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Chapter 2

Table of Contents

Chapter 2

Evolution of the Continental Army Medical Department

The Continental Army's Medical Department, established in July 1775, was assigned an almost impossible task by the Continental Congress. A staff for the most part totally unfamiliar with military medicine, handicapped by a serious and chronic shortage of drugs and by confused and inadequate legislation, was expected to provide uniformly competent care for an untrained army whose health was jeopardized by poor hygiene and frequently inadequate food and clothing. Medicines and supplies were in many instances imported and, even before the war, often in very short supply. The chain of command was confused because the legislation establishing the department did not recognize the existence of regimental surgeons and regimental hospitals and, when the scope of the medical service's activities broadened to cover operations beyond Massachusetts, did not define the relationship of the heads of the hospitals in other areas to the original Director General. (Table 1) In an era when violent quarrels between ambitious men were common, these legislative omissions fueled disagreements and even feuds which would threaten the Medical Department with paralysis. Thus the medical service was all too frequently unable to provide adequate and compassionate care, even by eighteenth century standards, for the Army's ill and wounded.1

CREATION OF THE HOSPITAL DEPARTMENT: CHURCH AS DIRECTOR GENERAL

When George Washington arrived at Cambridge, Massachusetts, on 3 July 1775 to take command of the Continental Army, the hospitalized sick and wounded, most of whom were from Massachusetts, were being cared for by Massachusetts regimental surgeons in Massachusetts facilities. It was obvious to all concerned, however, that this approach would be inadequate when units from other colonies became involved and when the fighting spread beyond the confines of that colony. Washington pointed out that already "Disputes and Contentions have arisen and must continue until it is reduced to some system."2

On 27 July, the Continental Congress, in a brief resolution, created for a Continental Army of approximately twenty thousand men what was termed in the language of the day "an Hospital" or, in modern terms, a hospital system or medical department, whose physicians were not, however, given military rank. This piece of legislation, like others to follow, was a source of considerable confusion, but the major problem at this time was caused by the failure to outline the relationship of the new department and its director to the existing regimental system, organized by each individual colony for the benefit of the regiments from that colony.3 (See Appendix B.)

The legislation creating the Hospital Department also failed to discuss its relationship to the Congress. In September 1775, however, in response to the increasing seriousness of the drug shortage, the Continental Congress created a Medical Committee "to devise ways and means for supplying the Continental Army with Medicines." This new committee, to which a


23

TABLE 1-AUTHORITY WITHIN THE CONTINENTAL ARMY'S MEDICAL SERVICES, 1775-83

Date

Highest Authorities Within Hospital Department

Highest Authorities Within Regimental System

Highest Independent Authority

Major Subordinates

July 1775

Director General and Chief Physician

Surgeons, apothecaries

Regimental Surgeons

September 1775

Director General and Chief Physician; Director General and Chief Physician in the Northa

Surgeons, apothecaries, mates

As Above

June 1776

As above, Director General and Chief Physician in the Southa

As above

As above

July 1776

As above

As above, including surgeons functioning as hospital directors

Regimental surgeons: must submit medicine chests for inspection to Hospital Department's hospital directors

September 1776

As above

As above

Regimental surgeons responsible to heads of Hospital Department

April 1777

Director General

Deputy Directors of each districtb

Physician and Surgeon General for each army; reports to Deputy Director for his districtc

August 1777

Director General; Director of the hospitals in the South

As above

As above

September 1780

Director General; Deputy Director General for area south of Virginia

Three chief hospital physicians

Chief surgeon and physician for each army

March 1781d

Director General

As above, Deputy Director in the South

As above

    Note: Only the legislation of April 1777 and March 1781 gave the Director General supreme authority over all medical services.
    a His relationship to the Director General and Chief Physician was obscure.
    bThe Director General functioned as the Deputy Director in the middle district.
    c
    The regimental system from this point onward was a part of the Hospital Department.
    d No further changes in command structure occured during the Revolution after this date.

physician, Benjamin Rush, was first appointed in August 1776, was but one of several which were to concern themselves with the Hospital Department at one time or another during the course of the Revolution. Its authority gradually grew, and by early 1777, it had become involved in such matters as the hiring and firing of Hospital Department personnel, smallpox inoculation policies, and the resolution of the internal disputes of the Hospital Department.4

Rush failed of reelection to the Continental Congress in February 1777, and the new Medical Committee which was formed after the elections contained no holdovers from its predecessor. Its responsibilities were broadly outlined from the outset; it was "to devise ways and means for preserving the health of the troops, and for introducing better discipline into the army." Some type of Medical Committee appears to have been in existence from this time until its functions were assumed by the Board of War in May 1781.5


24

ACT CREATING HOSPITAL DEPARTMENT. (Courtesy of National Archives.) [page 1]


25

ACT CREATING HOSPITAL DEPARTMENT. (Courtesy of National Archives.) [page 2]


26

BENJAMIN CHURCH. Apparently no picture of Church taken from life exists. This portrait was based on "contemporary description" (James Evelyn Pilcher, "Benjamin Church, Director General and Chief Physician of the Hospital of the Army, 1775," Journal of the Association of Military Surgeons 13 (1903): 324). Courtesy of National Library of Medicine).

Despite the existence of the Medical Committee, the Congress continued to involve itself directly in the operations of the Hospital Department. The shortage of drugs eventually became so critical, however, that even Committees of Safety from various states joined the attempts to relieve it and the search for medicines was expanded to include France, Holland, and the West Indies.6

To head the newly created Hospital Department, the Continental Congress unanimously elected Dr. Benjamin Church of Massachusetts as the first Director General and Chief Physician.7 Church was known not only as a talented and well-educated physician and surgeon but also as an enthusiastic poet-patriot, an author of Liberty songs who played an active role in the operation of the hospital system for Massachusetts military units and in the examination of candidates for positions as surgeons for those units. He had received his medical training in London, practiced in Boston, and served Massachusetts as a member of both the Provincial Congress and the Boston Committee of Correspondence.

When Church assumed office, colonial soldiers were being cared for in about thirty hospitals, some of which were in wretched condition under the management of surgeons who had little understanding of the problems which faced them. He continued within the new department the same policy of examining candidates for medical positions which was originally followed in the appointment of surgeons for Massachusetts units and moved to consolidate hospitals, ordering regimental surgeons to send their patients, whenever possible, unless their complaints were very minor, to the general hospitals. Massachusetts surgeons generally cooperated with Church's efforts, but those from the regiments of other colonies generally did not.8

Many believed that the smaller hospital intended for the care of the ill and wounded of a four-hundred- to five-hundred-man regiment was less hazardous to the health of its patients than the large general hospital. It was also true that soldiers felt more secure when cared for by their own doctors among the men of their own units. General hospitals, however, were reputed to be more efficient and to have better staffs, since regimental surgeons and mates were a motley crew named by their respective colonels and their competence was not necessarily tested before appointment.9

Church found that the costs of running the regimental hospitals were extremely high and believed that this indicated the existence of "inexcusable neglect" on the part of the regimental surgeons managing them. He wished to have patients moved to general hospitals rather than to have medicines


27

issued to regimental surgeons to permit them to continue to care for their patients. By the end of August, although he acknowledged organized resistance to his plans, Church believed that he was making progress in his fight against the supporters of the regimental hospital. He was sure that the soldiers themselves appreciated the advantages of the hospitals he had established and claimed that regimental surgeons had begun to seek out mates' berths in the general hospital.10 In early September, Washington expressed support for the general hospital concept, commenting, "there is no need of regimental Hospitals without the Camp when there is a general Hospital so near and so well appointed."11

The opposition continued, however. Regimental surgeons complained to their officers whenever the general hospital denied them the drugs they demanded. Brig. Gen. John Sullivan protested that his wounded were being moved three to four miles to Cambridge to have their wounds dressed while his regimental surgeons stood virtually idle. His officers continued to bring pressure upon him: "Are the Dolorous Groans of the Disconsolate, agreeable to any human Ear-That they should be still Increas'd by Dragging our sick . . . In Waggon Loads to Cambridge? Humanity shudders at the Prospect." General Sullivan insisted that fully half of the patients ordered by Church to the general hospitals refused to go, "Declaring they would rather Die where they were and under the care of those Physicians they were acquainted with." The period of enlistment for the Continental Army at this time was for one year, making it necessary to raise a new army at the end of the soldiers' terms. Consequently the effects of the controversy over medical service on the morale of the average soldier were of great concern. General Sullivan commented, "I greatly fear that if it does not Ruin the present Army [it will] prevent another being raised in America."12

