Dr Benjamin Church Jr Takes Control of the Continental Army Hospital -III

    At this point it would help to once again quote a portion of Dr Church's letter to Samuel Adams  giving his version of his actions upon assuming his position as Director General of the Hospital.


Continental Hospital, Cambridge, Aug 23,1775

 Honoured & dear Sir!

Accept my most sincere acknowledgements for the honour and favour of my late appointment., derived from you my Friend! and the rest of that august body, for whom (abstracted from Self-Consideration) I have ever felt the warmest Devotion, the most heart-felt Reverence: the most acceptable Expressions of my Gratitude, I am assured will be a zealous Application of myself to discharge the important Duties of my Commission. 

  An acquaintance with the economy of Hospitals derived from a Residence of almost three years in the London Hospitals, made the Task before me very acceptable, but I confess the extreme Disorders in which I found matters upon a closer scrutiny, rendered the attempt to effect a Change a very formidable One; a total Revolution was necessary, to fix upon any Principles at all: there existed near 30 Hospitals, each distinct and independent, and some of them under the Guidance and uncontrouled Jurisdiction of Surgeons who had never seen an Hospital; the demands yon the Commissary General and Quarter-master were so extremely frequent and rapid that they informed me, the Expense of supplies for the Surgeons exceeded all the other Expenses of the Army: a matter so ruinous to the Cause demanded, an instant remedy.

I immediately procured two good Houses in Cambridge, the one already improved as a Colony Hospital, the other a regimental sick-House, a perfect sink of Putrescence, filth and Disease; to these I have since found it necessary to add a third viz the House of the fugitive Judge Lea,

I found little difficulty with the Surgeons of this Colony, for having examined and appointed them, they considered me in the light of a Master or Director before, and readily conceded to my Orders; but I have had much difficulty with my Brethren of Connecticut &c, they viewed themselves as Lords of their little Dominions; each Surgeon had his Hospital, to which the officers submitted as matters of Right, already established by uninterrupted usage, and hugged as a Benefice by each distinct, some Surgeons divided the Regiments with their Col'., their Orders were undisputed at the publick stores: The Officers indeed groaned that Diseases became so grassant, the Committee of Supplies and the Commissary groaned with good Reason that they should never be able to answer the Demands.

a cabal has been formed against me, which now exists in a crumbling situation, I still persevere in demolishing these little Pagoda's, and altho much Art and much malice  have been exercised to discredit the American Hospital, it is now arrived to such a degree of reputation that the Soldiers bless the happy Institution, and several of the Regimental Surgeons are soliciting mates Birth, at the loss of 30/pr Month, to improve themselves in the Practice of the Hospital.

We have now 200 Patients in three Houses, which go under the Denomination of Washington's Hospital, Lee's Hospital and Putnam's Hospital.[illegible] to the Brigade on this Quarter. We have likewise three Houses at Brookline to accommodate Roxbury Camp in which are 170 Patients, but these I am reducing to 2 Houses Loring's and Barnard's which I shall call Ward's Hospital and St Thomas's Hospital in honour of the two Generals on that Quarter.

I should be happy could every purpose be effected agreeable to the Disposition of Offices made by the Honle Congress, with the Allowance annexed to sundry of them. The number of Surgeons I apprehend must be enlarged  to three more.

The Houses at Cambridge now improved for Hospitals are most advantageously situated to accommodate the Camps on Prospect Hill, Mystick, &c. And in the course of two days by which time I hope to compleat the Number of Beds & Slaw bunks [ some type of a bunk bed with straw as near as I can determine], will be filled and will contain about 240 Patients with their proper number of attendants. These Hospitals are not only insufficient to hold all the sick of both Camps, but they are so remote from Roxbury being 6 miles at least, that in many Cases it would be greatly inconvenient, and in case of an Engagement totally impracticable to remove the wounded men so far;

the Houses lately the property of Barnard and Loring are already made use of for the sick, stand very conveniently, and are sufficiently elevated & capacious these will accommodate the Camp at Roxbury, and the disposition of the Surgeons could stand thus: [Church names his seven surgeons] 

I must entreat your Indulgence to mention one or two other matters - the sick thicken upon us so rapidly, that we are obliged to send the Recovering Men too early to the Camps; being obliged to do duty immediately, and being thereby exposed to all Weathers in their weak state, they frequently relapse; 4 out of 5 generally return to the Hospital within a Week after their Dismission. An Airing house, or as 'tis usually called a Convalescent Hospital is a wise and salutary Provision; here the Patients upon their recovery ought to be sent, to be kept upon a half-Diet and tonic medicines, till they have recovered such a degree of firmness, as to be able to do their duty in Camp without hazard - these Houses require nothing more than a good careful Mate or two to attend them, and to be daily visited by the Hospital Physician.........

