rgp ■Mwwjwy^Mjjyy' ■$vz "&&£ y-C ;":''■■■■•■ If.. 1'.' ,.-**«*<**•/ ECONOMICAL OBSERVATIONS MILITARY HOSPITALS; /£***<> ^ AND THE PREVENTION AND CURE OF DISEASES INCIDENT TO AN ARMY, dP^l/T t^t^C** IN THREE PJRTSt ADDRESSED S, TO MINISTERS OF STATE AND LEGISLATURES.. II. TO COMMANDING OFFICERS, HI. TO THE MEDICAL STAFI, Br JAMES TILTON, M. D. r-arsiciAN and surgeon in the revolu&ohajw armt OF o'k the right whereof he claim- as proprietor, in the word9 following, to wit : " Q£co. nomical observations on Military Hospitals and the prevention and cure of diseases incident to an army, ^v In threes^feris. Addressed * 1st to Ministers of StaU ^. *4 * *atW Legislatures. 2d To commanding officers. 3d To the Medical staff. By James Tilton, M. D. Physician ■/ >.\ and Surgeon in the Revolutionary Army.of the United ' States." In conformity to the act of Congress of the United States, entitled " An act for the encouragement of learning, by securing the copies of Maps, Chart; and Books to the authors and proprietors of such copies during the times therein mentioned," and also to ihc act entitled " An act supplementary to an act entitled an act for the encouragement of learning by securing the copies of Maps, Charts and Books to the authors and proprietors of such copies during the times the: tin mentioned and extending the benefits thereof to the arts of designing, engraving and etching historical and •ther prints." A. JOHNS, C. D. C. D. B. TO GENERAL JOHN ARMSTRONG, SECRETARY OF WAR: SIR, Although I have not the honor of a personal acquaintance with you, I am sufficiently acquainted with your character to know that you are a competent judge of the following essay ; and that your official station puts it very much in your power to extend its usefulness, according to its merits. Permit me, therefore, to recommend it to your patronage so far as you may deem it of public utility. And be assured that I am, with great respect for your talents as a man and your virtues as a citizen, Sir, Your most obedient servant, . T^C^Or^ wt*~ \#- ,\ <>m oVm**. *\«* \^V* A ■.» PREFACE. Ekperieuck is said to be the best of teachers ; and our own is belter than that of other people, I nave, therefore thought it matter of serious regret, that no one has hitherto publicly communicated his remarks upon the conduci and success of the military hospitals of our revolutionary army. Having lon-g waited in fruitiest expectation, from abler hands, I have resolved at least to introduce the subject. As another war hat commenced, the public in general, as well as the army in particular, must be deeply interested, in a recollec- tion of what lias passed. My feeble essay may serve at least as an example and stimulus to those better qualified for the task. The first part of this work, or that addressed to t ministers of state and legislatures, was written A. D. ■ 1781, at a time of general reform in the army. It was , laid before the medical committee of Congress, of , which Governeur Morris was chairman, and likewise presented to the financier, Robert Morris, Esq* who waa called upon, by Congress, to report upon the me- dical, in common with other departments of the army. Both the chairman of the medical committee and the financier expressed an entire approbation of my obser- vations. Nevertheless, the financier, before he would act upon them, in his report, thought it adviseable to have them impugned by three respectable physicians i of Philadelphia, viz. Doctors Jones, Hutchinson and ■ Clurkton. These gentlemen, by their report, sane- « tioned the whole of my theory ; and only advised some ' trivial alteration, in the plan ef arrangement, as to the mode of appointing stewards, and in recommending eight hospital surgeons only, instead of thirteen, which I had proposed. I have conformed, in this publication, to their modes of appointing stewards ; but am still 6f opinion, that one hospital surgeon, to evrr? rntijor general s command, is a good proportion : more es- pecially when it i« taktn into cousidtration, tbet in all ■wars, the whole force of th« United States, must be divided intosev»ra! armies, stationed at different points, for the defence and protection of a widely extended] continent. I have every reason to think the medical commit- tee »rrd financier employed their joint influence te have VI the principles and plan 1 had suggested, adopted by Congress. Great reforms were made, and the number of prescribing surgeons were reduced to thirteen. But it was impossible to overcome entirely the influence of , interested individuals. The medical board, intended , as che base of the whole system, was never instituted ; i more than one physician general was retained ; and • the flying hospital remained a kind of separate depart- ment, to the end of the war. Nevertheless, the success of the hospitals was much improved ; there was more ■responsibility, and the prescribing surgeons had reason to expect all the credit of their successful endeavo rs. I have therefore reason to be well satisfied with this first part. It was written after five years strvice, and in the midst of official duties, observations and en- quiries, that gave me a full comprehension of the sub- ject. It