Although a second problem which plagued the Continental Medical Department, that of the Director General's authority within the expanding Continental medical establishment, did not appear in its ultimate dimensions under the Church administration, its foundations were laid in September 1775 when Dr. Samuel Stringer was appointed "director of the Hospital, and chief Physician and surgeon for the Army in the northern department." Stringer was to be paid a salary equal to Church's and had the right to appoint four men to serve under him. These men, however, were to be surgeon's mates, not surgeons, implying that Stringer's position was comparable not to Church's but to that of a surgeon. Although Church was clearly supreme within the establishment centered at Cambridge, Congress had failed to define either the relationship of the new system in the north to the one in Massachusetts or Stringer's position in the chain of command and had thus created fertile ground for future quarrels.13

It was in the midst of his struggle with the advocates of the regimental hospital that Church fell from power. By September, the quarrel between the two factions was so intense that Washington ordered that an investigation be conducted within each brigade. He required each brigadier general to sit with his officers as a court of inquiry into the various complaints, talking to both the Director General and the regimental surgeons. On 20 September, after three such hearings, Church attempted to resign, but Washington urgently requested the doctor to consider the matter at greater length. The final hearing was planned for 30 September, but on that day Washington announced the postponement of this last inquiry because "of the Indisposition of Dr. Church."14

The true reason for the postponement, however, was the discovery of a letter from Church to a British officer within British-occupied Boston. It had been suspected for some time that someone in the Provincial Congress of Massachusetts was informing to the British, but Church had explained his


28

own suspicious friendliness with an enemy officer as an effort to keep himself informed of enemy activities. Washington now learned of a letter written the preceding July which had been left with a patriot by the "infamous hussy" who had been asked to deliver it. His suspicions aroused by her obvious anxiety, the patriot had offered to take the message into Boston for her. Although written in cipher, the letter was easily decoded and the woman, questioned by Washington himself, finally confessed that Church was the author. An immediate search of the doctor's papers, however, revealed nothing incriminating, leading the general to conclude that a protégé of Church's had removed anything suspicious.15

The letter was, according to John Adams, "the oddest Thing imaginable. There are so many lies in it, calculated to give the enemy an high Idea of our Power and Importance, as well as so many Truths tending to do us good that one knows not how to think him treacherous: Yet there are several strokes, which cannot be accounted for at least by me, without the Supposition of Iniquity." Indeed, it was only in the period immediately preceding World War II that the discovery of Church's letters to the British General Gage definitely proved that he had been sending secret military and political information to the British for six weeks before the battle of Lexington. Until that time, many others shared Adams's uncertainty. Church himself claimed that the letter was intended for his Tory brother-in-law in Boston and was designed to bring about a delay in the British attack which was anticipated when their momentarily expected reinforcements arrived, since colonial forces were still weak. James Warren and Samuel Adams, however, noted as significant the fact that Church had apparently never mentioned the correspondence to George Washington or, indeed, to any of the patriots.16

While Washington laid the question of how to proceed before his generals on 3 October 1775, Dr. Isaac Foster (also spelled Forster), head of the Massachusetts military hospital system before the creation of the Continental system, was appointed acting Director in Church's place. The next day, Washington's Council of War unanimously decided that Church had been caught in "criminal correspondence with the enemy." Close examination of the Articles of the Continental Army revealed, however, that the only punishment which the Army could legally inflict upon Church for this treason was cashiering and either the loss of two months' pay or thirty-nine lashes. Further legal problems arose from the fact that the alleged crime was committed before Church's appointment to the Army post and that the letter, the only evidence then available of his treason, was never actually delivered.17

Washington turned to the Continental Congress for a way out of this dilemma, but with the decision of that body on 14 October 1775 to elect a new Director General, Church passed beyond the scope of this history. It might be added, however, that although the Continental Congress and both Massachusetts and Connecticut attempted to find some satisfactory way to dispose of this case, none was ever found. Commented John Adams in June 1776, "Nobody knows what to do with him. There is no law to try him upon, and no court to try him. I am afraid he deserves more punishment than he will ever meet." Church's health began to fail, however, and he was permitted to board a ship bound for the West Indies. Neither he nor the ship was ever heard from again. His widow successfully applied to the king for a pension as the widow of a loyalist, claiming that her husband had been imprisoned for services rendered the British crown.18


29

MORGAN AS DIRECTOR GENERAL, 1775 TO 1777

On 17 October 1775, Dr. John Morgan was selected by the Continental Congress over three other official nominees to be Director General. Morgan was not Washington's first choice, however, since the general wished to see his young friend, Dr. William Shippen, already Morgan's rival in their home town of Philadelphia, take the post.19

Although the quality of Morgan's mind and training was undeniable, the honors he had received were many, and his "moral character" was deemed "very good" by John Adams at the time of his selection,20 none other than James Boswell, Samuel Johnson's famous biographer, who joined the youthful Morgan for a tour of Holland in August 1763, called him "un fat bonhomme," translated by Morgan biographer, Whitfield Jenks Bell, Jr., as "a conceited fool."21 Several years after Morgan's dismissal from the department, Dr. Barnabas Binney called him "the most implacable, revengeful man under the Heavens."22 Morgan, Bell has stated, always suffered from "the same tension between the ideal and the possible, the same conflict between what he knew ought to be and what in the actual circumstances could be, and the same inability to understand the difference." Unable "to see anything touching himself in normal perspective,"23 Morgan was driven by the demands and disappointments he experienced as Director General of the Continental Hospital Department to the point where vengeance upon the man he eventually blamed for his every frustration became his main goal in life.

Morgan was appointed Director General in October, but before actually reporting for duty, he took a month to put his personal affairs in order and to collect drugs and instruments. Washington was sufficiently distressed by the delay to point out that Morgan's presence was most urgently required at camp and that the Director "ought not to delay his departure for the camp a moment, many regulations being delayed, and accounts postponed, till his arrival." When he finally did arrive in Cambridge, Morgan was confronted with hospitals crowded with the victims of various diseases, Army officers inexperienced with the maintenance of the health of large numbers of men, and a department already experiencing increasing difficulties keeping up with the demand for supplies. The problems posed by two parallel and conflicting medical systems were by no means diminishing, while those posed by conflicting authorities within the department were just beginning.24

Seemingly undaunted, Morgan inspected the entire department and its operations. The stock of medicines and hospital supplies on hand proved to be totally inadequate. There were almost no blankets, for example, although there were more than 500 mattress


30

SURGEON'S FIELD CASE. (Courtesy of Armed Forces Institute of Pathology.)

ticks. There were only 200 bandages and little in the way of materials from which to make more. The report on drugs from the apothecary revealed that, although 120 different items were on hand, the supply of some of the most highly regarded medicines was very limited.25

Medicines were being brought in from Philadelphia, but they came in slowly while the number of soldiers in the area increased rapidly. Morgan's position required him to deal with the supply crisis directly. Instruments were so difficult to obtain that he was reduced to suggesting to one surgeon that he use a razor blade as an incision knife. He succeeded, nevertheless, in equipping chests for regiments both in Boston and elsewhere. The wool and woolen cloth so highly valued by many eighteenth century military physicians were hard to obtain, although some was purchased on credit in France. The general shortage of textiles meant that even tent materials were in short supply. Congress rarely voted enough money to meet the department's needs, and Washington further complicated the problem in December 1775 by underestimating the costs of supporting the hospitals required by the Army.26

The conflict between the Hospital Department and the regimental medical system which caused so many difficulties under Church also continued under Morgan and was intensified by the shortage of medicines and hospital supplies. Morgan's necessarily meager release of supplies from the general hospital to regimental surgeons, which was in part caused by his desire to stockpile stores against future need, only served to heighten the tensions already existing between the two systems. Regimental surgeons assumed that they had a right to draw on the general hospital's stores and blamed hospital surgeons for the shortages which they experienced, but Morgan maintained that he had no orders to supply regimental needs. Since he was unable to account for the way in which regimental surgeons used what they drew, he believed it necessary to limit carefully what they were


31

issued. Morgan did think, however, that the regimental hospital served a useful purpose and was even reasonably confident of his own ability to handle the situation if Congress would clarify the legal relationship between the two systems. Morgan believed it was essential that the regimental surgeons, whose number was increasing as new regiments were formed, be "placed in some subordination." He asked Congress to inform him whether regimental surgeons were subject to any rule "that may be devised for the government of the Hospital, and the good of the service."27

