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Part 4

Table of Contents

PART IV

From the First to the Second
War With England (1783 - 1812)

DEVELOPMENTS CONNECTED WITH THE
MEDICAL DEPARTMENT (1783-1812)

The Legion.-The progress in military preventive medicine, keeping pace perforce with that of the Army of the United States, began to lose headway when Congress halted the forces shortly after the defeat of the British and the surrender of Cornwallis at Yorktown on 19 October 1781. Congress rapidly demobilized the Army during 1782-1784. The Hospital Department was practically disbanded by the time the Revolution was officially closed by the Treaty of Paris, signed on 3 September 1783. During several years, the strength of the total Federal force was under 1,000 officers and men, including a few surgeons and surgeon's mates. In 1790, it was increased to about 2,000, and in 1792, to about 5,000. It was then called a "Legion," and, under the command of Major General Anthony Wayne, was deployed to fight the Indians in various localities. There was a "Surgeon to the Legion," Dr. Richard Allison, who had served as a surgeon's mate during the Revolution. On 13 May 1798, when war with France seemed imminent, Congress authorized an army of 10,000 men, and appointed as Physician General Dr. James Craik, friend and physician of George Washington and formerly physician to the Army of the Revolution. As the threat of war with France evaporated, this force was never completely organized. All but a few officers and men were discharged by 15 June 1800. This disbanded

 


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all the medical officers except 6 surgeons and 12 surgeon's mates. James Craik was mustered out of service on 15 June 1800. No additional military force, or medical organization, was authorized by Congress until 1808 and again in 1812, when a second war with Great Britain appeared inevitable.

Military medical retrogression.-The period of 12 years at the beginning of the 19th century has generally been regarded as one of retrogression in American military medicine. As an example of this appraisal, the following is quoted from (65) the "Military Medical Manual":

1800-1812. During this interval very little information is available concerning the medical service of the Army. It is known that there was no central organization of the medical staff, and there was no hospital department. Sanitation in the modern sense did not exist. The average soldier was without medicines or medical attendance and recovered from illness by the strength of his own physical resistance or died in misery.

This dismal assessment is partly correct and partly due to ignorance. It can be shown to have been too pessimistic. When the whole period from the Revolution to the War of 1812 is examined, as was done in the preparation of this volume, a number of events of importance to the evolution of military preventive medicine in the United States Army are seen identified. Some of these developments took place in direct relation to the residual or fluctuating Medical Department. Others, which were to be influential in the future, arose in scientific and medical communities outside the Army.

Naturally, drugs and medicinal preparations were used by soldiers as well as by civilians in attempts to preserve health and cure sickness. After the Revolution, patent medicines began to flourish. According to Young (66):

* * * ingenuity on the part of Americans themselves did not come until after the fighting was over. It was part of the great fire of cultural nationalism, kindled during the war and fanned into higher flame by the pride of victory. The United States gloried in new American textbooks, American maps, American Bibles, American machines. Reputable medicine reflected the trend. There was a renewed search by American physicians to discover American herbs

 


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which could relieve the American sick of "unrepublican dependence" on European medicines. Efforts were begun to compile an American pharmacopoeia.

First American pharmacopoeia (Lititz).-Actually, the first American pharmacopoeia (67), known as the "Lititz Pharmacopoeia," had been compiled by Army medical officers as early as 1778 in the days of Valley Forge. This was a small booklet of 32 pages, with the text in Latin, presenting, as the translated title states, "the simplest and most efficacious drugs and prescriptions for use in the military hospitals belonging to the Army of the United States, especially adapted to our present poverty and straightened circumstances due to the ferocious inhumanity of the enemy, and cruel war unexpectedly brought upon our fatherland." It was based upon the Edinburgh Pharmacopoeia of 1756. Among the prescriptions were three preparations of Peruvian bark for use in the treatment of intermittent fevers; apparently not used for malarial prophylaxis. A prescription for sulfur ointment was provided for the treatment of scabies and the prevention of its spread. The second edition of this small compendium was published in Philadelphia in 1781, with the authorship ascribed for the first time to William Brown, M.D., who was Physician General of the Hospital of the Middle Department and was stationed in Lititz, Lancaster County, Pennsylvania, in 1777-1778. From this start can be traced interests and developments that led to the production of the Massachusetts Medical Society Pharmacopoeia (1807), the New York Hospital Pharmacopoeia by Drs. S. L. Mitchill and Valentine Seaman (1815), and the National Pharmacopoeia, developed through the efforts of Dr. Lyman Spalding (1817-1819).

