in


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ordinary cases: To a general hospital, one nurse to every ten, one matron to every twenty, and one cook to every thirty patients. To a regimental hospital, one noncommissioned officer, as steward and wardmaster, one cook, two matrons and four nurses. To a post or garrison with one company, one private as steward and wardmaster, and two nurses, or one nurse and one matron; for each additional company one nurse. The non-commissioned officer who acts as steward and wardmaster, to receive 20 cents per day extra-pay, and the private employed as steward and wardmaster to receive 15 cents per day extra pay. The women to receive 5 dollars per month, and one ration per day.

The allowance of quarters, fuel and straw, for the sick, and of wagons for transporting medicines, stores, furniture, &c., will be regulated by the surgeon and commanding officer or Medical Director; the requisitions to be made by the former and countersigned by the latter.

Whenever a soldier is sent to a general hospital, or left in the hospital or infirmary of a regiment, post or garrison, it shall be the duty of the officer or surgeon sending or leaving him to furnish a certified copy of his descriptive list to the surgeon taking charge of him; who shall, on the return of the soldier to duty, transmit it to the officer under whose command he is put, with a certificate of any payments made or clothing issued to him while in hospital.

Should a soldier leave an hospital on furlough, he shall be furnished with a certified copy of his descriptive list; should he desert, it shall be the surgeon's duty to advertise him in the usual manner; and in case of his death, his descriptive list shall be preserved in the hospital for the benefit of his friends and heirs, and on it shall be stated the amount of clothing, money, &c., left by him; and the surgeon shall in all these cases forthwith inform the commanding officer of his company or regiment of the facts and the attending circumstances; and also of the time to which those who die were last paid, and the money and effects in their possession at the time of their decease.

Whenever a soldier is rendered incapable of performing military duty by reason of wounds or injuries received in service, and while in the line of his duty, any surgeon or mate of the army, upon obtaining sufficient evidence of the fact, the time, place and manner of its occurrence, shall furnish him with the necessary certificate to obtain his discharge and pension.

No candidate shall receive the commission of surgeon or mate in the army, who has not obtained a diploma or certificate from some respectable medical school, college or society, or passed the examination of an Army Medical Board.

No surgeon of the army shall be engaged in private practice.

When any officer employs a citizen surgeon, he shall immediately inform the Surgeon General of his name and place of residence, and also cause him to be furnished with a copy of the regulations of the Medical Department.

Citizens employed as surgeons will be allowed the following rates of compensation: For attending a post, garrison or detachment of one hundred men and upwards, forty dollars per month; of from fifty to one hundred men, thirty dollars per month; and for attending any number under fifty, twenty dollars per month, exclusive of medicine. When they furnish their own medicine they shall be allowed an addition of from twenty-five to fifty per cent upon their pay, the proportion to be determined by the Surgeon General or Medical Director. If engaged to accompany a regiment or detachment on a march or expedition they will, while actually thus employed, be allowed the full pay and emoluments of a regimental surgeon's mate. They will be


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required to make quarterly reports of sick to the Surgeon General, and morning reports to the commanding officer, in the form and manner directed for the surgeons of the army; and when they have charge of public property of any description, they will make returns of the same at the times, and in the manner required by the regulations, or as often as the Surgeon General may direct.

Their accounts must be accompanied with a certificate from the officer employing them of the number of men under his command and the length of time they were employed, and also with a report of the sick under their charge; or of the cases that may have occurred subsequent to their last quarterly reports.

Recruiting officers will, if necessary, employ citizens agreeable to these regulations; the rate of compensation to be determined by the average number present during the month. If engaged merely to inspect recruits, they will be allowed one dollar per man for inspecting and signing the necessary certificates.

No citizen shall be employed to inspect recruits at posts or places where there is a surgeon or mate belonging to the army.

