Wednesday, October 26, 2016

Dr Benjamin Church Jr. Takes Charge as Director General of the Continental Army Hospital - I

     The appointment as Director General of the Continental Army Hospital must have come as a huge relief to Dr. Church. The battles of Lexington and Concord had effectively marooned him outside of Boston where he continued to play a major role in the rebellion as a delegate to the Massachusetts Provincial Congress, member of the Committee of Safety and many other important committees, but had completely destroyed his ability to practice medicine, his one source of income, as far as we know.  By the time of his appointment, he had had no income from his medical practice for over three months, yet he had considerable expenses, to include a wife and children, forced out of Boston,  now living with friends in south-eastern Massachusetts. The salary as Director General must have been most welcome.
George Washington Warrant Book Showing a Payment of $1000
 to Benjamin Church on August 26,1775.

    I have previously quoted Dr Church's rather long August 23, 1775 letter to Samuel Adams setting forth the steps he took to bring order out of the chaos he found when he assumed control of the Continental Army Hospital in Cambridge in late July 1775. And just what was the situation he inherited? Upon assuming command in the first week of July, 1775, Washington found the 17,000 officers and men of the Continental Army scattered in a disorganized fashion through several camps. He quickly asserted his authority and brought some some order into this chaos. There was a severe shortage of clothing and shelter, which Washington had some success in addressing. A far greater menace, however, was the health of the Army; for the Continental Army besieging Boston was a very dirty, filthy army. The soldiers were so dirty that Washington lamented  the "odious reputation, which (with but too much reason) has stigmatized the character of the American troops." Why was this so? The Continental troops were a collection of ordinary citizens temporarily organized into a loose military force. Unlike most eighteenth century armies, they had no women about their camps to do the cooking, cleaning, sewing, or to provide an incentive for cleanliness. The troops lived in crowded quarters and suffered from a shortage of fuel and extra clothing. (One wonders how Samuel and John Adams would have reacted to camp followers in the army beseiging Boston.)

   Washington's continuous efforts to induce sanitation and personal cleanliness did bring about a slight improvement but the Continental Army continued to deserve its "odious reputation" as a dirty organization. This was particularly true in two unsanitary practices. One was the continued use of unskilled and dirty cooks who not only prepared rather indifferent and unhygienic food, but also disposed of their waste and offal without any regard for sanitation. The other was the tendency of soldiers to void themselves almost anywhere, contrary to strict orders  to only use the army's latrine pits. As an example, in August 1775, a Captain lamented that the men besieging Boston were voiding "Excrement about the fields Pernishously ."

   There is no doubt that these practices and the generally low level of sanitation helped to spread the dysentery, typhus, and typhoid that was found in the army during the late summer and fall of 1775. On the other hand, it is rather surprising that given the lack of sanitation, shelter, fuel and clothing amongst the besieging army that these diseases did not rage with far more fierceness. But the low level of sanitation that prevailed undoubtedly contributed to the dysentery epidemic that swept eastern Massachusetts in the fall of 1775.

   Smallpox was a recurring problem in Boston and the surrounding area and it was very much on the mind of Washington and everyone in the Army. That it did not become widespread during the siege is due to the experience and techniques developed over the previous several decades by Boston physicians. Several soldiers did come down with it, but the pox did not spread because it was quickly detected and those infected isolated.

   I will not deal here with the rumors widely believed at the time that General Howe and the British Commanders in Boston deliberately planned to spread smallpox among the Patriots by the manipulation of newly inoculated refugees into Continental Army lines I don't think the evidence is convincing.

Percentage of Continental Rank and File Sick and Wounded on Specific Dates in 1775 During the Siege of Boston.

Date                   Total Rank and File                Total Sick/Wounded             Percent

Jul 3                     16,770                                        1,598                                        9%
July 19                 16,770                                        1,517                                        9%
July 29                 16,898                                        2,020                                       12%
Aug 5                   17,694                                        2,693                                       15%
Aug 24                 19,303                                        3,250                                       17%
Sep 9                   19,532                                        3,014                                       15%
Sep 23                 19,365                                        2,817                                       15%
Oct 17                  19,497                                        2,428                                       12%
Nov 6                   19,404                                        2,162                                       11%
Dec 30                 16,768                                        1,748                                       10%

