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HISTORY OF THE OFFICE OF MEDICAL HISTORY
Early Campaigns in the North, 1812 to 1813
During the first campaign season of the War of 1812, the physicians caring for the regular soldiers of the U.S. Army were forced to work under a decentralized, peacetime organization. During the second season, the effort required to meet the unpredictable demands of war at the same time that the Medical Department was being reestablished made it difficult for Army surgeons to give their patients the best care available even by nineteenth century standards.
SEASON OF 1812
American plans for the early months of the War of 1812 called for a three-pronged attack on Canada by means of thrusts from the Lake Champlain-St. Lawrence River area, from Niagara, and from the Northwest Territory. (Map 10) By the end of 1812, all three moves had failed.1
For the attack against Canada from the American side of the St. Lawrence River, six thousand to eight thousand men were gathered in the fall of 1812 at Greenbush, near Albany, under the personal command of Maj. Gen. Henry Dearborn. In November, the army marched from Plattsburg, New York, to launch an attack against Montreal. The militia, however, stood on its right not to fight on foreign soil. Those who did cross into Canada managed to fire on one another in the confusion. After the fiasco, the militia returned home and the light artillery and dragoons returned to Greenbush. Three regiments of regulars went to Burlington, Vermont, for the winter, while three more spent the season at Plattsburg.
Maintaining the health of the troops in this area was a problem from the outset. The season was rainy and the ground was wet. Although the camp at Greenbush was often moved, diarrhea and dysentery took a considerable toll. Not only intermittent fever but also typhus and rheumatism were prevalent even as early as mid-September. Despite the threat to the army posed by the high disease rate, when Dr. James Mann, placed in overall charge of the medical services for the forces in upstate New York, arrived at Greenbush the second week in August, he found that the physician who was to have preceded him had not arrived and that the troops were without medical care.2
Since no preparations had been made to care for those of the men at Greenbush who might fall ill, upon his arrival Mann had to go over the hospital supplies, which, fortunately, he found to be in good order, as well as to care for the ill with the aid of but one other physician, a regimental surgeon's mate who arrived a few days after Mann. There were no buildings prepared to receive the sick and Mann did not wish to erect new tents because of the wet ground, so the sick were left in the tents they shared with their healthy comrades. An average of 100 men fell ill each week at Greenbush, and by the
time the last units of the army left for the abortive attack on Montreal, a total of 200 men had been left behind because of poor health. Nevertheless, Mann believed that the health of the men at Greenbush was good when considered in the light of the fact that most of them were new to the military life.3
Mann believed that the basic problem which underlay all others as far as medical support of the Army was concerned was the lack of overall organization. He himself worked on an outline of rules and regulations for a hospital department when he could find a spare moment, but he had difficulty finding the time to complete it. He was not sure of his authority; although he had hired a wardmaster and steward, for example, he had not taken on nurses or orderlies because he was not sure that he was entitled to do so. He also noted that conflicts with line officers were made almost inevitable by the ill-defined nature of the role of the hospital surgeon.4
Among the varied duties which Mann was required to perform in the fall of 1812 was the distribution of hospital supplies from the Greenbush area to Niagara and Plattsburg, New York, and Pittsfield, Massachusetts; the administration of medicines to the ill of the rifie corps who did not have a regimental surgeon to care for them; and the revision of diets for hospitalized patients. He decided that the convalescents in his care did not need the full diet required by the healthy and active soldier. Mann suggested that the convalescent receive 12 ounces of meat and 12 ounces of bread a day. The "half diet" should consist of 6 ounces of meat and 10 ounces of bread, with the addition of a gill of rice or a half pint of meal plus half a gill of molasses. Those on a "low diet" should receive only bread, rice, or barley with sugar, without any meat. Although chocolate or tea with sugar was to be permitted from time to time, Mann opposed the use of whiskey.5
Mann regretted being so busy with his responsibilities as hospital surgeon that he had little time to study the diseases he encountered and to record his observations. During the fall and winter of 1812-13, however, he saw many cases of rheumatism, pneumonia, measles, dysentery, and intermittent fever. When he first arrived at Greenbush, he also found that a few of the men had fallen ill with what he diagnosed as typhus before they reached the camp. Four of the seven men who died in the period from mid-August to the end of September were from among this group of typhus patients, and two others who died had long been afflicted with what we would today call tuberculosis. Mann had expected to encounter what he called spotted fever, which had been prevalent in the East in earlier years, but this disease never became a problem in the Northern Army.6
On the basis of his observations during the first fall and winter of the War of 1812, Mann concluded that rheumatism afflicted men older than 40 more frequently than younger soldiers and was quick to recur after exposure to wet, cold weather in those who had previously suffered from it. Mann preferred to reserve venesection for the treatment of the acute form of rheumatism, using calomel, opium, blistering, and the application of warmth for chronic cases.7
Among the other conditions studied by Mann were pneumonia and dysentery. In some cases of pneumonia, death could occur within 24 hours of the appearance of the first symptom, which was usually a sensation of weight upon the chest. The convalescent from this form of pneumonia, Mann noted, often had a jaundiced appearance. The type of dysentery seen by physicians in the North at this time "was attended in most cases with a fever of the synochal type, accelerated action of the arteries, and heat increased considerably above the healthy standard." Mann favored treating it by bleeding, preferably a single bleeding of 16 ounces followed by a "full cathartic of
WILLIAM BEAUMONT. (Courtesy of National Library of Medicine.)