Surgeons shall be particularly attentive to the examination of recruits, and will suffer no man to pass, who has not at his examination been stripped of all his clothes, in order to ascertain, as far as possible, that he has the perfect use of all his limbs; that he has no tumours, ulcerated legs, rupture, nor chronic cutaneous affection, nor other infirmity which may render him unfit for the active duties of the field; and it shall be their duty to ascertain, as far as practicable, whether he is an habitual drunkard, or subject to convulsions of any kind. With any of these defects the man is to be rejected as unfit for service; and any surgeon or mate, who shall suffer any one to pass without a careful examination on all these points, shall be dismissed the service; and the accounts of no citizen shall be allowed, who does not conform to this regulation in every particular.

Invalids having piles or other infirmity, not always to be discovered by the inspecting surgeon, who shall impose themselves upon recruiting officers as sound and able-bodied men, shall previous to dismission be put into close confinement or otherwise punished, at the discretion of a court-martial, as swindlers and imposters.

Whenever a recruit arrives at the post, garrison, station or depot to which a surgeon is attached, or joins the regiment or corps to which he belongs, it shall be his duty forthwith to ascertain whether he has had the variolous or vaccine infection, and if he has not, to see that he be vaccinated as soon as practicable; and for this purpose he shall constantly keep good matter on hand, making application to the Surgeon General for a fresh supply as often as may be necessary."

Probably the retention in the foregoing regulations of the paragraph forbidding officers of the Corps to engage in private practice will excite some surprise. It certainly did at the time, for although it was originally incorporated with the regulations of 1814, it had never been enforced; in fact the position of the frontier posts, and the comparative scarcity of physicians fifty years ago, rendered it often an act of humanity for them to afford professional assistance to citizens living in the vicinity of the garrisons. After the distribution of these regulations Post Surgeon McMahon wrote to Doctor Lovell on the subject, and the Surgeon General replied "that the regulation forbidding army surgeons to engage in private practice, was intended to prevent neglect of duty,


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by entering extremely into it, as well as an improper application of public property which often occurred." There would be no objections to this practice, provided the officer desiring it would make an application to the Secretary of War, through the Surgeon General, setting forth clearly the circumstances, in which case especial authority would be granted.

On the first of November, 1818, the Surgeon General made his first report to the Secretary of War on the sickness and mortality in the army. From it we learn that the total number of sick reported for the quarter ending June 30th, was 1,929; of these 1,569 were either returned to duty or discharged the service, 16 died, and 344 were remaining under treatment. The principal diseases were, inflammatory fever (including slight cattarrhal affections) 229; venereal disease, 84; rheumatism, 93; diarroha and dysentery, 294; typhus fever, 29; malarial fevers, 92; and wounds of all kinds, 153. The deaths were chiefly due to excessive indulgence in drink, no less than three of them being reported from one post. Of the officers of the Corps, the Surgeon General says:

"With regard to the manner in which the several officers of the Medical Corps have performed their duties, so far as I have been able to observe, they appear in general disposed to a prompt and strict obedience to orders. Not having been heretofore required to make such reports and returns, as will be necessary in future, some time will probably be required to obtain them in a proper form and regular manner; particularly those relating to the nature and treatment of diseases, which can only be described in general terms, while all their usefulness must depend on the respective surgeons. Those, however, of Doctor Gale of the Rifle Corps, and Post Surgeons Mann, Stewart, Turner, and Mercer, are laudable exceptions to this remark. Some few surgeons chiefly at the South have as yet neglected all orders, and unless good reasons be assigned therefor, it will be necessary to adopt some means of enforcing obedience, or to supply their places with those who are disposed to be more attentive to duty.

The Apothecary's Department labours under all the inconveniences consequent upon irregularity and want of system, but both Doctor Le Barron and Doctor Cutbush, are well calculated for their duties, and I have no doubt will faithfully perform them. Doctor Backus may make a useful assistant to the Apothecary General, but is not at all calculated for an independent public agent."