has also been scanned and approved by thoss best qualified to judge of its merits. And I may rea- sonably expect, it will now meet with a faxorable re- ception from the public But the two last parts, or those addressed to com- manding officers and the medical staff, may require apology. They were hastily written, in the course of a few leisure evenings, this winter, 1813, thirty years after my derangement from Ihe service, and Avilh very few documents to assist cie, excepting such as relate merely to time and place. However imperfect, I hope they will be considered as well intended. My medical brethren particularly will have it in their power to 6tip. ply all defects, by faither observations. My observations were made in the middle depart- ment with the main army, under the immediate com- mand of the commander in chief. I have had no means of comparing them with what passed in the northern or eastern department of our army. Hut my friend, doct. George Monro, who was kind enough to revise these sheets before they went to press, assures me, that my i;m#iks correspond correctly with what happened in lit southern department, where he served &eveial years. He alledg«■ s, however, that they made less use oi g-neral hospitals iban we did, that their mudical system was less complex »nd proportionably more successful. This may have been very morn owing to their army being am&lltr, and the period of service at a time vrhta tbj Vll uoops were veteran and reduced to better discipline thau when we commenced the war. It may be observed that I have studied brevity throughout the whole performance ; that instead of giving my readers the trouble of picking a good idea now and then out of a pile of verbage, my object has been to condense important topics wiihin the smallest compass possible ; and that the whole is intended merely as a manuel, vademecum or text book, which every man of laudable ambition, who wishes to enquire into the subjects treated of, may carry in his pocket. m*: ECONOMICAL OBSERVATIONS ON MILITARY HOSPITALS, 8cc. PART I. ADDRESSED IO MINISTERS OF STATE AND LEGISLATURE It is remarkable, that none of the military writers have paid much attention to the regula- tion of military hospitals; and while every other branch of army arrangements is digested into method and system, yet this is still unsettled, different in almost every service, changeable and to be learned at the commencement of every war. Sir John Pringle and Donald Monro seem to be the first writers who have attempted any thing of essential use even to the medical gen- tlemen of an army ; and Dr. Brocklesby is the only author, that I have met with, who has writ- ten on the subject of military hospitals, with a special regard to statesmen and commanding of- ficers. This learned and candid physician was the immediate successor of Sir John Pringle, as principal and head of the medical department, in the British army. He wrote from practical observation, and has given us some general hints that do him great honor. But the good doctor lived under a monarchical 'government, where it was dangerous to give the least offence to favorites; and frankly confesses he was long retarded in his intention of writing, for fear of altercation in the medical department ; and (10) sterns at last to be stinted in his design, rather than risk his own ease and conveniency. I rejoice in the advantage I have over Brock- leshy, in time and place. I'write under a re- publican government, where the first principle of my education, the love of my country, teach- es me to banish every fear, as well as every sel- fish consideration, that can come in competition with the public good ; and at a time of general reform of the army, when I am led to believe, that every honest endeavor will be acceptable to virtuous rulers, and the simple garb of truth will render my style most agreeable. Zeal alone, however, will not render me of • sufficient authority. But, if a diligent applica- tion to all the duties of a prescribing surgeon, for five years, and having served in a regiment as well as the hospital, so to become acquainted with the duties of every station, can, in anywise compensate for moderate abilities and give some weight to my observations, I hope to establish them, by the concurrent remarks of the best authorities : and it will make me extremely happy to succeed so far in my design, as to ren- der it acceptable to Congress and through them • advantageous to the army. It is nowan established maxim, that the direc- tion of the practice and the purveyorship of the . hospitals should be entirely distinct and sepa- rate, in difitrent hands, so as to be a check upon each other. We need not have paid so dear for our instruction upon this head, had the least attention been given to the salutary advice of Dr, IVionro, who expressly says, " the directing an d purveying branches ought never to be en- ! trusted to the same person, as the temptation of accumulating wealth, has, at all times, anj m aE services, given rise to the grosest abuses, winch have been of great detriment to the service, and has occasioned the loss of many lives. And therefore neither the physician general, noranv of the physicians or surgeons of the army, or any other person concerned in the direction of military hospitals, ought ever to act as pin ve\ or or commissary; nor ought they ever to have any thing to do with the accounts, cor.nv.cfcs or any other money affairs relating to the hospi- tal ; and if ever they be found to intermeddle in these affairs, tbey ought to be immediately dis- ?nissed the service. The purveying or eomrni-- sariate branch ought to be entirely distinct from the physical. The purveyors or commissaries ought punctually to obey whatever orders thev receive from the physicians and surg ons, to provide every thing for the hospitals ; and th. ir accounts ought to be controled by such persons as the government may think proper."