I must here renew my solicitation to be supplied with Medicines, I will particularly attend to eke out the few on hand, to prevent distress for want of medicines before the rest arrive. 3 lb of Ipecac is our whole stock, for 400 sick men, and great part of them Dysenteries, and no more to be obtained this way. Tow-Cloth for Beds I am much embarrassed for, the stores are exhausted and none can procure as yet elsewhere....

  

 The friction between the regimental surgeons and Dr Church continued. At the end August and the beginning of September 1775, Church actually thought that the tensions were easing because several regimental surgeons, being attracted by the educational opportunities in the reorganized hospitals, were accepting appointments as hospital mates at a 30 % reduction in pay. But then the frictions between the Army Hospital, headed by Church, and the regimental surgeons reached Washington.

George Washington By John Trumbull

1780

Washington reacted to this on September 7,1775 expressing his desire to have "the utmost care taken of the sick (wherever placed and in every stage of their disorder)" but at the same time announcing his determination "not to suffer any impositions upon the publick." He then ordered his brigadier-generals, with their regimental commanding officers, to sit as a court of inquiry, and directed that they summon Dr Church and the regimental surgeons before them, investigate the matter, and report back to him. Dr Church would have to face six separate courts of inquiry. Courts composed of regimental commanders who appointed the regimental surgeons. Men who were not only from the same colony or even town but who were in the closest units in the armies, the regiments. Washington revealed his organizational concept of the medical service by stating that "when a soldier is so sick that it is not safe or proper for him to remain in camp, he should be sent to the General Hospital," Further, he declared that "there is no need of regimental hospitals...when there is a General Hospital so near, and so well appointed." If, as some believe, that this was an attempt by Washington to shore up his Director General, then it sure was a strange way of doing it. But Washington, at this point, was not the Washington that emerged  at the end of the war. At this point, he was a new Commander, commanding units in a colony hundreds of miles away from Virginia with subordinates whom he hardly knew and, frankly, with New England troops that he found rather repulsive.

   Dr Church must have been furious when he learned of Washington's decision to hold these courts of inquiry. He would have to appear, in person, in front of  men with whom he had little in common and who he, undoubtedly considered his intellectual, social, and professional inferiors and justify his actions, even though he had been appointed by the Continental Congress to the position as the Director General of the Hospital.

   We do not have a single shred of evidence as to what Washington thought of Church at this point or, indeed what Church thought of Washington. But one would imagine that the Harvard educated, London trained Doctor, a brilliant, renowned  poet, polemicist, satirist, scion of a distinguished New England family, with a long record of Whig activity, and the self-educated, ruthlessly ambitious Virginia planter, land speculator, and surveyor had little in common.

   The first court of inquiry was held by Brigadier General John Sullivan of New Hampshire on September 13, 1775. Regimental surgeons complained to the court that the general hospital denied them the drugs they demanded. Gen Sullivan protested that his wounded were being moved three to four miles to Cambridge to have their wounds dressed while his regimental surgeons remained idle. Sullivan complained:

Are the Dolorous Groans of the Disconsolate, agreeable to any human ear - That they should be still increas's by Dragging our sick...in Waggon Loads to Cambridge? Humanity shudders at the Prospect."
   
  Sullivan insisted that fully half of the patients ordered by Church to the general hospitals refused to go.

   "Declaring that they would rather Die where they were and under the care of those Physicians they were acquainted with."

   Sullivan concluded that since the enlistments in the Continental Army were for only one year that Church's policies would so affect morale that soldiers would not reenlist.

   We do not know how Dr Church responded to General Sullivan's accusations but he, apparently believed that matters were concluded in his favor since he sent the following letter to Gen Sullivan the very next day. It is quintessential Church:

American Hospital                                September 14, 1775

  Dr. Church presents his most respectful compliments and most heartily felicitates himself on receiving so honorary a testimonial of General Sullivan's approbation, as he met with the last evening at Headquarters. The Doctor esteems himself peculiarly happy that the undeserved prejudice against him is so totally removed which from frequent intimations he was apprehensive had possessed the general's mind. He flatters himself that his whole conduct, during the present unhappy conduct, will bear the strictest scrutiny. A regard to place, popularity, or the more detestable motive of avarice never influenced his conduct in publick life. The sole object of his pursuit, the first wish of his heart, was ever the salvation of his country.

The Doctor, nevertheless, in Justice to himself, and with respect to the man behind the curtain has influenced and took the lead in the opposition to him, must declare that although he could never stoop to act the parasite, play the buffoon, or become the herald of his own eminence in his own profession would feel the indignation of conscious merit should be put in competition with the person who vainly endeavours to supplant him.