Until 1896, authorship of the Lititz Pharmacopoeia was attributed to Dr. William Brown. In that year, perversely, an anonymous writer of an undocumented editorial in a medical journal claimed that the actual author was Dr. James Tilton. This aroused a controversy not yet settled (68). In 1937, the considered opinion of the assistant librarian of the Army Medical Library was: "So far as

 


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known Dr. James Tilton is not associated with the edition of this work." Whether Brown or Tilton wrote it, the work stands as an important early contribution by medical officers of the Continental Army.

Prevention of communicable disease a military duty. -Prevention of communicable diseases appears to have been specified for the first time, officially and legally, as a military-medical duty in the "Act to regulate the Medical Establishment" passed by the Congress on 2 March 1799. The pertinent portion of this law is as follows (69):

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 hospitals; 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 [italics added] * * *.

The passage of this enlightened Act of Congress was instigated by a report made to President George Washington on 24 December 1798 by Dr. James McHenry who was Secretary of War from 29 January 1796 to 13 May 1800. He pointed out that in its recent enactment for enlarging and strengthening the Army, Congress had not made provision for the Hospital Department. "The certain consequence of disregarding so essential a measure," he wrote, "in the event of war, and the encampment of an army, will be a train of diseases which must cut off a large portion of our troops." Dr. McHenry had been surgeon of the 5th Pennsylvania Regiment from 10 April 1776 to 16 November 1776 when he was captured by the British at Fort Washington. Soon after his exchange he served as secretary to General Washington during 1778-1780. This ended his medical career but not his intelligent interest in military medicine and hygiene. It appears probable that he supervised the drafting of the above-cited Act of 2 March 1799.

Observations by Benjamin Rush.-Although Dr. Benjamin Rush resigned from the Medical Department of the Army on 30 January 1778, he remained a member of the

 


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Medical Committee of Congress which was concerned with the regulation of the Medical Department. Throughout the remainder of his civilian life, he was in touch with American military medicine and hygiene. He influenced activities in those fields by two notable publications, and by his theories of the nature and causes of epidemic diseases, to which brief reference will be made later in a passage concerned with Noah Webster. The first of these two publications was his observations upon the diseases which occurred in military hospitals and camps during the Revolution. The "Result of Observations" is presented in 28 succinct and cogent paragraphs, abstracts of most of which are as follows (70):

1. The Army, when in tents, was always more sickly than in the open air; more healthy when kept in motion than when it lay in an encampment.
2. Men under 20 years of age were subject to the greatest number of camp diseases.
3. The southern troops were more sickly than the northern and eastern troops.
4. Native Americans were more sickly than European natives serving in the American Army.
5. Men above 30 and 35 years of age were the hardiest soldiers in the army.
6 The southern troops sickened for lack of salt provisions; their strength and spirits were restored by meals of salted meat.
7. Officers who wore flannel shirts next to their skin, in general escaped fevers and disorders of all kinds.
8. The principal diseases in hospitals were typhus fevers (typhus and typhoid). Men admitted with other troubles often suffered or died by the above-mentioned fevers.
9-18. Observations on symptoms, course, and treatment of typhus fever.
19. Causes that concurred to produce and increase typhus fever; such as lack of cleanliness, excessive fatigue, ignorance or negligence of officers in providing suitable accommodations and diet for their men, the general use

 


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of linen instead of woolen clothes in summer, overcrowding of patients in hospitals, the sudden assembling of a great number of persons together of different habits and manners. From Blane "* * * it sometimes happens that a ship with a long established crew shall be very healthy, yet if strangers are introduced among them, who are also healthy, sickness will be mutually produced." This happened in the American Army at Cambridge in 1775. While that Army consisted only of New Englanders, there was scarcely any sickness, but when troops of the eastern, middle, and southern states met at New York and Ticonderoga in 1776 typhus became universal and highly fatal.
20. Dysentery prevailed in the military hospitals in New Jersey in 1777, but the mortality was low. The diarrheas and dysenteries were often long continued.
21. The itch (scabies) can be cured by rubbing with flower of sulfur.
22-23. Discusses amputation for gunshot wounds of joints; and describes loss of hearing from artillery fire.
24. Soldiers billeted in private houses generally escaped hospital fever and recovered soonest from all their diseases.
25-26. Tilton's log hut hospitals were found to be very conducive to the recovery of soldiers from hospital fever.
27. "Soldiers are but little more than adult children. That officer, therefore, will best perform his duty to his men, who obliges them to take the most care of their HEALTH."
28. Hospitals were the "sinks of human life" in the army. "They robbed the United States of more citizens than the sword."