Morgan was expected to participate in the preparation and issuance of medicine chests and the instruments and drugs in them to regimental surgeons. Since new regiments were being formed rapidly at this time and supplies were running short, finding the items necessary for these chests was quite difficult. Morgan realized, however, the potential threat to the general hospital which would arise should regimental surgeons choose to alleviate the strain on their system by turning all their patients over to the Hospital Department. He predicted to Washington that the population of the general hospital might be increased by such an approach from the approximately 300 there at that time to 2,000 and therefore suggested, with Washington's concurrence, that regimental and general hospitals be brought into harmony. On 17 July 1776, however, Congress itself finally passed legislation which, while to some degree officially clarifying the relationship of the two medical systems as far as supplies were concerned, failed to eliminate ill feeling. (See Appendix C.) The resolve stated that regimental surgeons were not to be permitted to draw anything but medicine and instruments from the Hospital Department and that patients whose treatment required anything more were to be sent into the general hospital. The directors of individual hospitals were entitled to inspect the regimental chests and surgical instruments; if regiments were reduced in size, instruments and medicines not being used were to be turned over to the Director General who would report on their number to Congress. Regimental surgeons also were required to submit returns on the number of sick under their care to the Hospital Department.28

This new act also permitted an increase in the number of Hospital Department surgeons and mates up to one surgeon and five mates for every 5,000 men and the hiring of as many storekeepers, stewards, nurses, and other hospital employees as deemed necessary, to be appointed by individual hospital directors. The suggestion, favored by Morgan, that hospital expenses be met at least in part by a deduction from the pay of each soldier did not pass, but some economies were achieved by stopping the regular rations of the sick as long as they were in the hospital. Hospital directors were required to give the names of the sick and dates of their hospitalization to the commissary and to the Board of Treasury to ensure accurate accounting.29

Unfortunately, neither Morgan's efforts nor those of the Continental Congress had much alleviated the conflict between the two systems. Complaints against the general hospital continued, and at least one colonel, Maryland's Smallwood, removed his men from the general hospital and refused to have others enter it, commenting that they were better off housed "in a comfortable house in the country, and supplied with only common rations." The Continental Congress forbade the placing of regimental hospitals near general hospitals and ordered commanding officers to send an officer once a week to check on the condition of their men in department hospitals.30

Many thoroughly distrusted regimental surgeons. Washington had been disillusioned by the facts brought out at the hearings of the preceding September and called regi-


32

mental surgeons "very great Rascals" willing to certify as sick those who were perfectly healthy. These surgeons were "aiming, I am persuaded, to break up the Genl. Hospital." Their bickering was endangering the entire army and their insistent demands for furniture and accommodations were resented by Morgan, who could not legally accede to their wishes. Washington now believed that only the subordination of regimental surgeons to the Director General would resolve the problem, but others maintained that the controversy could be ended by a firm decision either to take everyone who was too ill to perform his duties into the general hospital or to have the general hospital provide regimental surgeons all they needed to care for their patients. Unfortunately, however, because of the shortage of medicine and hospital supplies, the Hospital Department was in no position to undertake either alternative.31

Regimental surgeons were also dissatisfied because, while they received only $25 a month, a sum raised in June 1776 to
$331/3, and regimental mates were paid but $18 a month, hospital surgeons received $40 a month from the outset and hospital mates $20. (See Appendix B.) Appeals to Congress resulting from the conflict between the two systems poured in even as a tendency to partisanship among the members of Congress grew and medical policy became highly controversial. The tension was increased by suggestions that it might not be possible to raise more troops unless the medical service was reformed. Congress's resolution of 30 September 1776 subordinating regimental surgeons to the heads of the divisions of the Hospital Department did not end the controversy.32 (See Table 1.)

Meanwhile, the confusion about the Director General's authority over the Director of the Hospital in the Northern Department had come to a head. Dr. Samuel Stringer took his post in the North in September 1775, a month before Morgan's official appointment. He apparently set to work at once to carve out an independent niche for himself among the troops under Maj. Gen. Philip Schuyler gathering for an invasion attempt against Canada. Saying that the four mates allowed him earlier were not enough, Stringer asked Congress in late October 1775 to assign him surgeons and more mates. Were surgeons assigned to work under him, his own position would, of course, be strengthened.

By 1776, an all-out three-way power struggle was developing, with Stringer attempting to maintain his own independence, Morgan attempting to "subordinate" Stringer, both physicians scheming to receive the support of Congress for their own ambitions, and Congress refusing to be pushed or manipulated by anyone into clarifying the situation. Washington himself urged that Congress set one single head over the entire Hospital Department. Stringer's request in May 1776 for an increase in his staff to a total of four surgeons, twelve mates, and other lesser figures was granted by Congress on 22 May in terms which did not make clear who was to name these men. Stringer now also informed Washington that his supply of medicines was totally inadequate for his predictable needs, but Washington referred the request for supplies to Morgan, implying by so doing that Stringer's position was subordinate to Morgan's.33

By June, Morgan was demanding that Congress clarify the situation. "From all I am able to learn," he commented, "everything in the Medical Department in Canada displays one scene of confusion and anarchy; nor have the Congress taken upon itself to establish . . . any person whatever with a power sufficient to establish a General Hospital in Canada." The positions of Stringer and Dr. Jonathan Potts, recently sent north, were unclear. Morgan warned that the surgeons in Canada were spreading smallpox through unwisely handled inoculation, some-


33

thing which did not happen, he insisted, where he was in control. Help was badly needed everywhere in the North, furthermore, and he recommended that he be given permission to appoint more surgeons, mates, and apothecaries so that he did not have to send men already on duty and needed in the New York City area. Stringer, however, although he admitted the difficulty of finding surgeons and mates, refused to accept the officers sent by Morgan in response to his stated need.34

The solution Morgan proposed to problems in the North was the establishment of a general hospital in Canada and the placing of all Hospital Department operations in the North under his own authority. The department as a whole would operate more smoothly if he, as Director, chose all surgeons, since unhappy effects would result from any undermining of "that idea of subordination so necessary in an Army." He boldly stated that "some resolves of Congress have been incautiously entered
into . . . or titles of rank and distinction given, which have a tendency to interfere with mine." The public, however, not understanding the situation, tended to blame only Morgan for conditions existing under Stringer's command. Stringer and Morgan continued to importune Congress, and Stringer even left his post in the guise of seeking a supply of medicines to pursue the matter personally with Congress. The response of Congress, however, was to state rather vaguely that Stringer had been appointed "director general and physician for the hospital in the northern department only" and to add that each hospital director was entitled to appoint his own subordinates unless Congress directed otherwise.35

Congress, indeed, was so little impressed with its own share of the responsibility for the conflicts among the medical officers serving the Continental Army that in June 1776, on the urging of the Virginia Convention, it created yet another hospital system, this time in Virginia, headquartered at Williamsburg, where Dr. William Rickman was appointed Physician and Director General.36

In September, one of Morgan's friends and supporters in the Continental Congress, Thomas Heyward, Jr., returned to South Carolina, after informing Morgan that he would not be able to continue to help him. Congress, meanwhile, was harried and harassed by the number and seriousness of the problems with which it had to deal and by late 1776 was apparently running out of patience with both Stringer and Morgan. In November 1776, Oliver Wolcott of the Continental Congress ominously commented that he hoped that "the Medical Department will undergo a Reform of Men at least, if not of Measures, that not so much Complaint which I fear has been too well grounded, may be heard respecting the Conduct of that Department."37

Morgan's position was further undermined in the last six months of 1776 by a quarrel with another Hospital Department physician. His opponent in this instance was more dangerous to him than Stringer, for Dr. William Shippen was talented, charming, superbly trained, highly regarded, and well connected by reason of both his own Philadelphia family and his marriage to a member of Virginia's influential Lee family. Despite Washington's desire to see him become Church's successor, Shippen had not joined the Hospital Department until the summer of 1776, when he became chief physician to the flying camp under the command of Gen. Hugh Mercer, himself a physician. This organization was composed of militia and state troops called in on short enlistments to form a strategic reserve in the emergency created by the impending British attack on New York, but it apparently never reached its 10,000-man goal.