calomel and jalap." "Anodynes," or painkillers, might be administered after the "intestines were well evacuated." Mann also discovered that "There were cases when calomel and opium, in small doses, at intervals of 4 or 6 hours, were found beneficial." Emetics were generally used only when all else had failed, but dysentery could take on "a typhoid form" which made the administration of wine or diluted brandy, up to two pints of the former, as well as purgatives, advisable. Milk was also recommended, especially for the convalescent from this variety of dysentery, but meat and broths were strictly forbidden.8
Intermittent fevers apparently appeared at Greenbush only in men hailing from south of the Hudson River who had had the disease before. These men were treated with emetics when the "cold stage" was about to appear and then, during periods when there was no fever, with cathartics, bark, and wine in addition to the emetics. A disease which was more common than intermittent fever was measles, which, at one time or another during the winter, afflicted as many as one-third of the entire army.9
Among the physicians who eventually served under Mann was Dr. William Beaumont, a surgeon's mate, who later was to gain fame through his studies concerning digestion. At this time, Beaumont was particularly concerned with the respiratory diseases he was encountering with great frequency. He commented that the men were making "the very woods ring with coughings & groaning." Pleurisy was a common affliction among his patients and was handled, in its earliest stages, by bleeding followed, as the symptoms subsided, by the administration of opium, digitalis, and "Glyc. Snn Tart. Atn," a combination Beaumont found to be "very efficatious [sic] in relieving the Cough." For patients who could not otherwise be relieved, Beaumont favored the raising of blisters.10
Mann believed that attention to certain precautions could lower the incidence of disease within the Army. Soldiers should, for example, wear woolen shirts. "Spirits" should be eliminated from the rations of the healthy as well as from those of the sick, since "Immoderate potations of spirits by weakening the sensorial powers, and inducing general debility" were a "predisponent cause of disease." The presence of alcohol in hospitals would constitute a threat to the health of the soldier who was "habitually intemperate," who would always be "industrious to procure the means of indulging his appetite." Mann observed also that some of the men were convinced that "ardent spirits" were good for bowel complaints and were, apparently, dosing themselves to the point of inebriation.11
No matter how successful Army surgeons might be with their patients, however, there would always be those who, for political
reasons of their own, in Mann's opinion, would be willing to exaggerate the Army's rate of death and disease "with design to render government and its officers odious." Furthermore, Mann maintained that this rate would always be higher than the public might expect it to be because young and healthy men did not join the Army.12
Early in February 1813, Mann made an inspection tour of the hospitals caring for General Dearborn's men at Plattsburg and Burlington. He was favorably impressed by the way in which Dr. Joseph Lovell, later to become Surgeon General of the United States Army, was managing the hospital at Burlington, although the number of deaths there from November to February approached 200. The death rate at Plattsburg, where the surgeon's mate who was in charge of that unit kept the wards clean and in good condition and supplies were more than adequate, was comparable to that at Burlington.13
When Mann returned to Greenbush, however, although the progress being made on a new building was encouraging, he discovered that the surgeon he had left in charge had been seriously neglecting his patients and that a pneumonia epidemic was growing. Mann was so angered by what he found that he considered placing formal charges against his subordinate but finally decided against taking so drastic a step. Despite the situation which had developed in his absence at Greenbush, only eighty-nine patients had died there from 1 August 1812 to February 1813, with the highest rates occurring in December. Mann attributed the improvement which followed in January to a change from using "stimulants . . . . employed as medicine" to "evacuating and antiphlogistic" remedies.14
The American forces in the area between Lakes Ontario and Erie, slightly less than half of whom were militia, numbered about 6,500. They were divided among Lewiston, Buffalo, and Fort Niagara. It is not surprising that the campaign here was also a failure; the militia exercised its right not to fight on Canadian soil whenever it wished, the commander of the militia was totally lacking in military experience, the commander of the regulars was unreliable, and the two commanders were apparently incapable of cooperation.