* It might seem to be unnecess ry to make so long a quotation, in support of a point settleel so longagoasthe beginingofthe campaignof 177S. , But am I not warranted from hence, to suggest , to Congress what Xenophon ranks among the « virtues of Cyrus ; that previous to the wrar, he selected the ablest and most disinterested physi- cians to preconcert proper plans for the manage- ment of the sick ; and after they had performed their task, dismissed them with suitable re- wards? And may I not, consistent with perfect decency and respect, compare the conduct of this wise prince, with the practice of modern Diseases of the army, pa$c 395. ( Y2 J times, when a director general alone (or with the advice of a few interested persons) is called upon to form a plan for conducting the hospi- tals, which he himself is to execute ; in the formation of which, he may be directed entirely from the most salutary methods of curing the sick ; to plans of gain, big with all the fatal consequences mentioned by Dr. Monro? I mention it not with a design to- reflect on any man, that in the fatal year 1777, when the di- rector general had the entire direction of prac- tice in our hospitals, as well as the whole dis- posal of the stores, he was interested in the in- crease of sickness, and the consequent increase of expence, so far at least, as he would be pro- fited by a greater quantity of money passing through his hands. Even at that time he might have done the best he could,, though Congress did not chuse to trust him any longer with the same inordinate powers; and, I trust, will ne- ver again lay any man under the same tempta- tions. But the sole use I wish to make of this ob- servation is, to remind Congress, that notwith- standing the evident impropriety of loading any one man with powers so multiplied and dange- rous in their tendency, yet it was found to be very difficult to arrest any part of them from the director; and even when Congress had or- \ dained the direction of practice and purveyorship to be separated, such was the influence of in- terested men, that the utmost efforts of the pre- scriptive line have never been able to carry it into execution, in the full and complete mrmer intended. And hence I would wish to awaken Congress to further care in establishing this; Heading principle, and especially to excite their attention to several other great out-lines, of no less consequence in the economy of military hospitals, of which I sliall proceed to tak« notice. Having no written instruction as to the pro- portion of sick or subjeets proper for the gene- ral hospital, it is of great importance to attend earefully to such observations relative to this matter, as we are able to collect. The scale of the hospitals seems to be different in differ- ent services-; The French make greater hos- pital provision than the English, and the En- glish than the Germans; yet the French lose more men of camp diseases than the English, and the English than the Germans ; and I may add, the Americans have out-done all their predecessors in the pomp and extravagance of their hospital arrangements, and have surpassed all other nations, in the destruction and havoc thereby committed on their fellow citizens,- It would be shocking to humanity to relate the history of our general hospital, in the years: 1777 and 1778, when it swallowed up at least onehalfof our army, owing to a fatal tendency in the system to throw all the s:ek of the army into the general hospital-; whence crowds, in- fection and consequent mortality too affecting to mention, I doubt not but humanity at first dictated the ample provision made for the sick in general hospitals; but we should learn, from experience, to contract our plan into greater simplicity j and to make it the interest, as well as the duty of all concerned in curing the sick, to send as few as possible to the general hospital. J£ it should be alledged, that for two cam* (H) paigns past, our hospitals have had better suc- cess ; I answer, that since the battle of Mon- mouth, our army has not been so much harrass- ed by hard duty, :s before ; and that the troops being veteran, with better discipline and a va- riety cf other circumstances contributing to good health, the whole sick of the army was not sufficient to crowd the hospitals; and had a proper proportion only of those been attended in hospitals, it would not only have contributed to a still more successful treatment of the sick ; but it would have