The appointment of a man he already regarded as a dangerous rival alarmed Morgan, who later maintained that Shippen's


34

WILLIAM SHIPPEN, JR. (Courtesy of National Library of Medicine.)

assumption of the post was part of a plot to take his place. The wording of the notification sent to Shippen, however, casts some doubt on Morgan's theory, since the phrase "should you accept the appointment" implies uncertainty as to Shippen's acceptance. By the fall of 1776, however, Shippen may have been thinking in different terms, since he let it be known that he was available should there be changes in the structure of the Hospital Department.38

On 9 October 1776, and apparently without consulting Washington, the Continental Congress once more produced a confusing resolve. Shippen was directed to "provide and superintend an hospital for the army, in the state of New Jersey" and Morgan one "for the army posted on the east side of Hudson's river." There was, in this instance, again no definition of the relationship of the two men, even though the Congress did detail carefully how the hospitals were to be managed.

The month was not over before Shippen wrote Washington that, although Congress had assigned him all army patients on the New Jersey side, Morgan had told all medical officers to follow only the Director's orders until either he or Washington told them otherwise. The basic issue, in Shippen's opinion, was whether he was to give orders only for patients of the flying camp, as Morgan seemed to think, or for all sick and wounded in New Jersey, as Congress, in Shippen's opinion, intended.

Washington apparently assumed that those of his men who retreated from New York to New Jersey nevertheless remained the responsibility of Morgan, as chief physician for the main army; he stated that he interpreted the resolution to mean that Morgan should hospitalize and care for patients of the main army wherever he found it to be most convenient, on either side of the river, and that Shippen should restrict his care to the men of the flying camp. He noted that the problem would in time probably solve itself, since wounded soldiers were now beginning to return to the army and Morgan would soon no longer need facilities on the Jersey side.

Shippen, declaring his own confusion, turned to General Mercer, who suggested that Shippen appeal for clarification to Congress. This Shippen did, commenting that Washington seemed to make no distinction between Shippen's original appointment in July and Congress's newer directive of October. The response of that body to his appeal was to state that all the sick in New Jersey were Shippen's responsibility.39

Morgan's position by December 1776 was very weak, and he blamed Congress for tying his hands by undermining his authority. Congress ordered investigations into the department and there were calls for reform. Shippen, in writing to his brother-in-law in


35

the Continental Congress, Richard Henry Lee, referred to directors who were not directing and noted that the care of the sick was being delegated to ignorant mates while surgeons and physicians found other things to do. Shippen presented a detailed plan to reform the Hospital Department, one which, he maintained, would have among its virtues the elimination of any need for regimental hospitals. Washington pointed out, however, that the clash between Morgan and Shippen greatly increased the sufferings of the sick in 1776.40

On 9 January 1777, without warning, the Continental Congress passed this brief resolve: "Resolved, That Dr. John Morgan, director general, and Dr. Samuel Stringer, director of the hospital in the northern department of the army of the United States, be, and they are hereby, dismissed from any farther service in said offices."41 Washington, in his letter of 18 January notifying Morgan of his dismissal, noted "What occasioned the above Resolve I cannot say, I can only assure you, it has not been owing to any representations of mine." The general confessed that he was "amazed to hear Complaints of the Hospital on the East Side of Hudson's River; Doctr. Morgan, with most of his Mates has been Constantly there, since I left with the main body of the Army" and stated his belief that Morgan had also done his best to keep costs down.42 Samuel Adams, however, writing to his cousin John Adams the day the resolve was passed, commented that both men were "dismissed without any reason assigned" and added that Congress had a perfect right to proceed in this manner. Echoing earlier comments by critics of Church's administration, Samuel Adams added, "The true reason, as I take it, was the general disgust, and the danger of the loss of any army arising therefrom," since "Great and heavy complaints" had been expressed concerning "abuse in the Director-General's department in both our armies; some, I suppose, without grounds, others with too much reason."43

Because of the abrupt nature of Morgan's dismissal, neither the charges against him nor his defense initially received an airing. Morgan, however, spent many long months working first to clear his own name and then to bring about the disgrace of his successor. His pride had been severely hurt and he made no secret of his bitterness. He explained:

. . . to be stripped of the rank of Director General, of the power of my station, and to be left but the shadow of a Director, and yet to be accountable for every accident, or misconduct of others, as well as my own department, and, from the highest post, to be rendered the mere dependent of a junior and subordinate officer, was what I would never submit to.

The source of all his miseries, the "junior and subordinate officer," was William Shippen, Jr.44

Morgan was not officially cleared of all charges of wrongdoing in office until June 1779, in part because of his attacks on others. In his Vindication of himself, he furiously attacked Shippen rather than limiting himself strictly to the matter at hand. One of Morgan's supporters in Congress drew censure from its President for altering Morgan's official appeal after its formal presentation to Congress in an attempt to make the document less vitriolic. It was, therefore, only on 12 June 1779 that Congress resolved that Morgan "did conduct himself ably and faithfully in the discharge of the duties of his office." He was never reinstated.45

NEW ARRANGEMENTS FOR THE HOSPITAL DEPARTMENT

Benjamin Rush, who was still a member of the Medical Committee, reacted quickly to the dismissal of Morgan, writing on 14 January to Richard Henry Lee to urge that the appointment of a new Director General be held in abeyance until the two men could


36

discuss the matter. He stated that he wished to give Lee the names of men who, like John Cochran, were so able that they should be appointed at once to high positions on the department's medical staff. He also wished to advise Lee on the reform of the Hospital Department, which, he believed, should be designed more along British lines in order, for example, to further remove the responsibility for obtaining supplies for the department from the office of the Director, so as to minimize the possibility for corruption.46

Shippen, also impressed by the British system, continued to work on his plan for hospital reform, at Washington's request with the aid of the same Dr. Cochran whom Rush so much admired. This plan suggested the appointment of purveyors to manage supplies received by the Hospital Department and of an Inspector General to inspect hospitals and apothecary shops. The general, who made it plain that he still wished to see Shippen become Director, was not sure that the higher salaries recommended by Shippen would be granted, although he himself felt them necessary, and pointed out that the Shippen-Cochran plan did not differ fundamentally from the ideas favored by Morgan himself.47

In response to Washington's urging, a special committee was appointed by Congress on 22 March 1777 to study the health problems of the Army. The report they issued was repeatedly brought up for consideration in late March and early April, but its consideration was also repeatedly postponed, often with suggestions for minor alterations. The absence of a Director General and the uncertain nature of future organization gave cause for concern to those who held responsible positions under the old system. Washington found it necessary in at least one instance to reassure an anxious medical officer that those who had been performing their duties faithfully had nothing to fear.48

At last, on 7-8 April 1777, legislation changing the organization of the Hospital Department, much along the lines suggested in the Shippen-Cochran plan, was passed by the Continental Congress. (See Appendix D.) Nothing in the new resolve suggested that the Director was not the head of the entire department. Among his many duties was to be the personal supervision of the hospitals of the Middle Department, between the Hudson and Potomac Rivers. The Eastern and Northern Departments, separated geographically by the Hudson River, were each to be managed by a Deputy Director General; a third Deputy Director would supervise hospitals south of the Potomac River if the military situation seemed to require the establishment of a formal organization in this part of the country. The new law implied that the relationship of this last deputy to the Director General would be identical with that of his counterparts to the north. Assistant Deputy Directors, with the hospital surgeons and


37

attendants who would serve under them, an apothecary general with his mates, and a commissary with his assistants were to work under each Deputy Director General.

In each geographical division (casually referred to as either a department or a district), the practice of medicine was to be supervised by a Physician General and the practice of surgery by a Surgeon General. In addition, a Physician and Surgeon General would be attached to the army in the Champlain area of the Northern Department, a second to the units in New England, in the Eastern Department, and a third to the army personally commanded by General Washington, for the specific purpose of supervising the work of the regimental surgeons and their mates and the management of regimental hospitals. These officers would be responsible to the Director General and to the Deputy Directors General of the districts in which they were serving.