The health of the men on the Niagara frontier appears to have been no better than that of their fellows in northeastern New York State. A letter written in early November 1812 from Buffalo reported that three or four of the Regular Army there were dying each day and that more than 100 of those wounded in an attack on British-held Queenston on 13 October later died. The high death rate there was blamed on a lack of "proper surgeons." The most common diseases afflicting the men at Buffalo were measles and dysentery, the latter being blamed on the fact that the men were eating fresh meat. At Lewiston, some units reported one-third to one-half of their men sick in November, and it was noted that the hospital tent of one regular infantry
JOSEPH LOVELL. (Courtesy of National Library of Medicine.)
regiment held the bodies of five men who had been dead more than 24 hours but had not been buried because of a shortage of coffins.15
The 1,300 regulars at Fort Niagara were cared for by three physicians. One was attached to the fort's regular garrison and two were from regiments newly stationed there. The situation of the surgeon of the 14th Infantry Regiment may well have been indicative of that faced by others near Niagara. In early October, he was without medicines, hospital stores, or surgical instruments. There were, unfortunately, not only sick but also wounded needing care at Niagara because the fort was bombarded at times by the British guns across the Niagara River.16
Brig. Gen. William Hull was in command of operations in the Detroit and western Great Lakes area in the first few months of the War of 1812. He arrived at Dayton, Ohio, early in the spring of 1812 and marched northward from there, reaching the Rapids of the Maumee River by the end of June. Here, since his horses were exhausted, he hired a schooner, the Cuyahoga, and a small boat to carry his sick and wounded and a major portion of his baggage, including his medical supplies and a trunk full of confidential military records, the rest of the way to Detroit.17
The British, however, controlled Lake Erie, and to reach Detroit the Cuyahoga had to pass under their guns at Fort Malden. Since General Hull had not been officially informed that war had been declared, he was unaware of the magnitude of the risk he was taking. The enemy, having learned of the declaration of war, captured the Cuyahoga on 2 July, but the small boat, carrying some of the sick, seems to have escaped to arrive safely at Detroit.18
There is some confusion as to what happened to the small boat and its occupants. A few patients and the surgeon's mate from the Ohio volunteers who was sent along with them apparently were in this craft. Although the diary of a physician captured by the British at this time has been attributed to this mate, Dr. James Reynolds, by its editor, others have disagreed with him. The preponderance of the evidence seems to indicate that the physician in the small boat and, presumably, the patients with him, reached Detroit safely on 3 July 1812 and that Reynolds was killed just before General Hull's surrender of Detroit in August by a nearly spent ball which tore off one leg and mangled the other.19
After their hospital supplies were captured, the providing of medical support for General Hull and the bulk of his army after their arrival at Detroit by land on 5 July posed a problem. New supplies were to have come in from Fort Fayette, located near Pittsburgh, but Fort Fayette itself was short on these items also. Further difficulties, according to General Hull, were caused by the fact that the hospital surgeon originally assigned to the units at Detroit, Dr. Josiah Foster, died before he had progressed far in the organization of medical services there. Foster's place was taken by Dr. Abraham Edwards, a former surgeon's mate who had also had experience as a line officer.20
The British deliberately played upon General Hull's fears. Rumors were circulated about huge numbers of Indians who were presumably thirsting for American blood. Canadian militiamen were clothed in the red uniforms of British regulars and paraded where the Americans could see them. On 16 August 1812, in what one historian has termed "one of the most disgraceful episodes in the military History of the United States "21 General Hull surrendered not only Fort Detroit but other forts in the area as well.
Among those included in General Hull's surrender was a detachment of fifty-four men with their families at Fort Dearborn, where Chicago now stands. The physician caring for the population of this fort was
Dr. Isaac Van Voorhis of the 54th Infantry Regiment. At the time of the surrender, General Hull ordered Fort Dearborn evacuated and, despite warnings from friendly Indians that they would be ambushed, the occupants obeyed. An estimated 1,500 Indians set upon the small group, which included 9 women and 18 children, after it left the shelter of the fort and killed 30 soldiers, 10 male civilians, 2 women, and 12 children. Among the dead was regimental surgeon Van Voorhis.22
Not long after General Hull's surrender at Detroit, Brig. Gen. William Henry Harrison was appointed commander of all forces, regular and militia, a total of approximately six thousand men, in the Northwest. Several expeditions were sent out against the Indians during the fall, and by December, General Harrison's men held a line across northwest Ohio from Fort Defiance to Sandusky.