Soon after making this report the Surgeon General was called upon by the Hon. J. C. Calhoun, Secretary of War, for recommendations for the improvement of the Medical Department for submission to Congress. In reply he wrote the following communication:

       SURGEON GENERAL'S OFFICE, 
     21st November, 1818.

SIR:

Since the new organization of the Medical Staff in April last, it has clearly appeared that its concerns cannot be properly regulated, unless the allowances of its officers are so far increased as to induce suitable persons to accept appointments in it, and to remain at least a few years in service.


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Besides the impracticability of obtaining the necessary reports, returns, estimates, etc., while many if not most of the frontier posts are without regular surgeons, and while the greater part of the staff is continually changing, I am convinced of the impracticability of our materially lessening the expenses of the department, so long as public property to a large amount is repeatedly transferred from one to another, and is often necessarily in the charge of citizens, who will not, and cannot become responsible for it, or of those who know nothing of its nature; for when it has once passed out of the regular channel, it is entirely without the control of any accounting officer.

It has been estimated that by proper and efficient regulations, about $50,000 per annum may be saved; but in order to effect this, a medical commission must be sufficiently valuable to enable the chief of the department to enforce obedience, by rendering dismissal from service a serious penalty. Very few are to be found (and these few are in general students, by no means qualified for the station) who will serve on the frontier or at frontier posts for thirty or forty dollars per month, without the expectation of promotion, or increase of pay; and none who will remain there long enough to become acquainted with their duties. Of nineteen mates, thirteen have been appointed within a few months; several have refused to accept, and some of those who have accepted begin to apply for transfers or promotion.

Since, therefore, the good of the public service, without any reference to the convenience of the officers, requires an increase of their allowances, that mode of doing it will of course be preferable, which is best calculated to induce them to attach themselves permanently to the army.

If the pay be increased to its maximum at once, it should not be less than sixty dollars per month, and four rations per day to a regimental surgeon, fifty dollars per month and three rations per day to a post surgeon, and forty-five dollars per month and three rations per day to an assistant surgeon; but from the propensity of all men to become discontented with their present condition, unless they can look forward to some improvement in it, though it be ever so small or even imaginary, the plan adopted the British service of increasing the pay and emoluments in proportion to the time they shall remain in service, would probably be much better. In this case the following appear to be the lowest allowances that should be made:

To a regimental surgeon, fifty dollars per month and four rations per day, to a post surgeon forty-five dollars per month and three rations per day, and to an assistant surgeon forty dollars per month and three rations per day. The pay of a regimental surgeon and assistant surgeon to be increased five dollars per month and one ration per day for every three years, and that of post surgeon five dollars per month, and one ration per day for every five years he shall remain in the same grade. Post surgeons being attached to the Corps of artillery, are generally stationed at convenient places along the seaboard, and therefore are more easily retained, whereas the regimental staff require greater inducements to continue in service for any length of time. The former plan would increase the expenses of the medical staff about $20,000, and the latter not much above half that sum for several years; so that should it have the desired effect, it would not only secure a faithful performance of duty, but actually save a large amount annually.

The number of surgeons is by no means sufficient; for supposing them all continually on duty, (which can never be expected), there are many posts which must be attended by citizens; and when they leave their posts from sickness or other causes, it is often impossible to supply their places. At least a surgeon is required at the Military Academy, which is now attended by a post surgeon, and another assistant


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surgeon to the Light Artillery, which is the only regiment in service that has but one, though from the nature of its duties it requires more than any other.

In order to enable the Surgeon General to superintend the disbursements of the Medical Department, a law appears necessary authorizing the Apothecary General and his assistants to purchase all medical supplies; and requiring them to give the usual bonds for the faithful application of public money.

Much inconvenience and delay and some additional expense have arisen from not making letters and packages to and from the Surgeon General free from postage; and these will be much increased now all returns, reports, etc., etc., are made to him.

These it is believed are the most important subjects connected with the Medical Department, which require the aid of Congress."