Among the features of the original Shippen-Cochran plan not found in the new legislation were the positions of the Purveyor, whose office was so important in the thinking of Benjamin Rush, and of the Inspector General. As a result of the elimination of these positions, the management of the department's supplies, as well as the responsibility for the condition of the department's facilities, remained entirely in the hands of the Director General, although the Medical Committee was empowered to inspect any aspect of the Hospital Department at any time.49

The reaction to the new plan for the Hospital Department seems to have been one of general satisfaction. John Adams considered it "A most ample, generous, liberal provision. . . . The expense will be great, but humanity overcame avarice." The pay scale was indeed high, since it gave the senior surgeon, for example, approximately a dollar a day more than a colonel of the Continental Army earned. The fundamental problem lay not with the pay scale but rather with the late payment of the assigned salaries, which ran months, if not years, late.50

Modifications and additions to the legislation as originally passed began to appear before a week had passed, partially as a result of an apparent trend away from the British custom which separated the function of the surgeon from that of the physician and toward a tacit recognition of the actual practice in the colonies. The Shippen-Cochran plan in the form it took on 14 February 1777 mentioned both senior surgeons and senior physicians and although the desirability of keeping the wounded and the sick physically separated was reiterated, the requirement of the 7-8 April legislation for separate positions of Surgeon General and Physician General was partially removed on 12 April when Congress gave both identical duties; each should function in the capacity of Physician and Surgeon General. The complete elimination of any distinction between the duties of the physician and the surgeon at all levels was not officially achieved until September 1780.51

On 22 April 1777, Congress issued still further additions to the new regulations. Concerned with providing care for military patients as quickly as possible, the legislation ordered that the Director and Deputy Directors publish frequently in the local newspapers the locations of military hospitals so that men unable to continue their march could be sent to the one closest to them. Officers were authorized to send patients to the nearest private physician for care if no military hospital were at hand, but were required to send them as soon as possible thereafter to a military facility.52

Shippen was not formally elected Director General until 11 April when the other high offices of the department were also filled, although his election was by the unanimous vote of the states. His Surgeon General in the Middle Department was Benjamin Rush, who had first worked with the


38

department as a volunteer in December 1776, and others of his staff were also experienced physicians; it was hoped that the reorganization would result in an influx of well-trained doctors to the Hospital Department.

The complete list of officers of the Hospital Department elected on 11 April 1777 is as follows:

Director General, William Shippen, Jr.
Physician General of the hospital in the Middle Department, Walter Jones
Surgeon General of the hospital in the Middle Department, Benjamin Rush
Physician and Surgeon General of the army in the Middle Department, John Cochran
Deputy Director General in the Eastern Department, Isaac Foster
Physician General of the hospital in the Eastern Department, Ammi Ruhamah Cutter
Surgeon General of the hospital in the Eastern Department, Philip Turner
Physician and Surgeon General of the army in the Eastern Department, William Burnet
Deputy Director General of the hospital in the Northern Department, Jonathan Potts
Physician General of the hospital in the Northern Department, Malachi Treat
Surgeon General of the hospital in the Northern Department, Francis Forgue
Physician and Surgeon General of the army in the Northern Department, John Bartlett

SOURCES: Ford, Journals of the Continental Congress, 7: 253; Francis Bernard Heitman, Historical Register of Officers of the Continental Army During the War of the Revolution, April 1775 to December 1783 (Washington: 1892-93).

On 5 June, in a further attempt to enhance the department's image, a notice signed by Shippen and Cochran in their official capacities was placed in the Pennsylvania Evening Post, publicizing the new appointments and stating that "all the military hospitals of the United States are in excellent order, and that the Army enjoy [sic] a degree of health, seldom to be seen or read of." The significance of this announcement becomes apparent when it is considered in the light of the fact that Washington believed that the condition of the Army's hospitals had contributed to the melting away of his entire army in the winter of 1776-77.53

SHIPPEN'S CONTROVERSIAL ADMINISTRATION

Shippen, like Morgan, was trained at Edinburgh and London after receiving his undergraduate degree in the colonies and serving there as an apprentice. Although he gained distinction as a physician who was genuinely concerned for his patients, it was as a teacher and as a social animal that he especially shone. "Nature had been uncommonly bountiful in his form and aspect," wrote a fellow physician, "his manners were extremely elegant . . . he belonged to a family proverbial for good temper ... he was ... particularly agreeable to young people." It was said that before the enmity arose between the two Philadelphia doctors, "there was no one who did not wish him well" and that at his death in 1808, "he left the world without an enemy."54

Shippen was immediately faced with the problems which had haunted both Church and Morgan. Supplies were disastrously short, rivalries were flourishing, the department's organization was still far from perfect, and Congress was still contributing as much to the problems as to their solutions. It is also possible that the new Director General himself to some degree added to the department's problems since, except for his first two winters in the Army, he continued to teach anatomy as he had before the war, and thus did not devote his entire time to the Hospital Department. It is also possible that he was unwilling to endure prolonged personal hardship and deprivation, although the matter is open to question.55

The number of sick, which was high even before the campaign of 1777 began, grew even higher as the cold weather came on. "The extreme fatigue and hardship which


39

the Soldiers underwent in the course of the Winter, added to the want of Cloath [sic], and, I may add, Provisions, have rendered them very sickly," Washington believed.56

This same lack of food and clothing also helped to make the sick in the hospitals even sicker. John Adams, noting that disease killed ten soldiers for one killed in battle, added that "Discipline, discipline is the great thing wanted. There can be no order nor cleanliness in an army without discipline."57

Supplies of almost any description were very hard to find and the problems experienced in this regard by the Hospital Department were but a reflection of the overall situation, although the larger budget allowed by Congress for drugs kept the situation from becoming in this respect as desperate as it was in 1776.58 Food, especially vegetables, vinegar, soap, and clothing were particularly hard to obtain for Army patients, although in August 1777, the Continental Congress gave the Hospital Department permission to draw upon the issuing commissaries. Many patients otherwise ready to rejoin their units were unable to do so because they were literally naked. By late October, Shippen was begging Congress for clothing but it was not until 19 November that this body granted Army hospitals a share of the Army's clothing supply and permission to install stoves to keep the unclothed patients warm.59

While Washington admitted that "It is but too melancholy a truth, that our Hospital Stores are exceedingly scanty and deficient in every instance, and I fear there is no prospect of their being better shortly,"60 many did not understand the nature of these shortages and blamed the sufferings of the Army's patients upon the Hospital Department and its Director, as they had under Morgan. By the end of 1777, for example, Rush was attacking Shippen with increasing vigor, citing as causes of patient wretchedness both the "want of checks upon the lower officers of the hospitals" and also what he maintained was Shippen's refusal to deal with these officers and to join him in appealing to Washington and to Congress. Rush was certain that Shippen's influence among politicians could produce action which would cure the problem. Congress, in response to the spiraling costs, resolved in early January 1778 that every officer hospitalized with venereal disease should be fined ten dollars and every soldier four, the sums so collected to be used to buy blankets and shirts for hospital patients.61

Congress was increasingly displeased about the operations of the Hospital Department and complained that for a lengthy period of time it had been forced to assume the role of Director General of the hospitals in addition to that of the other Army department heads. Great hopes were held out, however, for a reform plan adopted in February 1778, partly as a result of the urgent complaints of Rush, who showed little awareness of the inevitable effects of the universal shortage of supplies and sought to solve the department's problems by reorganization. (See Appendix E.)

Under the new plan, the Director was relieved of all supply responsibilities. The new position of Deputy Director for the Middle Department was created and Jonathan Potts was named to fill it. Although he was not given the title of purveyor, the new Deputy Director would assume all purveying functions. He would pay salaries and incidental expenses and buy medicines and supplies, distributing them with the aid of assistant deputy directors to be specifically assigned responsibility for such matters in each district. Accounting procedures were tightened. The staff which would in the years to come assist the officer functioning as purveyor generally included not only clerks and storekeepers but also purchasing agents and assistants to help with the distribution of supplies. Estimates of need were routinely sent to the purveyor, who then


40

turned to such agencies as might reasonably be expected to provide the requested items. Among these possible sources were state agencies, the Commissary General, the Quartermaster General, the Clothier General, the Continental Druggist, and the various contractors serving the Army. When the purveyor attempted to buy privately, however, he was forced to bid against other governmental representatives, a situation which resulted in artificially inflated prices for all. Congress through its committees looked as far as Europe and the West Indies for drugs which, when received, were turned over to the Apothecary General by the purveyor. The new organization was, of course, unable to keep inflation and inadequate funding from interfering with the department's ability to supply its needs.62

The new legislation also reduced the responsibilities of the office of the Deputy Director General in the Eastern and Northern Departments, where there was little action after Burgoyne's defeat in the fall of 1777. The number of hospitals in each district, for example, would be determined by the district's Physician General and Surgeon General, who would also consult directly with the Director General concerning supply needs rather than work through the Deputy Director. In the absence of the Director General, these two officers would also appoint the wardmasters of their district. Reports from the Physician General and the Surgeon General would no longer be routed through their Deputy Director but would be submitted directly to the Director General. (See Appendix E.)