By November, however, typhus had appeared among General Harrison's men, the weather was cold and wet, and proper shoes and clothing were lacking. Three or four men were dying each day. On Christmas, one of General Harrison's officers reported that, of the approximately six hundred men in his unit, recently returned from an expedition against the Miami Indians, more than three hundred were suffering such severe frostbite that they were unfit for duty.23
Near the ruins of old Fort Defiance in the fall of 1812, where militia units and detachments from two infantry regiments were stationed under Brig. Gen. James Winchester, the burden borne by the Army's physicians was great. Hospital stores were being stolen before they could be delivered at the camp, and typhus was raging among the men. By winter, although the new fort, including its hospital, had been completed, supplies were exhausted and the suffering from cold and hunger was increasing. One of Winchester's men noted on Christmas Eve that "Our sufferings in this place have been greater than if we had been in severe battle. More than one hundred lives have been lost, owing to the bad accommodations. The sufferings of about three hundred sick at a time, who are exposed to the cold ground and deprived of every nourishment, are sufficient proof of our wretched condition."24 Wrote another soldier, "We now saw nothing but hunger, and cold, and nakedness, staring us in the face.25
Having been ordered by General Harrison to move from their new fort to the Falls of the Maumee River and to build huts there for the winter, General Winchester and 1,200 men set out, arriving at the rapids on 10 January. Shortly thereafter, upon learning that the Americans at a small settlement called Frenchtown (now Monroe, Michigan), thirty-five miles away and only eighteen miles from British-held Fort Malden, were being threatened by the enemy, General Winchester sent an advance party of his men to help them.26
After an indecisive engagement on 18 January when more than fifty Americans were wounded and twelve killed, these men set up camp at the village. The officers took over some private homes and the hospital was set up in a tavern at some distance from the main camp. On 21 January, however, after General Winchester and the main body of his force had joined the men already at Frenchtown, the enemy attacked and overwhelmed the Americans, killing 397, wounding 27, and capturing more than 500, including General Winchester. Among the dead were the senior surgeon for the entire force and the surgeon of the 17th U.S. Infantry Regiment. Another physician had taken up the weapon of one of his patients while the struggle was still taking place and set out to join the fighting; he was never seen alive again. A volunteer surgeon and his mate were captured when they elected to remain with about sixty to sixty-five wounded men at the hospital.27
On accepting the surrender of the Americans who were still fighting, the British promised to assign a guard for the wounded to keep them from being killed by the Indians before they could be moved to Malden. The promise was ignored, however. No guard was posted, and so, after enjoying the liquor they found stored in the tavern-hospital, the Indians tore the blankets away from the wounded and then set fire to the buildings. Those who tried to escape were shot and tomahawked.28
General Harrison attempted to aid General Winchester, but his relief party was unable to reach the scene of the battle in time.29 General Harrison then fell back on the Maumee River and, abandoning any further thoughts of a winter offensive, passed the rest of the winter constructing the fort to be known as Fort Meigs.
SEASON OF 1813
Although there was military activity both in the North and the South during the campaign season of 1813, the United States forces involved in the South were for the most part either those of the Navy or of the Tennessee units of Andrew Jackson which he led against the Creek Indians of the Mississippi Territory. General Wilkinson's expedition of Army regulars into West Florida which culminated in the occupation of Mobile met with no opposition. In the Northwest, the campaign season of 1813 was so successful that by the onset of winter and after young U.S. Navy Commander Oliver Hazard Perry's victory over a British fleet on Lake Erie, the entire area was under American control. General Harrison was thus able to move 700 of his regulars from the Northwest to Buffalo and Sackett's Harbor. Although the general himself resigned from the Army at this time, these men took part in the campaign in western New York State.
In the Northwest in 1813, there do not appear to have been any general hospitals, at least not of the size and caliber of those in northern and western New York State. There were garrison facilities at some of the posts,30 but presumably most of the ill and wounded of General Harrison's army were the responsibility of regimental surgeons and mates or even of militia physicians.