         Hon General Sullivan


   Dr Church also alluded to a someone plotting to replace him in his letter to Samuel Adams. That he would mention it so openly in his letter to Gen Sullivan is an indication that there is substance to his belief. One gets the impression that General Sullivan knew who this person was. There is no definitive evidence just who this person might have been, but a reasonable suspicion could be placed on Dr Issac Foster of Massachusetts , one of the surgeons Dr Church hired to attend at the Cambridge Hospital.  (See my post on the surgeons hired by Dr Church.). It is known that when Church was later replaced by Dr John Morgan of Philadelphia, Dr Foster and Lt Col Hand, a physician serving as a line officer in a Pennsylvania rifle battalion were competitors for the appointment. Foster was actually appointed to serve temporarily in Church's place after he was removed by Washington.

  The inquiry at Sullivan's brigade was followed by inquiries at Gen Greene's and Gen Heath's brigade. We have no information as to what transpired during these two hearings, but within a few days, Church apparently took leave to visit his family.

   The next record we have is of Church writing a letter dated 20 September 1775 to Washington requesting release from his position as Director General of the Hospital. I have not been able to discover a copy or the original of this letter. We know about it because of a letter written by Horatio Gates, Washington's Adjutant General, to Church.

Cambridge September 24, 1775

          To Doctor Church:

           Sir: I am directed by his Excellency the General to inform you that his unwillingness to part with a good officer alone prevents his complying with your request, in your letter of the 20th instant. He desires you would stay with your family some time longer, and if there then is no prospect of its being in such a situation as to permit you to return to your duty, you will  receive a discharge pursuant to your letter.
           Horatio Gates, Adjutant-General

    Dr Church's wife and children are believed to have been residing with family friends in South-Eastern Massachusetts at this time so it is reasonable to assume he was there when he wrote this letter. We do not know what reasons(s) he may have given for his resignation but we do know that in later correspondence Dr Church said that he fell ill at this time. The precise nature of his illness is not known. In any event Dr Church returned to Cambridge to resume his duties and complete the series of Brigade inquiries into the hospital situation ordered by Washington. The inquiry at General Frye's brigade was held on September 24th so Church must have been back in camp by then. An inquiry in General Thomas' Brigade was scheduled for the 29th. That inquiry may never have been conducted since General Nathaniel Greene arrived in camp on 26th September with some earth shattering information.

   So on Saturday, September 30, 1775, the following order was issued:

     A Court of Inquiry ordered to sit this day in Brigadier-General Spencer's Brigade in relation to the dispute between the Director-General of the Hospital and the Regimental Surgeons is, on account of the indisposition of Dr. church, to be postponed until further notice. 

       

 

Dr Benjamin Church Jr Takes Charge as Director of the Continental Army Hospital - II

As we have noted previously, upon assuming his duties as the Director, Dr. Church recruited surgeons who met his rather strict conditions for competence, moved to consolidate hospitals, and ordered regimental surgeons to send their patients, unless their ailments were minor, to these hospitals. Massachusetts surgeons generally cooperated with Church but surgeons from other colonies did not. This opposition is something that anyone appointed as Director General, no matter who, would have faced.

 There would be natural opposition not only to a colony's belief that its political authority was being usurped and that a colony's soldiers where being attended by surgeons from another colony, but there was also a philosophical dispute involved. Many believed that a smaller hospital established to care for the sick and wounded of a four to five hundred man regiment was less hazardous to the health of its patients than a large hospital. It is also only natural that soldiers felt more secure and confident when cared for by their own doctors among the men of their own units. These were militia units composed of men who cam from the same town or area and had not traveled much beyond their towns. General Hospitals, on the other hand, were believed to be more efficient and to have better staffs since regimental surgeons and mates were a motley crew named by their respective colonels and competence as a surgeon may not have been a prerequisite for their appointment.

   Church believed that, upon examination, the costs of running the regimental hospitals were extremely high and came to believe that "inexcusable neglect" on the part of regimental surgeons was the reason for these high costs. Therefore, he directed that patients be moved to general hospitals rather than have medicines issued to regimental surgeons for treatment of their patients.

Plan of the town of Boston and Environs 1775.

   Church also wished to take advantage of the fact that there were already excellent general hospitals, one at Cambridge and one at Roxbury, already in existence. The Cambridge General Hospital was the larger and more important of the two since it was more centrally located.. (For a discussion of the Continental Army Hospital complex in August 1775, see my Oct 6, 2015 blog post.) Church immediately incorporated these two hospital complexes into the new Continental Army Hospital Department.