It was also in February 1778 that the French entered the war against Great Britain. Although this development was crucial to the eventual winning of the war, initially it only added to the supply problems faced by the Americans, since the French handled their own supply and paid higher prices than the Americans to be sure of obtaining what they needed, which raised the prices the Americans had to pay.

Following the appointment of Jonathan Potts as Deputy Director for the Middle Department, Congress was for a time financially more generous to the Hospital Department, and both morale and hospital conditions seem to have improved. By the fall of 1778, the clothing situation appears to have improved as well. As time went on, however, congressional generosity no longer sufficed. The Treasury did not have enough money to give the Hospital Department that which Congress assigned to it, and increasing inflation was severely undercutting the purchasing power of such sums as the department did receive. By the end of 1779, inflation was so great that $30 in Continental money was not worth $1 in specie, and food was again short everywhere, although appeals to the local populace at times produced good results. By the summer of 1780, the department was "destitute of those necessaries which are indispensable for the sick," and suggestions were even being made that Potts might be profiting from his position. In attempting to defend himself, Potts accurately pointed out that a number of men including other physicians within the department and assistant Directors General, such as Thomas Bond and James Craik, commissaries, assistant commissaries, and stewards handled purchasing at one time or another.63 John Cochran, soon to become the fourth Director General, had little hope for improvement in the supply situation and blamed Congress and its Medical Committee "who will probably pow-wow over it awhile and nothing more be heard of it."64

Although the legislation of April 1777 ended the regimental medical system as a separate entity, the enmity between regimental and hospital surgeons also continued to plague the department for a time and their "continual jealousies and altercations" in January 1778 "had a very pernicious influence," in Washington's opinion. His


41

efforts to have regimental surgeons submit regular weekly reports to the officers of the local division of the Hospital Department on the number and condition of their patients apparently met with limited success, since he found it necessary to repeat them from time to time. Eventually, however, general distrust of regimental surgeons began to wane, and Washington himself noted his desire to see the regimental surgeon given more leeway, since being moved to a general hospital could harm many patients.65

The confusion about the extent of the authority of the Director General, however, did not disappear under Shippen. Although the April 1777 legislation placed no geographical restrictions on Shippen's authority, in August 1777 the Continental Congress stated that the April reform plan was not to be applied to the division of the Hospital Department operating in Virginia under Rickman and, furthermore, that Shippen must withdraw any doctors whom he, assuming that he was Rickman's supervisor, may have sent into the South.66

Presumably already damaged by the confusion within the department, morale was further damaged by the fact that in the early years of the war the men of the Continental Hospital Department had neither military rank nor the privileges of the military officer.67 They appealed to Washington in April 1779 for permission at least to draw clothing from Army stores, but Washington did not have the authority to permit this. In November 1779, after Congress passed and then rescinded one resolution on the matter, a clothing allowance was finally voted, to be granted on the same basis as it had been in 1777 to line officers. When additional regulations governing the drawing of clothing were passed for line officers a few days later, physicians were again omitted, and the oversight was not remedied until September 1780. It should be noted, however, that as late as March 1780, even line officers were apparently not in actual practice receiving clothing from the Army. The members of Congress also agreed in November 1779 upon legislation assigning Army physicians a monetary subsistence allowance to replace the rations assigned them in 1777 and to be based on a formula derived from the pay scale of line officers, the Director General receiving a colonel's share.68

Army doctors resented, however, the fact that they still had not been granted retirement half pay for a seven-year period as had line officers in 1778. To force Congress to assign them half pay, they threatened in December 1779 to resign en masse the following January 1780. An attempt to put through the desired measure on 3 January 1780 failed of passage, but the men of the Hospital Department did not, despite their disappointment, desert their patients by carrying out their threat of mass resignations, even when line officers were given half pay for life in October 1780. Not until 17 January 1781 and only after strong urging by Washington were medical officers included under half-pay provisions passed earlier for line officers. According to the 1781 legislation, all medical officers appointed by Congress who remained in the service for the entire war would receive half pay for life, but the Director was paid as if his rank were that of a lieutenant colonel. Medical officers also received at this time compensation for the effects of depreciation, a measure they had been supporting since 1780.69

The ability of the department to function was further diminished by stories of great abuses within the Hospital Department, spurred by Rush's almost continuous criticisms, which again began to carry considerable weight in 1779, when demands for further reform reappeared. A request for $1 million for the Hospital Department was halved after violent debate on the waste believed to characterize its operations, especially as far as food and wine were con-


42

cerned. Benjamin Rush, who had resigned his commission in the Hospital Department as a result of his quarrels with Shippen and was by now considered to be the Director General's bitter enemy, accused Shippen of trading in the very hospital stores with which Congress was most concerned, especially wine and sugar. In June 1779, his own name cleared, Morgan joined Rush in clamoring that Shippen be court-martialed. Since Washington insisted that nothing be done until the campaign of that season was complete, however, Morgan's demands that Shippen be at least suspended from office until he could be brought to trial were in vain.70

By December 1779, preparations for the court-martial of the Director General were under way, but the Hospital Department was facing further hardships. The winter of 1779-80 was unusually bitter, food was scarce, and the deep snow hindered the delivery of provisions. When a thaw set in, the resulting mud made roads impassable. By March 1780, when the case against Shippen was ready for trial, hospital stores, according to Cochran, were exhausted.71

Most of the accusations which were formally placed against Shippen originated in the period of Rush's service in 1776 and early 1777 when, as Shippen pointed out, Morgan had voluntarily remained in enemy-occupied Philadelphia.72 Morgan was, therefore, forced to rely heavily upon Rush in his attempts to disgrace his old enemy. Rush was a man of obvious charm but questionable integrity. A contemporary, Dr. Thomas Bond, who was described by Whitfield Bell as "one of the sanest of the Philadelphia physicians" and at one time praised by Rush himself,73 commented bluntly that Rush was "capable of LYING in the WORST SENSE of that approbrious [sic] word" and called him "an unprincipled man."74

In the spring of 1780, Morgan and Rush were ready to present five formal charges against their enemy. Shippen was accused of fraud in selling hospital stores as his own and moving them at government expense in government-owned wagons, of speculation in hospital stores and adulterating hospital wines at Bethlehem, of keeping no regular set of accounts for the Hospital Department, of neglect of his hospital duties to the point where soldiers died as a result, and of behavior unbecoming an officer and a gentleman in his alleged attacks upon Morgan. Unfortunately, the official records of the prolonged trial have not survived so that only the correspondence of that period and the newspaper evidence of the struggle in the form of "letters to the editor" can shed light upon the nature of the testimony offered by both sides during the trial and during the hearings of the Continental Congress which followed it.75

The reputations of Shippen and Morgan are still controversial. The documents of the time, however, indicate that the major difficulties of the Hospital Department were not only frustrating but also inevitable and not to be blamed upon any single man or group of men. It seems likely, furthermore, that neither Shippen nor anyone else could have emerged unscathed from an attack by Morgan and Rush once their ire had been sufficiently aroused. Shippen appears to have been the kind of man the ambitious Morgan (and perhaps Rush also) wished to be and to have won without great effort the acclaim Morgan was struggling so fiercely to gain for himself. On the other hand, Shippen does not seem to have been, for all his charm and talent, capable of great self-sacrifice. The basic conflict here appears to have been not so much of principle as of personality and ambition.