abated very much of that extravagance, which has ever been a reproach to the department. That no argument may be wanting to shew the propriety of lessening the proportion of sick in the hospitals, and increasing the scale of re- gimental practice, in our army, I am happy to have it in my power to adduce two of the first authorities in Europe, in point as to this matter. Sir John Pringle expects his readers to be surprised, that he should rank the hospitals in- tended for health and preservation, among the chief causes of sickness and death in an army. He elescribes a melancholy scene of infection, whose pestilential influence nothing could sup- press, until, by general orders, the hospitals at Bruges and Ghent were broke up, and the sick distributed, in small parcels, under the care of the regimental surgeons. The doctor candidly acknowledges, this was done fiom the sole mo- tive of frugality ; but that it had the more hap- py effect of preventing any farther infection.* It is notorious that Frederick, king of Prus- * Yidi observations, chap. 3 & 4. (IS) sia made very little use of general hospitals. Wounds and chronic eliseases Were the only cases he suffered to be carried any distance from camp. All accute diseases of his army were treated by the regimental surgeons, or in what he called his field hospitals. And I am told . from good authority,* that it was customary, in the late German war, for the hospital staffof the British army, almost wholly to retire, to Eng- land, during the winter. It woulel appear from what has been said, that the humane and benevolent design of large and extensive hospital accommodations must necessarily be defeated in the execution; that profusion and extravagance serve only to pre- cipitate destruction and ruin, and that econo- my and frugality are necessary to the success of our hospitals. Paradoxical as this may seem to some, it is not the less true. The observa- tion before cited from Sir John Pringle, is pointedly to this purpose. And I appeal to all the experienced officers of our army, if more men have not been lost by death and otherwise wasted, at general hospitals, than by all other contingencies that have hitherto affected the ar- my, not excepting the weapons of the enemy. Is it not, then, high time to contract our plan, more conformable to the Prussian practice be- fore cited ? I hope, from these considerations, whenever Congress shall revise the medical department, they will free it from that complexity which has hitherto contributed very much to crowd the hospitals; and abolishing all separate depar- * Dr. William Brown, one of the physicians general of our army. ( *6 ) tnents and every distinction between 'general and flying hospitals, will arrange the officers of the hospital into one corps, connected with the ar- my, and capable of a uniformity of conduct, in all the armies the government may have occa- sion to employ. The flying hospital being on- ly useful when the army is in the field, should be a temporary institution. In every service, except the American, it is considered as a branch of,the general hospital, under the same common head and managed by the same set of , officers, so as to maintain a reciprocal and com - ' mon interest. It is very different in our army, where a chief physician and all subordinate ar- rangements constitute a flying hospital of per- manent institution and consequently a great ex- travagance ; and creating a distinction of interest between the flying and general hospitals, might in worse hands than at present, be attended with dangerous consequences: for the former may at pleasure and without restraint send all their sick to the latter, and crowd them, regardless of consequences. To give the regiment.il practice weight and efficacy, an honorable appointment and good pay are especially necessary to the surgeons ; and if certain perquisites were to be connected with the practice, such as the service will ad- mit of, a two fold benefit to the army would flow from it. Every surgeon would be prompted from motives of interest, not only to attend such patients as oflcred; but also to excel in skill and success, as the means of obtaining more. Dr. Brocklesby, who lays great stiess on the medical character, says, the surgeon should be considered as the fourth character in a regiment, (17) or next m consequence to the field officers; and to give him that weight and influence necessary to extensive usefulness, he recommends the ut- most care in the manner of appointment. The method he most approves is, by a board of phy- sicians or surgeons of the army, (who are cer- tainly die best judges) and observes that very mischievous consequences ensued to the Bri- tish army, when that salutary method, by some neglect, fell through, and the appointments were made by the surgeon general only. But surgeons of ability, such as are able to pass the scrutiny of a board, cannot be retained in the service, without a valuable consideration, Brock Iesby, after proposing that the surgency should be encreased in value, by the manner of sale and otherwise, concludes with this obser- vation. " Such a competency as 250/. per an- num, in time of peace, would be an inducement, to divest themselves of ambition and to quit the further bustle of a busy world, for the means of a genteel employment, in those paths, into which, from their first out-setting in life, they , had early entered."