   One of Dr Church's innovations was to designate one building at Cambridge and one building at Roxbury as a convalescent hospital/barracks. Church noticed that the rapid increase in the number of sick had overstrained the hospital's resources and, as a result, physicians were sending patients back to the lines too quickly thus contributing to a high rate of relapse. In the convalescent wards, patients recuperated on a regimen of rest, diet, and large doses of tonic medications until they were strong enough to return to active duty. This resulted in a marked decline in the number of relapses. These convalescent barracks were entrusted to the supervision of a hospital mate rather than a surgeon; however, one or more surgeons visited each day.

   Church succeeded in getting Washington's cooperation in regulating the visiting of the sick in the two hospital complexes. An August 22,1775 general order asserted that no private or non-commissioned officer was to visit patients in the two hospitals without the permission of the attending surgeon or a written pass from the commanding officer of the regiment. This was an attempt to put a stop to the highly popular practice of unregulated visits to the sick that had been a major source of contagion and had disrupted the hospitals' routine as well as the recovery of the patients. Washington backed up this order with the following:

A Serjeant, Corporal & nine Men, to mount Guard to morrow morning, at Mr Fainweathers House, lately converted into an Hospital. The Serjt to receive his Orders from Dr Church, Director of the Hospital.

   Church's success in organizing and administering the two hospital complexes and in combating the spread of disease was offset by his failure to solve two very difficult problems he had inherited - obtaining sufficient medical stores and regulating the anarchic and wasteful practices of the regimental surgeons. The problem of obtaining supplies, most of which had to be imported, was a serious one throughout the siege of Boston. There was no shortage, however, of largely useless patent medicines, most of them imported for the newspapers of Eastern Massachusetts and Rhode Island were full of advertisements for these products.

   There were limited supplies of vital medicines in nearby Connecticut and Rhode Island but, for some reason, these were not purchased by the Continental Army. The need for medicines after Bunker Hill was acute and the regimental commanders and surgeons put great pressure on Andrew Craigie, the medical commissary and apothecary of the Massachusetts Army. Craigie is a rather interesting character about whose efforts in 1775 and 1776  little is known.  In any event, the problem of obtaining medicines was transferred from Craigie to Church in his new position as Hospital Director. Church then turned around and appointed Craigie as the Hospital apothecary with the very able John Brown Cutting as Craigie's assistant.

Vassall-Craigie-Longfellow House

(Craigie is a fascinating and a rather shady character who made fortunes, lost them and, in his later years, lived in Cambridge as a virtual recluse to avoid debtors prison. After his death, his widow had to take in boarders, one of whom was Henry Wadsworth Longfellow who later obtained the house as a marriage gift. It's the same house that George Washington used as his HQs in Cambridge.)

   An illustration of just how serious the medical supply problem  is demonstrated by the fact that, in late August 1775, when several hundred soldiers were diagnosed with highly contagious dysentery, the hospital at Cambridge had, on hand, only three pounds of ipecac, an essential ingredient of Dover's Powder, the chief remedy than employed against that disease. There was a severe shortage of such basic items as old linens for bandages and compresses, tapes, threads, needles, adhesive plaster, blankets, sheets, and pillows. Surgical instruments were desperately needed but in short supply.

Dr Samuel Stringer

   As if Church didn't have enough problems, the Continental Congress added to them when, in September 1775, 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 not comparable to that of Church but to that of a surgeon. Although Church was clearly supreme in Cambridge, the Congress had failed to define either the relationship of the new department in the north, to be located in Albany, to the Hospital Director in Cambridge or Stringer's position in the chain of command. It just was not clear if Stringer was subordinate to Church or precisely what the chain of command was. This would create serious problems in the future for Church's successors but, for now Church had more immediate problems.

   At the end of August Church began to face an open revolt from the Regimental Surgeons against his efforts at reform. He began to face an organized resistance. Church believed that the soldiers appreciated the advantages of the general hospitals. 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."

   The opposition from the Regimental Surgeons continued until Brigadier General John Sullivan of New Hampshire got involved. Gen Sullivan had a very long and somewhat controversial career

during and after the Revolutionary War, but in September 1775, he was a 35 year old successful lawyer and mill operator from New Hampshire who was elected a delegate from New Hampshire to the Second Continental Congress. Although he had been a Major in the New Hampshire Militia and was an active Whig, Sullivan had no real military experience. He did lead the assault party that managed to seize 16 cannon, powder, and small arms from the King's Armory stored in Fort William and Mary in Portsmouth Harbor. Surely a rebellious and  treasonous act for which Sullivan was hardly repentant.Yet, in June 1775, the Continental Congress appointed him as a Brigadier General in the Continental Army.

 
         
                                                    To Be Continued

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