Rush's second publication of particular importance for military preventive medicine after the Revolution was his annotated American edition of Sir John Pringle's "Observations on Diseases of the Army," brought out in 1810.

Edward Cutbush on preserving the health of soldiers and sailors.-In 1808, Benjamin Rush came to the fore again as an authority on matters of military hygiene through the publication by Navy Surgeon Edward Cut-

 


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bush, MD (1772-1843) of his volume on the means of preserving the health of soldiers and sailors (71).

As the book is concerned with preventive medicine for both soldiers and sailors, the author dedicated it to "the Honourable Robert Smith and Henry Dearborn, Esquires, Secretaries of the Navy and War Departments of the United States." In connection with his observations on military hygiene for soldiers, Cutbush reprinted in the volume Rush's "Directions for Preserving the Health of Soldiers" (1778), saying that: "As it contains many judicious remarks, which will corroborate what I have endeavored to say on a subject of so much importance to the army and government" he wished particularly to make it available in this manner.

Appointed Surgeon in the United States Navy on 28 May 1799, Cutbush saw extensive service in America, at sea, and abroad on missions to Spain, Italy, and North Africa. Eventually, he became senior surgeon of the Navy, and on the basis of his contributions to nautical medicine he is regarded as (72) "the Nestor of the Medical Corps of the Navy."

Cutbush's volume is full of sensible remarks based on experience and reading. It can stand alone without a coroborative prop from Rush. Most of its contents are similar to standard writings already abstracted in this volume. It does, however, present effective statements of both old and new knowledge in refreshed phraseology, and, it contains some new material, of which the following are examples.

Guyton de Morveau and disinfection.-Disinfection of foul air (miasmas) in enclosed spaces is considered at some length, and in the appendix the new portable and permanent disinfecting (or fumigating) apparatus of Guyton de Morveau (73), by which chlorine gas was liberated, is described. This apparatus became known in Philadelphia soon after it was devised in France. Two specimens of the permanent apparatus were received by the American Philosophical Society-one in 1803 presented by Thomas Jefferson, and one in 1805 presented by L. A. Pichon who

 


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appears to have been a French military officer. "L. B. Guyton de Morveau, a prominent French chemist associated with Lavoisier in the reformation of the nomenclature of that science, is credited with originating the general method of disinfection of sickrooms in use through much of the 19th century."

Cutbush stressed the need for concern over the quality of drinking water, attributing some gastrointestinal disorders to the consumption of polluted water and to water containing "animalcules." He advised that water should be tested: "Its purity should be examined by chemical tests, which the surgeons should have in their possession." Evidently, this referred to articles that were later called "chemical kits."

Cutbush devotes a large section to physical standards: "In raising an army attention is necessary to procure men who are free from disease, and capable of undergoing the fatigues inseparable from a military life." Observations are made on the subjects of age, and the preferred sizes of soldiers for various categories.

Jackson's system of military hygiene.-Naturally, as Cutbush had been much abroad, he presents a section "On the Different Theaters of War and the Means of Correcting the Influence of Climate." In this connection, he cites two volumes (74) by the veteran military surgeon, Robert Jackson, M.D. (1750-1827), who was in Jamaica and America during the years 1774 to 1782. He served with the troops of Cornwallis in North Carolina and Virginia from 1778 to 1780. Both of Jackson's books, containing remarks on military hygiene, were known in America after the Revolution.

The first, reprinted in Philadelphia in 1795 from a London printing of 1791, contains wise remarks on the system of military hygiene of the times. The treatise on fevers in Jamaica and America includes an appendix: "Containing some hints of the means of preserving the health of soldiers serving in hot climates." Clothing received special consideration. Jackson recommended special clothing, lighter than the regular issue of heavy uniforms: "There

 


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can be no grounds for supposing, that a soldier will not fight as well in dowlas [coarse linen or calico] as in scarlet."