              Very respectfully, etc.,
    JOSEPH LOVELL,
         Surgeon General."

A controversy having arisen in the winter of 1819 in reference to the comparative rank of medical officers and their position in regard to choice of quarters at the post where stationed, the War Department decided the questions in dispute by the issue of the following order:

      "ADJUTANT AND INSPECTOR GENERAL'S OFFICE, 
       March 22, 1819.

GENERAL ORDERS:

The Medical Department of the army will be governed in their relative rank as follows:

Surgeons of regiments will have precedence over post surgeons, and post surgeons will have precedence of regimental mates; in their several grades, further reference will be had to date of commission.

In the choice of quarters, the Medical Staff will have precedence of subalterns, under the direction of the commanding officer, (who may always claim precedence of those under his command).

Medical and hospital supplies are not to be detained or diverted from their destination, except by generals of division and commanding officers of departments, in cases of emergence and absolute necessity, when a report will be promptly made to the Adjutant and Inspector General, that further orders for deficiency may be given.

*         *         *         *         *        

                  By Order,    D. PARKER,
             Adjutant and Inspector General."

On the twenty-seventh of December, 1819, the Surgeon General again called the attention of the Secretary of War to the importance of requiring the officers of the purveying department to give bonds for the faithful performance of their duties, and consequently on the eighth of May, 1820, Congress passed the following act:

"Be it enacted, etc., That the Apothecary General, and Assistant Apothecary General shall severally give bonds to the United States with good and sufficient security, for the faithful performance of their duties, in such sums as shall be required by the Surgeon General of the army, under the direction of the War Department."


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The passage of the act of April 14, 1818, has generally been considered as the commencement of the modern history of the Medical Corps. This is true to the extent that from that date, by the appointment of a Surgeon General, and the assumption of direct authority over the officers by that official, a great change was made in the responsibility of the Medical Staff, in their accountability for public property, and in the collection and preservation of the records pertaining to their duties. Nevertheless, the organization of the Department was not essentially different from what it had been for many years before, the only material change being the consolidation of the hospital and garrison medical officers under the denomination of post surgeons. It was not until the reduction of the army in 1821, that the Corps assumed the form which it has retained without decided alteration to the present time. It has therefore been thought better to close the history of the Department under the old regime with the general reduction of the army in 1821, and the abrogation of regimental medical officers. This went will be considered more in detail in the next chapter. 

It will be proper before doing so to give a brief statement, from such information as is now attainable, of the expenses of the Medical Department previous to this period, as a comparison of those with subsequent years will be of value in estimating in one respect the relative efficiency of the different organizations. Under the establishment of 1802, the average appropriation for the Medical Department was $13,500 per aunum, or about $4.00 per man for every soldier in service. With the increase of the army in 1808, the expenses rose to $50,000 per annum, or about $5.00 per man. Of the cost of the Department during the war no reliable figures have been found, but in the years 1816-18 under the military peace establishment of 1815, the appropriations averaged $95,382 per annum, or $7.00 per man, while after the reorganization of the Staff in 1818, they were reduced to $39,104 per annum, or only about $3.00 for each soldier in service. Commenting on this great variation in the expense of this branch of the Staff, Surgeon General Lovell remarks (Letter to the Secretary of War, November 28, 1822):

"In explanation of this great difference in expense it may be proper to add that a perfect system of responsibility for all public property from the period of its purchase to that of its expenditure, has been established in this office; that the returns of the surgeons, of every article, are regularly rendered and examined, and full receipts required in the case of every transfer before their accounts are settled. This with the plan of purchasing adopted, and of paying all bills without advancing money absolutely precludes the possibility of fraud, extravagance or undue expenditure. It may also be remarked, that during the last four years, our military hospitals have been regularly and abundantly furnished with every article of furniture, medicine, stores, etc., necessary for the comfort, convenience, and recovery of the sick, to which as well as to the skill and attention of the surgeons, the quarterly reports bear ample testimony."