   As one can see from the above chart, the situation of the sick and wounded in the army besieging Boston changed abruptly in late July and early August. Between July 19 and July 29, the percentage of sick and wounded jumped by one-third from 9 to 12% and by August 24, it was 17%, nearly twice what it had been a month before. Diarrhea, dysentery, and typhoid-typhus now plagued the army. Fortunately their effect was fairly mild. Several elements account for the rapid increase. First, during late summer and fall in most eighteenth century armies, the number of sick was usually at its peak. Second, the poor hygienic conditions and overcrowded conditions that had existed in the camps from the beginning of the siege for diseases such as dysentery and typhoid-typhus are closely associated with cramped quarters and uncleanliness. A third factor may have been the arrival in late July and
early August of the tough, undisciplined, and unsanitary riflemen from Maryland, Pennsylvania, and Virginia. Still another possible factor was the exodus to Chelsea in early August of a number of refugees from Boston. Typhoid-typhus had been active in Boston prior to Lexington/Concord.  It is not certain the the British Army and the civilians in besieged Boston were suffering from typhoid-typhus in early August, but they were ravaged by diarrhea and dysentery. It could be that British Army reinforcements from Europe brought more typhoid-typhus with them. Refugees carrying these ailments could have easily passed through the guard at Chelsea.

   And finally, another cause for the rapid rise in the sick returns may be found in this passage from General Orders of August 8,1775.

As the number of absent Sick by the last returns, are astonishingly great, it is ordered that the Names of each man (absent under that pretence) be given in by the Commanding Officer of each Regiment, and signed by him; setting forth the Town which each particular Soldier is gone to, that the Committee therof may be applied to, to inspect into the Nature of their complaints, and to make report of those, who are fit for duty. It has been intimated to the General, that some Officers, under pretence of giving Furloughs to Men, recovering from Sickness, send them to work upon their Farms, for their own private Emoulument,at the same time the public is taxed with their pay, if not with their provisions. 
    It appears also that some regimental surgeons  were selling recommendations for furloughs and discharge.

   In September, the number of sick in the Continental Army turned downward. Between September 2 and November 6, the the percentage of sick dropped from 17 to 11 percent, where it remained until the end of the year. But although the number of sick declined, the virulence of the diseases suffered increased. Dysentery and typhoid-typhus were the most prevalent diseases but jaundice was becoming more frequent. Dysentery had long been the scourge of New England and the colonial militia. It had been widespread in Boston since early July. A little later it appeared in the Continental Army's dirty and over-crowded camps where, at first it was apparently mild in effect. In September it increased considerably in intensity and remained that way through the fall. A far more deadly epidemic of dysentery ravaged the towns of Eastern Massachusetts from late August until late October., when it abated, only to be followed by sporadic outbreaks of jaundice, scarlet fever and rheumatism.

   Dysentery (Bloody Flux)  was very difficult to treat by a physician in this time period and home remedies for it were widely published. One called for the ingestion of liquefied salt free butter and another called for the ingestion of equal measures of molasses, rum and sweet oil warmed over a low heat taking a spoonful every hour or two.

   This is the background as Dr. Benjamin Church, Jr became Director General, probably in the first week of August 1775, of the Continental Army Hospital. The siege of Boston was in its fourth month and Washington had been directing it for about a month. The medical situation was deteriorating, the number of sick was rapidly increasing, and medical supplies were critically short. The vast majority of doctors ministering to the needs of the Continental Army were suffering from a serious lack of direction and unity and were not accustomed to receiving direction or taking orders from a central authority. They saw themselves as members of their state militia first. ( One study avers that the average of these regimental surgeons was below 25 years of age. ) Patients were being treated in some thirty hospitals of varying quality and size.with no attempt made  to separate those with contagious diseases from the wounded. Visitors were allowed unlimited access to patients, and there were no regulations to supervise conduct.

    When Church took over, soldiers of the various colonial regiments were being cared for in about thirty hospitals, a great number of which were in wretched condition under the management of surgeons who had little idea of what they were doing. Church recruited surgeons who met his rather strict conditions for competence, moved to consolidate hospitals, ordered regimental surgeons to send their patients, unless their ailments were minor, to these hospitals. Massachusetts surgeons generally cooperated with Church but those surgeons from other colonies did not. This opposition is something that anyone appointed as Director General, no matter whom, would have faced.

To Be Continued