Jackson's "system" deals with many matters of military hygiene and administration. Two items of special importance are rank and education. For effective performance of functions, he urged that those to whom the important charge of superintending health is committed "* * * should be so constituted as to maintain an honourable and respectable rank in the military fabric." If this is not attained, the medical officer "will not be useful to the extent of his intrinsic value. He will then be a name without a reality-blamed for the ravages of evils which his knowledge probably foresees and estimates, but which his limited powers do not permit him to control." Finally, Jackson points out the national importance of establishing a medical school for the education and training of army surgeons in all their duties.

DEVELOPMENTS OUTSIDE THE ARMY
(1783-1812)

Several civilian intellectual formulations between the end of the Revolutionary War and the War of 1812 exerted effects upon doctrines and practices of military hygiene in America, which persisted through many years of the future.

The cosmic epidemiology of Noah Webster. - Among these developments was the predominating epidemiology of Noah Webster (75) which molded Benjamin Rush's pervading theories of epidemic diseases and influenced orthodox medical thought in generations of physicians. Both Winslow (76) and Smillie (77), among others, honor the memory of Noah Webster as the first American historical epidemiologist but deplore the errors of his theories which for a long time inhibited, or retarded, advances in preventive medicine and public health.

The epidemiological theories of Webster and Rush were developed from the relative potencies ascribed to principles of contagion, miasmas due to organic decomposition, and

 


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the epidemic constitution of the atmosphere. Contagion was admitted in measles and smallpox, but in other epidemic diseases such as malaria, yellow fever, and plague, it was either denied a role or given a low rating. Webster, a confirmed disciple of Thomas Sydenham (1624-1689), placed his main stress upon the genus epidemicus. He attributed the production of "zymotic" (fermentative) diseases to external stimuli, cosmic objects, conditions, and forces. Derivative dogma specified that zymotic diseases were not transmissible from person to person, and that epidemic diseases were due to natural phenomena which, for

 


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the most part, were unfathomable and uncontrollable. From such hypotheses were developed not only local and global epidemiology but also cosmic epidemiology. Even 50 years later, these views were reiterated influentially in a series of aphorisms by Clot-Bey (78) who summarized opinions expressed at the Sanitary Congress held in Paris in 1851. The first aphorism was: "Epidemics are always the result of cosmic conditions."

Anticontagionists: Stubbins Ffirth and others.-A contemporary apparent confirmation of the doctrine of non-contagiousness of epidemic diseases appeared in the remarkable thesis of a student at the University of Pennsylvania Medical School in 1804, Stubbins H. Ffirth (1784-1820) (79). He reported that all of his 15 experiments, in attempts to transmit yellow fever, were negative. Remarkably, he performed all of the tests of transmissibility, except carriage by a mosquito and the periods of infectivity of insect and yellow fever patient, which Walter Reed and his associates carried out in Cuba in 1900. Ffirth slept in the soiled clothing and bedding of yellow fever patients, swallowed their black vomit, dropped black vomit into the conjunctival sack of his eye, and injected black vomit and the blood of yellow fever patients subcutaneously into himself. In no experiment was yellow fever transmitted. Although it is not known with certainty that Ffirth was dealing with cases of yellow fever, the probability is that he was. Whether or not he was immune to yellow fever is not known, although he gave no history of having had the disease.

At the beginning of the 19th century, when the Webster-Rush cosmic epidemiology was taking hold, none of the authorities (brushing aside the earlier suggestions of Mather, Leeuwenhoek, Fracastorius, and others) gave any credence to the possibility that micro-organisms might be able to produce diseases and that parasites might be carried by insects. Apparently, none of the authorities suspected that at least two of the supposititious cosmic influences were so minute as a virus and a mosquito in yellow fever, and so miniscule as a flea and bacterium in

 


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plague. Nevertheless, the ecology, prevalence, and biology of insect vectors of disease and their hosts are admittedly subject to certain cosmic conditions (meteorological, radiological, telluric, etc.). There are still some unknown "Xs" in epidemiology, and the concepts of cosmic epidemiology are not to be cavalierly discarded.

Although the anticontagionists dominated medical thought during the first half of the 19th century, progress in the practical, empirical control of communicable disease in cities and towns, and imitatively in the army, was forced by the devastating power of the great epidemics and by the fears aroused by them.