During the spring and early summer of 1813, General Harrison's army was in unusually poor health and his hospital stores and medicines were being consumed not only by the sick but also by the wasteful habits of militia surgeons and mates at the various small posts scattered throughout the Northwest. Hospital supplies of liquor were apparently a source of particular concern to General Harrison, who noted that a "dry Barrell" should be "put over that which contains" hospital liquor because "Experience has long since convinced all those in the Western country who are desirous of having their Liquors secured from plunder and adulteration that it is the only way of affecting it."31
In May 1813, the enemy attempted to take Fort Meigs before the reinforcement expected by the troops there could arrive. Although the siege was abandoned after nine days, the defenders suffered 81 killed and 189 wounded at a time when the medical support available for them was "extremely deficient in almost every respect." There was "no head to the Hospital Department," and the surgeons were young and inexperienced and, for the most part, from the militia. One officer noted that the militia was content to look for its physicians "wherever a person could be found with a lancet in his pocket, or who had by some means or other obtained the title of doctor." Although there had been a "man of skills and talents" in charge of the medical services at this fort before the siege began, this otherwise unidentified gentleman was no longer in the Army by May of 1813, having left both the fort and the Army, it would
seem, in disgrace, considered to be "alike destitute of honor and reputation."32
There was no place to put the wounded at Fort Meigs while it was under siege; they lay in trenches "on rails barely sufficient to keep them up out of the water, which in many places from the bleeding of the wounded, had the appearance of puddles of blood." There were even times when there was nothing available with which to cover these unhappy creatures, since the same supply shortages experienced by other camps also afflicted Fort Meigs. The force there was so shorthanded that men could not even be spared to give adequate care to the wounded,33 several of whom died "of a lock-jaw," brought on, General Harrison believed, by "their great and unavoidable exposure to the cold."34
Once the siege was over, blockhouses were cleared of guns and stores and turned into temporary hospitals, but the men were still "but badly provided with the little necessaries and comforts which belong and afford so much relief, to the brave soldier who has recently lost a leg or an arm, or had his side pierced with a bayonet."35 General Harrison took it upon himself to forward an urgent order worked up by a hospital mate for medicines and stores in their behalf. (See Chapter 1.)
General Harrison's operations in the summer and early fall of 1813 in the Lake Erie area were successful and culminated in October in the defeat of the British and their Indian allies in Canada at the Battle of the Thames River and the death of the Indian leader Tecumseh. However, apparently little had been done in advance to prepare for the care of the sick and wounded. One of the men with this expedition described coming down with "the Ague" on board a boat because of the wet, cold weather. He had, apparently, no alternative but to continue the march once on land. The only help available to the sick was that which their fellows could provide by carrying their weapons and packs for them and, when crossing small streams, by carrying the sick themselves on their backs.36
After the final battle in October, General Harrison reported that five of his men had been killed and twenty-two wounded in the engagement and that five of the wounded died shortly thereafter. Although there does not seem to be any record of where these men were initially cared for, after Detroit was recaptured a hospital was opened under Dr. Cornelius Cunningham, a garrison surgeon's mate, in the house formerly occupied by Governor William Hull. For a brief time before moving on to New York State, General Harrison and his men returned to Detroit, and in November of 1813, four hundred of the regulars who had been with him in Canada were left behind in the Detroit facility. By this time, the sick rate was again soaring and the men were both tired and hungry. Some of the illness was blamed upon the large quantities of bad bread they had reportedly eaten. A month later, however, the situation had not improved. "The troops . . . . still Continues to be very much sick and many have Died since we came to this place."37
In the Northeast, troops under Maj. Gen. Henry Dearborn left Sackett's Harbor in April 1813 to take Toronto, then called York, and Fort George. (See Map 10.) They then held off an enemy attack on Sackett's Harbor itself, but in December 1813, the British launched a successful attack, retaking Fort George and capturing Fort Niagara as well. A series of enemy raids which included the burning of Buffalo and Black Rock brought the hostilities of that campaign year along the Niagara to a close.
Farther east, a two-pronged American move against Montreal in the autumn of 1813 was a complete failure. After replacing the ailing General Dearborn at Sackett's Harbor, General Wilkinson moved east along the St. Lawrence River, intending to join Maj. Gen. Wade Hampton's forces
FORT NIAGARA. (Courtesy of Library of Congress.)
moving north from the Lake Champlain area. Both generals, however, retreated after separate defeats by the enemy. General Hampton returned to Plattsburg and General Wilkinson fell back on French Mills. General Wilkinson was accused at this time of excessive drinking and of attempting to blame his condition on illness.38
In New England and the states south of New York in this period, where there was little if any military action involving the Regular Army, there were at least one or two garrison or regimental physicians in each military district, caring for the men of small Army units scattered among small posts. In the 1st District, which included Massachusetts and New Hampshire, for example, there were eighty-seven patients at such posts as Forts Independence, Constitution, Sullivan, Preble, Seammel, and Sumner.39 (See Chapter 7.)