On 27 June 1780, the court-martial acquitted Shippen of all the charges against him, noting in the instance of the speculation charge, however, that Shippen had indeed speculated in stores of the kind used in hospitals and that this was "highly improper and justly reprehensible." The final


43

charge, that of conduct unbecoming an officer, was dismissed as "groundless and malicious."76

The results of the trial established that, despite their claims, Morgan and Rush could not find witnesses to prove the first charge of selling stores belonging to the hospital for his personal profit. Dr. Bond's testimony that the third charge, of not keeping proper accounts, was false was apparently convincing. The charge of neglect made public much conflicting testimony, possibly including letters dated 1777 from Rush himself in which he praised Shippen's conduct of the department. The trial also raised questions as to the propriety of the ways in which Morgan and Rush had gathered their testimony on this charge.77

Since the court-martial had taken place at the request of Congress, Washington wished its verdict to have congressional approval, but he urged that it hurry its decision because of the disordered state of the Hospital Department. After some delay in coming to a decision, on 18 August 1780, a month after it received the court's verdict, the Continental Congress resolved that "The court martial having acquitted the said Dr. W. Shippen, Ordered, that he be discharged from arrest."78

This was by no means the end of the matter, however. Morgan, despite his earlier firm assurances that he would abide by the court's decision no matter what it might be, joined Rush in criticizing the verdict, the court's methods of handling the trial, the officers conducting it, and Shippen's witnesses, using as their vehicle a newspaper, the Pennsylvania Packet.79

Although Shippen remained as Director General of the Hospital Department, Congress still believed that reform was desirable. The Medical Committee brought in a report in July, and a reform resolve was finally adopted on 30 September, to be followed on 6-7 October by the election of officers for the newly reorganized department.80

The new legislation increased the role of Congress in choosing department personnel, who were reduced in number through a reorganization which no longer called for a separate staff for each geographical division. (See Appendix F.) The posts of Deputy and Assistant Deputy Directors General were among those eliminated. The office of Purveyor was officially created; the Purveyor was required to render his accounts to the Board of the Treasury rather than to the Director General. Three chief hospital physicians were responsible for the general hospital system and a chief physician for each army supervised the regimental medical staff. The fifteen senior hospital physicians, in addition to the highest ranking members of the department, were all to be elected by Congress. Any participation in trade by employees or members of the department was forbidden, and all medical officers from surgeon's mates upward were to receive allotments of land upon retirement just as had been voted line officers earlier, the Director ranking for this particular purpose as brigadier general and the surgeon's mates as captains. The Army hospitals from North Carolina to Georgia, however, were to continue under the old organization.81

When elections were held for the newly reorganized department, Shippen, rather than being quietly dropped, as might have been expected had serious credence been given to the charges so recently placed against him, was reelected as Director General. John Cochran and James Craik, both recommended by Washington, in addition to Malachi Treat and Charles McKnight, received other top posts. The next day the rest of the medical staff was selected;82 it was apparently determined at this time that only one Chief Physician and Surgeon General for the Army was needed and the position was given to Cochran.

Officers of the Army Hospital Department as of 7 October 1780 were:

Director General, William Shippen, Jr.


44

JOHN COCHRAN. (Coutesy of National Library of Medicine.)

Chief Physician and Surgeon General of the Army, John Cochran
Chief Hospital Physicians and Surgeons, James Craik, Malachi Treat, Charles McKnight
Purveyor, Thomas Bond, Jr.
Assistant Purveyor, Isaac Ledyard
Apothecary, Andrew Craigie
Assistant Apothecary, William Johonot
Hospital Physicians and Surgeons, James Tilton, Samuel Adams, David Townshend, Henry Latimer, Francis Hagan, Philip    Turner, William Burnet, John Warren, Moses Scott, David Jackson, Bodo Otto, Moses Bloomfield, William Eustis, George    Draper, Barnabas Binney.

SOURCE: Ford, Journals of the Continental Congress, 18:908-10.

Despite repeated reorganizations, the old problem of supply remained. In December, the Medical Committee admitted to the Continental Congress "That on account of the failures in obtaining money, the sick are in a suffering condition; The Physicians unable to proceed to their respective charges, and the business of the Department greatly impeeded [sic] in every part." Bond, as Purveyor, was unable to obtain even such funds as had been voted to him. As the winter deepened, transportation difficulties once more complicated the desperate supply situation and the lack of funds further hindered attempts to obtain horses and wagons. With conditions becoming ever more grave, on 3 January 1781, Shippen resigned, claiming that he did so because Congress had decided that the duties of a professor of anatomy and those of the Director General of the Hospital were not compatible.83

THE HOSPITAL DEPARTMENT UNDER COCHRAN

On 11 January, John Cochran and two others were nominated for the post of Director General, and on the 13th, John Morgan was added to the list of candidates. On the 17th, Cochran was elected. The new Director was known to his contemporaries as "an able and experienced practitioner." He also apparently possessed considerable administrative ability, badly needed at this time.84 He had achieved an enviable professional reputation without the benefit of graduation from any formal medical school, having been entirely apprentice trained, but had gained military experience as a surgeon's mate in the French and Indian War. Not as personally ambitious as his predecessors, he once wrote that his "appointment was unsolicited, and a rank to which I never aspired, being perfectly happy where I was." He openly maintained that he preferred James Craik for the post. He had considerable experience in the Continental Army, having been appointed Assistant Director of the flying camp hospital in 1776, Surgeon General of the Middle Department in 1777, and Chief Physician and Surgeon of the Army in 1780.85

On the same day that Cochran was ap-


45

pointed Director General, several changes were made in the rules governing the Hospital Department. The power of the Chief Physician and Surgeon of the Army to remove regimental surgeons and mates for neglect of duty was modified so that these officers could only be suspended until they could be court-martialed, hospital physicians were empowered to appoint matrons, nurses, and other lesser figures necessary to the smooth functioning of Army hospitals, and the half-pay provision was passed.86

Various other changes in the organization of the Hospital Department followed one upon the other throughout the last three years of the war. In March 1781, the Southern Department was at last brought directly under the Director General, although in his absence from that area, its administration was placed under its own Deputy Director, Dr. David Oliphant. The entire staff in the South included, in addition to the Deputy Director, a Deputy Apothecary, a Deputy Purveyor, a Chief Physician of the Hospital who was required also to have the skills of a surgeon, two hospital physicians also to be qualified as surgeons, four surgeon's mates, one assistant each to the Deputy Purveyor and Deputy Apothecary, and lesser figures as necessary. Named to these positions were men who had served under Oliphant in the South before this change, including Dr. Peter Fayssoux as Chief Physician of the Hospital.87

In May 1781, the Medical Committee which had for so long supervised the affairs of the Hospital Department was discontinued and the department was required to submit its returns to the Board of War. The board was itself superseded later in the year by the War Office under Secretary of War Benjamin Lincoln. The following July, a hospital board was established, consisting of the Director General, the Chief Physician of the Army or one of the Chief Hospital Physicians, and two hospital physicians, with a general officer presiding who could exercise a tie-breaking vote as necessary. This board was assigned the task of determining the fitness of applicants for positions applied for in the Hospital Department.88

Still not satisfied with the operations of the Hospital Department, the Continental Congress began in the fall of 1781 to consider complex proposals for yet another reform. Among the ideas examined was a suggestion that a complete turnabout be made and the use of regimental hospitals strongly encouraged. By early January 1782, however, the committee studying the matter had determined that, since the war was apparently near an end, such a complete change was not appropriate and that lesser modifications would be satisfactory. The offices of the Chief Hospital Physician and of the Chief Physician of the Army were abolished and a three-man hospital board was set up to examine all candidates for promotion and to give advice.89

Under the new legislation, the Purveyor, under whom the stewards were to serve, was to report to the Superintendent of Finance, Robert Morris, appointed in 1781 to bring order to the chaotic finances of the Revolution. Further steps were also taken to tighten accounting methods. A committee investigating this matter recommended in July 1782 that an invariable standard of prices be established in the apothecary's office to systemize accounting. Accounting procedures were carefully outlined in detail so that this aspect of the department could function in as orderly a manner as possible. The committee also requested an immediate inventory of all the public property held by any medical officer. By October 1782, Morris was ready to appoint commissioners to settle the Hospital Department's accounts.90

The winter of 1780-81 was a tragic one for the Continental Army and particularly for the Hospital Department. Shortages were extremely severe, to the point where some hospital physicians were unable to


46

make out their returns because of the shortage of paper. Cochran wrote repeatedly to the President of Congress, emphasizing his belief that "unless some speedy and effectual means are taken to relieve the sick, a number of valuable soldiers in the American Army will perish through want of necessaries." In February, Cochran was ordered to take over all publicly owned stores being held in private hands and, in at least one instance, Washington stated that, if necessary, force should be used to acquire this property. Specifically mentioned at this time were the medicines of Dr. Isaac Foster, former Deputy Director General in the Eastern Department and former acting Director after Church's disgrace, who, maintaining that he had not been reimbursed for drug purchases, refused to turn over his supply.91

The appointment of Morris as Superintendent of Finance on 29 February 1781 led to a gradual improvement in the young nation's finances, which in time favorably affected the supply problems of the Hospital Department; in January 1781, the Army was experiencing mutinies, and by March, the staffs of some hospitals were reduced to sending ambulatory patients into the surrounding communities to beg for food. Even in the summer of 1781, Army patients were "suffering extreme distress for stores of every kind," physicians were being asked to furnish their own instruments, and Bond, as Purveyor, was being urged to turn once again to the ladies of surrounding communities to obtain old linens for dressings.