Medical journalism.-After a detailed, scholarly review of phases of epigraphy, archival collections, and early serial publications (chiefly British and Germanic), Garrison, in 1934, concluded (80): "Thus, the components of medical and scientific journalism as we know it, existed, all of them in the 17th century." This is not to say, however, that there was any useful medical journalism in colonial or Revolutionary America. On the contrary, the first medical journal printed in America appeared in New York only in 1786. This issue was a small volume of translations of selected articles from the first three volumes of the French (Paris) Journal de medecine militaire (81). Although only one number was published, Billings (82) and others rate it as a "medical journal." It is of special interest that this first expression of medical journalism in America presented material of value to army surgeons and dealt, in part, with matters of hygiene, sanitation, and preventive medicine relative to preservation of the health of soldiers.

The first indigenous American medical journal (83) was The Medical Repository, a quarterly established in New York and started on 26 July 1797. It was edited by Samuel L. Mitchill, M.D., Edward Miller, M.D., and Elihu Hubbard Smith, M.D., of Connecticut who was called by Dr. Welch (84) "the father of American medical journalism."

This journal gave American physicians a much needed medium for publication of their observations, experiences,

 


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theories, commentaries, and criticisms of their fellow practitioners. It furnished also critical reviews of articles and books.

The Medical Repository was discontinued in 1824, after 27 years of good service that opened the way for a vigorous development of medical journalism in the United States. The New England Journal of Medicine and Surgery, established in Boston in 1812, has persisted uninterruptedly to this day. The American Journal of the Medical Sciences, begun in 1827, superseding the Philadelphia Journal of

 


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FIGURE 16.- Benjamin Waterhouse (1754-1846). Having procured cowpox virus matter from Dr. Haygarth of Bath, England, he introduced vaccination against smallpox into the United States in 1800. This method supplanted inoculation, and on 26 May 1812, the War Department, by command of the Secretary of War, ordered vaccination of the troops of the Army; namely, the Peace Establishment and the additional Military Force of 1808. (Photocopy of portrait engraved by R. Reeve. Courtesy of the Armed Forces Institute of Pathology, photograph negative No. WW-2820.)

Medical and Physical Sciences, which had been functioning since 1820, is another old substandard journal with continuous publication.

During the first half century of the Republic, when medical journalism was coming into its own in America, there were hundreds of ephemeral medical magazines, appearing momentarily and disappearing after a few months or years. From the point of view of preventive

 


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medicine and public health, it was not until the last decade of the 19th century and the beginning of the 20th century that the great American journals were established in the fields of hygiene, epidemiology, tropical medicine, bacteriology, virology, immunology, pathology, and statistics, and in numerous other disciplines.

Smallpox vaccination (Jennerian) of the Army (1812).-The period under consideration here may be closed by a salute to one of the greatest achievements in the history of preventive medicine and public health, and to the application of the results of the achievement to the whole United States Army. This event was smallpox vaccination.

In 1798 (85), Edward Jenner published the account of his discovery that active immunization of man against smallpox could be attained by artificial induction of cowpox. In 1799, Jenner's "Inquiry" came to the attention of Dr. Benjamin Waterhouse (86) (fig. 16) in Boston, and in 1800 he introduced the method among civilians in America.

Smallpox vaccination (Jennerian) of the Army was first ordered by the War Department on 26 May 1812, on the eve of the outbreak of the War of 1812. This first great War Department official action in military preventive medicine in the Army of the United States is recorded in the archives of the offices of The Inspector General and The Adjutant General, under the date of 26 May 1812, as follows (87):

From the Index of War Department General Orders:

Vaccination: Orders the immediate, of troops, May 26 1812.

From War Department General Orders:

The Surgeons and Surgeon's Mates of the Peace Establishment and additional Military Force of 1808 at the several Posts and Stations will immediately procure matter and vaccinate the troops.

By Command of the Secretary of War.

Thus was vaccination substituted for inoculation in the Army. It soon became a generally accepted method for the prevention of smallpox among both military and civilian personnel, and on 3 March 1813, Congress passed

 


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an act authorizing the President to take a number of steps to make vaccine matter available to the citizens of the United States. During this period, the brilliant success of Jennerian vaccination inspired the concept of the eradication of communicable diseases.