Although hostilities in the North and Northwest involved both the 8th and 9th Military Districts, the greatest amount of action during the entire period was concentrated in the 9th District, or upstate New York and Vermont. Hospitals here were relatively numerous and during the campaigns of the summer, in response to demand, could be quickly set up in barns or tents. Finding attendants for these facilities, however, was difficult and they were initially selected from the line. Such men often turned out to be those "of incorrect habits, and bad dispositions" and eventually it was realized that it was better to choose attendants from among convalescents, some of whom could always be found who had "happy dispositions, who were kind to the sick."40
When it was necessary to move the sick and wounded, a number of forms of transportation could be used to negotiate the notoriously poor roads of the area. Some
patients were moved in litters made of blankets hung between poles, others in wagons or sleighs, according to the weather, while still others avoided the roads altogether when they were moved in boats. The concept of the ambulance also appeared during this period; Mann referred to the "flying machines, called volantes" developed in France during the Napoleonic Wars,41 and Winfield Scott, in that section of his memoirs which concerned the War of 1812 but which was written many years later, actually used the term ambulance.42
The forty-ward general hospital at Burlington, Vermont, with its staff of eight hospital surgeons and mates, had as fine a reputation as any facility in the 9th District. Its site, sixty to seventy feet above the level of the lake and on sandy, well-drained soil, was healthy. Rules requiring high standards of sanitation were firmly established. Floors and walls were kept scrupulously clean with soap and limewater, and all bunks were removed and thoroughly washed when they fell vacant. The straw in each bed sack was removed every two weeks and burned. When the weather permitted, windows were kept open all day; when it was cold, they were opened frequently for short periods of time. Closestools, bedpans, and "urinaries" were removed as soon as used. Although there could be as many as seven hundred to eight hundred patients at Burlington at any one time, infectious diseases did not pose a major problem.43 The responsibility for the good record of the Burlington facility in the first two years of the War of 1812 was shared by two surgeons, Dr. Joseph Lovell, who opened the unit in 1812, and Dr. Walter W. Wheaton, who succeeded Lovell some time in 1813.44
Another general hospital was in operation late in 1813 at Malone, New York, about thirty-one miles from Sackett's Harbor and near the northern border of the state, where General Wilkinson had set up his headquarters. An academy, an arsenal, and two private homes which seem to have been located near the borders of a millstream "surrounded by a fine country of land" were taken over for this purpose. Within ten days, these accommodations, with a total capacity of 250 men, were prepared to house the sick comfortably, each man in his own bed, under the supervision of hospital surgeon Mann, who arrived in December.45
There was at least one general hospital in the vicinity of Sackett's Harbor throughout most of 1813. At Sackett's Harbor itself there was a facility which in 1812 had been occupied by the militia's patients and which was, by the spring of 1813, when Mann first saw it, "in filthy condition." Dr. William Beaumont arrived with his regiment at Sackett's Harbor in March 1813 and joined Mann in reporting the prevalence of respiratory diseases, diarrhea, and intermittent fevers, among the ill there.46 Beaumont described a type of pneumonia characterized by "universal pain in the bones & musseles [sic], cold chills, nausea & pain in the head and breast,-sometimes accompanied with acute local pain in the side, with cough & other evident Pneumonia symptoms" which appeared among his patients.47
General Dearborn, however, believing it impossible to care for the sick within the line of defense at Sackett's Harbor, ordered a temporary hospital established at Watertown, New York, twelve miles from Sackett's Harbor. Within ten days, Mann had prepared accommodations for 100 there and moved the sick into them. Among those so moved were twenty men whose feet had been badly frozen in the course of a march from Plattsburg under Brig. Gen. Zebulon Pike. On 23 April 1813, however, Mann was ordered to leave Watertown and to return to Sackett's Harbor to be ready to accompany the 1,600-man expedition preparing the move against Toronto. A surgeon's mate was left behind at Watertown to care for the patients there.48
It was fortunate that the patients had been
moved away from Sackett's Harbor by April because in May, the British raided the town, killing twenty-two Americans and wounding eighty-four, before being repulsed. By late June 1813, however, when a hospital surgeon was ordered to report there, a general hospital had once again been opened at Sackett's Harbor. A total of three surgeons and five mates seem to have cared for the sick and wounded here during the summer of 1813. By early September, there were 62 in the general hospital here as well as 501 in regimental ones, and conditions remained poor. It was reported that there was little good water available and that the food, particularly the bread, was bad. Great difficulty was being experienced in maintaining standards of camp sanitation because so many of the soldiers were inexperienced, and diarrhea, dysentery, and jaundice afflicted half of those who were acutely ill. The atmosphere was not considered to be healthy, and it was urged that camp be moved to a drier site for winter quarters before autumnal diseases made their appearance in full force.49