Although the decisive battle of Yorktown culminated in the British surrender in October 1781, the Continental Army was still experiencing supply shortages well into the summer of 1782.92 Many suppliers had not been paid and, as a result, were reluctant to continue to deal with the Continental government. By early 1782, Bond was being accused of using the money sent him "to different Purposes from those which were intended," and of delaying the sending in of his reports. Morris sharply informed the Purveyor in February 1782 that "Until I am possessed of these Things, I will not advance one Shilling for the Purpose." Bond's deficiencies as far as reports were concerned so distressed Morris that, in June 1783, he wrote the unfortunate physician that he would very much regret it if he were forced by Bond's delinquency to request these documents "in Terms which might excite your Painful emotions."93

By the fall of 1782, however, supplies and gold were beginning to arrive from France94 by which time, of course, the need for supplies was dwindling as the pace of the war slowed.

When Cochran became Director General of the Hospital Department in 1781, however, the personal financial situation of the officers of the department still was neither clear nor strong. The most immediate problem at this time was the tardy arrival of pay, which in some instances was two years overdue. This situation led even to resignation on the part of physicians unable to support themselves and their families under such circumstances. Cochran himself was at times unable to pay his way to Philadelphia to bring the department's problems before Congress. When Congress did issue warrants for pay, inflation seriously undercut their worth. "For God's sake," Cochran wrote Robert Morris on 26 July 1781, "help us as soon as you can. Most of our officers have not received one shilling of pay in upwards of two years." Furthermore, Cochran noted that the French paid their military doctors over half again as much as the American doctors were supposed to be receiving and that even the British medical officer was better paid than his colonial counterpart.95 Although legislation calling, on paper, for compensation for depreciation had been granted to medical officers, when attempts were made to execute this law, difficulties were encountered. The warrants


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for this purpose were to be drawn on the states, but New York refused to go along,96 and none of the states was in a position to pay a lump sum all at once. Pennsylvania, for example, decided to issue "Certificates of Indebtedness" as compensation.

The problem of half pay was only partly settled, although the original resolution on this subject was dated January 1781. In March 1783, a new modification was proposed, permitting the officers of the Hospital Department, as well as line officers, to receive five years of full pay in money or securities at 6 percent rather than half pay for life, if they so voted as a group.97

Resignations, often prompted by financial problems, left openings within the Hospital Department and raised the question of standards for promotion. Men such as Dr. James Tilton favored a general promotion by seniority, but Cochran noted the possibility of the promotion of unqualified men and pointed out that the British did not promote in this manner. "It affords me but Melancholy Prospect," he wrote, "when Gentlemen, who are capable and willing to do their Duty, . . . take their departure from us. . .God knows, with what kind of Cattle their Places will be supplied."98 Less than three weeks later, Cochran pointed out in a letter to the President of Congress that he had several vacancies and suggested that the most senior mates could move up. By July, there were seven vacancies among the fifteen positions of hospital physician. Congress ordered that vacancies in the state lines be filled as would any other vacancy within the regiment and that the Director appoint men to fill any positions vacant in the regiments not of state lines. By August, Washington was urging that an overall solution be developed for the problem, and Cochran was wondering if Congress had forgotten the wounded and sick. By September, there was also an urgent need for physicians within the Southern Department, but Cochran believed that these vacancies should be filled by southern physicians who could report for duty at once rather than by men promoted to these positions from the north.99

On 20 September 1781, the matter finally reached a vote and Tilton's recommendations for promotion by seniority were adopted. Senior hospital physicians from hospitals recently closed were to receive first consideration for vacancies at that level. Hospital mates of the greatest seniority and regimental surgeons held the next priority, the two classifications to be equally ranked and examinations necessary for both. Appointments to the highest positions were still to be made by Congress, in theory on the basis of merit alone.100

On 21 September, however, once again a motion was put before Congress to completely rescind a resolution just passed the previous day. This attempt to rescind Tilton's proposal failed of passage, but on the 22d, a motion to suspend the promotion of mates to physicians passed. On 3 January 1782, Congress ordered that hospital physicians be appointed from amongst hospital mates and regimental surgeons. The latter, to qualify ahead of the former, would have to take an examination to prove their competence. The obvious reluctance of Congress to promote physicians apparently stemmed from the conviction that the department already had enough officers in each rank.101

During the summer of 1782, Washington was in correspondence with the British general, Sir Guy Carleton, over the matter of granting immunity from prisoner-of-war status to hospital officers as first proposed by Carleton. By September 1782, Washington was able to notify his generals Heath and Knox that Congress had, on 9 September, resolved that captured surgeons, hospital officers, and chaplains were no longer to be classified as prisoners of war.102

Even before the British surrender at Yorktown in October 1781, however, Cochran received totally unexpected orders


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from the Board of War to start closing hospitals, beginning with those at Yellow Springs, Pennsylvania, Albany, and Boston. He found these orders most confusing, since the cost of closing the Boston and Albany hospitals and transferring the patients elsewhere would be great both in money and in the danger to the patients. Some who were interested in the problem were now raising once again the old matter of the death rate in general hospitals, as Cochran noted in a letter to Craik, and were saying that general hospitals should be eliminated entirely in favor of regimental hospitals. Cochran likened this attitude to the notion that one should never go to bed because so many people died there; he told the President of Congress that he feared that Congress was not so familiar with the medical establishment as it might be and was being unduly swayed by the advice of those who were seeking their own advantage. "I fear we have some evil Counselors who are endeavoring to lead us astray, for astray we are going, as fast as the devil can drive us," he wrote to Dr. Barnabas Binney.103

Cochran apparently resigned himself to the closing of the Boston unit in the face of the argument that it held few Continental patients and that the state should assume the responsibility for returning prisoners and Massachusetts recruits. He believed, nevertheless, that the breakup of the Boston and Albany hospitals would be very expensive. Money would be necessary to procure accommodations for the patients who were put out of these facilities when the nearest hospital still open was 200 miles away. To save a relatively small sum, the Board of War, in Cochran's opinion, was spending a large sum.104

Although Cochran wrote to Dr. John Warren in Boston in October 1781 that the Boston hospital must be closed, he hoped to delay the closing of the Albany hospital, especially since he had just ordered 200 more men to be sent there. Cochran seems to have had his way as far as the Albany hospital was concerned, for it was still in operation in November of 1782.105

It was almost two years after the Yorktown victory that, on 3 September 1783, the Peace of Paris was finally signed. On 18 October, Congress resolved to disband the Army as of 3 November, and on 23 October, the wartime Hospital Department was replaced by an institution to aid those "invalids of the army and navy"106 still in need of care.

During the most active years of the Revolution, the Continental Army's Hospital Department had been crippled by confused legislation. Its staff, often unpaid, frequently without needed medicines and supplies, torn by feuds, its reputation tarnished by the ambitions and greed of a few, struggled against hopeless odds in the often vain attempt to provide adequate care for the sick and wounded. Death rates in Continental hospitals in this period were high and conditions in them, particularly at those times when the Army was suffering its greatest reverses, were often horrible. The most vocal critics of these institutions, however, were physicians whose comments were their weapons in their bitter feuds. It should be noted, furthermore, that even the civilian facilities of Europe, which in some instances were housed in magnificent buildings designed specifically to serve as hospitals, might shock those who visited them; the Paris Hôtel Dieu, for example, with its four to six patients in a bed, its stench-filled rooms, and its appalling death rate, which at times reached a reported 33 percent, was notorious.107 In the eighteenth century, hospitals established on an emergency basis in hastily procured buildings and filled to overflowing with patients from a lice-infested, starving, wretched, and retreating army could not be expected to exhibit conditions which were other than frightful.

Only in the closing years of the Revolu-


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tion did the picture brighten, when the chain of command was clarified, the most contentious physicians were no longer with the department, and money and supplies began to come in from France just as the lack of major engagements began to reduce the patient load. It was at this point in the war that the officers of the American Army's first Medical Department began to receive recognition of their devotion to duty when the Congress granted them the same pensions, allowances, and other considerations which had already been awarded to officers of the line.