Further confusion exists concerning the nature of the facilities in the Fort Niagara-Fort George area. (Map 11) Mann described a tent hospital located two miles east of Fort Niagara where the wounded from the attack on Toronto were cared for beginning on 8 May 1813 and also noted that about two hundred wounded were moved from Fort Niagara to Lewiston in mid-June 1813. It is not clear whether it was from the tent hospital or from a regimental facility that those two hundred came. Despite the fact that it was believed that the wet nature of the area was bringing on fevers and diarrhea, some type of hospital seems to have remained here throughout the summer and into the fall, when it was reported that two-thirds of the sixty-five men the British killed and fourteen of those they wounded in the taking of that fort were hospital patients.50 Whether the hospital referred to in these later documents was still a general hospital rather than a regimental facility is not apparent.
There was also a general hospital at Fort George, which was taken from the British in late May 1813 and held for several months. Although the alternating cold and heat, dryness and dampness here were blamed for the high incidence of typhus, intermittent fever, diarrhea, and dysentery among military and civilian populations alike, the water came in for its share of blame, since it was said to have "a purgative quality." A contributing factor in the high disease rate, in Mann's opinion, however, "was the effluvia from the sinks [latrines]," which filled the air with a heavy stench even when the "sinks" were covered with earth every day.51
In June, some of the patients at Fort George were also moved to the higher, healthier facility at Lewiston. By August, however, more than one-third of the men still there were sick and, with half the medi-
cal staff too ill to work, only three surgeons and four mates were available to care for six hundred to seven hundred patients. Hospital stores were running short by September when Mann decided to move the general hospital from Fort George to a site near Buffalo and to send all 100 invalids ready for discharge with a surgeon's mate from Fort George to Greenbush.52
It was in May 1813 that a unit Mann described as a flying hospital was opened at Lewiston in two barns and a number of hospital tents which were located about seventy feet above water level. Initially the staff there appears to have consisted of Mann and four hospital mates, who were expected to care for as many as six hundred to seven hundred patients or more, among them the wounded from the garrison hospital at Newark, near Fort George, who were moved to Lewiston in June. Later, however, two of the mates were ordered to Fort George, leaving Lewiston severely understaffed. Mann was able to obtain a sufficient number of bunks and bed sacks for this unit to assign one to each patient and located a good supply of milk for his patients.53
By the end of September 1813, the weather along the Niagara had become "very pleasant, and the troops generally more healthy." The convalescents at Lewiston were put on light duty and they did so well that only three experienced significant relapses. When his army left the area, General Wilkinson ordered that those not strong enough for the march be sent to Lewiston and that Mann locate winter quarters for them which would be secure from the enemy. Since, with the arrival of colder weather, the sick in the tents became uncomfortable and some developed pneumonia, Mann concluded that, although the Lewiston unit had earned an excellent reputation, it should now be abandoned. There does, however, seem to have been a hospital operating at Lewiston again in the summer of 1814.54
Although typhus and diarrhea had been a problem in Lewiston in 1813, Mann observed that wounds seemed to heal more quickly there than at other hospitals in the area, a fact he attributed in part to the healthy site. Of the 950 to 1,000 men cared for there, 59 died, with half of these deaths occurring within a three-week period in one sixty-man ward. Mann concluded that this tragedy had been caused by "an imprudent and injudicious administration of tartrite of antimony."55
When Mann broke up the Lewiston hospital, he sent approximately 100 of the strongest of his patients there to Greenbush also, but 250 others were sent to Williamsville, the site he had chosen near Buffalo. They were taken first in wagons from Lewiston to Fort Schlosser, where they boarded boats to travel to Black Rock. Before they could disembark into the wagons which took them the final forty miles to Williamsville, however, a sudden rainstorm and wind arose and some of the hospital stores and baggage were lost. Six "of the most enfeebled" patients died on the way.56
The hospital at Williamsville was located in an extensive barracks which had been renovated for use as a hospital. Since some of the men brought to this facility lacked adequate clothing, it was doubly fortunate that it was possible here to keep the rooms warm. Only six men were assigned to each ward, the rooms were easy to keep clean, and the patients tended to recover their health quickly. Having settled his patients in Williamsville's wholesome accommodations, Mann set out to join General Wilkinson at his winter camp at Malone, leaving surgeon's mate Joshua Whitridge, a physician whose "services . . . cannot be too highly appreciated," in charge. It seems probable that this facility, too, was closed at some time in the winter of 1813-14 or the spring of 1814.57
The regimental surgeons and mates of the units in the North also established their own hospitals or infirmaries. Beaumont described
one aspect of the work of a regimental surgeon in his account of the attack upon Toronto in the spring of 1813, when the explosion of an ammunition dump caused American casualties in excess of 300, 109 of whom came from his regiment, including 65 deaths. "Wading in blood," he personally operated on fifty patients in a two-day period. "Their wounds were of the worst kind, compd fractures of legs, thighs, & arms and fractures of Sculls." "I cut and slashed for 48 hours, without food or sleep--My God! who can think of the shocking scene, where his fellow creatures lye mashed & mangled in evry part with a leg--an Arm--a head, or a body ground in pieces." Although Beaumont performed his operations at Toronto, some surgeons seem to have worked on board ships of the American Great Lakes squadron.58
The patients at Toronto were placed on a boat when it was time to evacuate them, but for several days bad weather kept the vessel in harbor. The men were not removed, however, and they spent a total of eight days on board, including the single day required for the voyage itself. They were so crowded that the surgeons could not effectively care for them. Although his wound was slight, one man died, apparently of suffocation in the close quarters. Diarrhea and dysentery also began to make inroads among his patients, but Beaumont commented that they survived in better condition than he would have expected under the circumstances. After their evacuation from Toronto, these casualties were hospitalized first at Newark and late in June were moved to Lewiston.59
After the unsuccessful attempt on Montreal in the fall of 1813, General Hampton was criticized for his handling of his wounded, who were reportedly "very much neglected, as far as regards comfortable quarters and transportation and . . . were strewed along the roads through which we marched, without care or attendance." General Wilkinson's wounded, however, received the benefit of organized care during the winter of 1813-14 after they arrived at winter camp. A regimental hospital was established at French Mills, in northern New York, sixteen miles from General Wilkinson's headquarters at Malone. Nevertheless, the patients here had to endure shortages of hospital stores and medicines and a poor diet, as well as the rigors of the weather, since they were for a short time sheltered in tents, the two houses taken over for their use being too small to shelter all the sick and wounded. The shortage of bedding required that some patients lie upon straw on the floor. The available blankets were of an inferior quality, and by early December, shirts for the patients had not yet been received. The port wine was reportedly not pure, the chocolate was so poor as to be inedible,60 and the flour was "so sour and damaged, as to prove unhealthy." The bread his men ate, according to General Wilkinson, contained lime, soap, "and other extraneous and even feculent ingredients." The water used in making the bread seems to have been at the root of the problem, since it was "impregnated with, and contains a diffusion of excrementitious matter."61 Sick and death rates were high in one instance; 75 men of a 160-man unit were ill, 39 with diarrhea and dysentery, 18 with pneumonia, 6 with typhus, and 12 with "paralysis of all the extremities."62
From June 1812, when war was declared, to June 1813, when Tilton was appointed Physician and Surgeon General of the Medical Department, the medical support of the Army continued to be, for all practical purposes, entirely in the hands of individual surgeons. The creation of the office of the Physician and Surgeon General, however, put Tilton in a position to assign and reassign surgeons, surgeon's mates, and hospital attendants on the basis of the overall need of the service and with due consideration for the skills and experience of the personnel of the Medical Department as a group. In the Northwest, slow communica-
tion and transportation made it impossible for any significant effects of the new organization to be felt in the period of scarcely a year remaining after Tilton's appointment before the end of the campaign season of 1813-14. In the Northeast, however, the benefits of centralization could be seen even in this short period of time in the sending of Mann, who had personally established an efficient hospital out of the chaos he found at Greenbush, to help his less experienced colleagues with the management of other hospitals caring for war casualties in upstate New York and New England.