* In the British service, txcry officer employs what surgeon he pleases and pays for his services. There are also va- rious perquisites to the regimental surgeons, from the private men, which I am not perfectly acquainted with. I will not undertake to sav", what perquisites our army can afford to the sur- geon. Perhaps that had best be lelttosuch a board as follows. .Agreeably to the ideas of Dr. Brocklesby, I would propose the director, or eldest surgeon •Observations, page 43. 2 b (18) in each army -respectively, ivith two or wore bos- pital surgeons to be a medical board, of which a field officer should always sit as president. It should meet statedly once a month and occa- sionally by order, as may be found necessary. They should be authorised to digest rules and carry into execution eveiy thing, relative to the medical department. But no act of theirs should be valid or take effect, until issued in orders, with the consent and approbation of the com* mander. The advantages of such a board are too nu- merous and obvious to require particular men- tion. Congress are too distant and commonly too much engaged to attend to special exigen- . cies of the hospital. This board would be al- ways at hand, and -would have nothing to divert k fro m its proper duty. It would specially pre- vent any misunderstanding between officers of i \ the line and the hospitals, and bring them into that perfect concert and harmony most advanta- j geous to the sick., , By common consent, every regiment is fur-' nished with a surgeon and one mate at least. J Sir John Pringle, who, from ample experience! was induced to lay great stress on the regimen-i tal practice, recommends that in time of war, each regiment should be furnished with a sur-; geonandtwo mates; least by the surgeon or mate falling sick, the regiment should suffer. 1 But we have no established rule to guide usj with respect to the proportion of hospital sur-; v geons necessary for an army. In our army the number provided has differed from 4 to 40 or 50. j We know that excessive numbers answer no valuable purpose ; that in this as well as eveiyl I (19) other extravagance, the sick are injured rathet than benefited. After mature deliberation, Iaro of opinion, that one hospital surgeon to every division of the army, would be a good propor- tion. I am tpld there are thirteen divisions or ' commands of Major Generals, in the -whole ] American army ; and I am, convinced, from ' sufficient observation, that the same number of surgeons would be adequate to all prescriptive duty necessary in the hospitals of the several ar- mies employed by Congress. It is true they ought to be well chosen and well paid; they would then be subject to strict discipline, and would do all the duty with alacrity, cheerful- ness and success. It may be remarked, that I make no distinc- tion between physicians and surgeons, regard- less of the British example. I know that in Britain, a high degree of civilization and luxury ( have divided'the practice of physic and surgery j and that after the fashion of their country, the j British are, in some measure, obliged to put ( these professions into diffeient hands, in their military hospitals. It is however, very differ. cut, in our country, where every medical cha~ racter, practises both professions; and it is found, by experience, in cur army, to be im- practicable to separate these duties. Dr. Jones, of New York, in his useful treatise published at the commencement of the war, has said enough to dissuade us from this error. And was it only to guard against complexity, and to ren- der our system simple and manageable, and consequently better fitted to the inexperi- ence of a young army, I would abolish the distinction. (20) For all the purposes of good order and subor- dination among the surgeons, it is only neces- sary to number them, according to priority of appointment. Nothing is more certain, from authority and experience, than that every sur- geon should direct the practice of his own hos- pital ; he being the best judge of every thing necessary for his own patients. Hence it was, that the physicians general, in the late arrange- ment, held perfect sinecures. And from a re- gard to truth, I hope to be pardoned for the , assertion, that the invidious distinction made, by the new arrangement between hospital phy- . sicians and chief hospital physicians, must be worse than useless, as well as unprecedented. Every hospital surgeon will require two mates to his assistance, who, together with the regi- mental mates should be appointed with a proper ."; regard to their opportunities and medical abi- \ lities. And having shewn, as I apprehend, that the direction of practice and purveyorship of hospi- tals should be separated into different hands; that large and extensive hospital plans, with com- plexity of system, are dangerous to the army, in proportion to their extravagance ; that simplici- ty of system and frugality in the economy of J hospitals are most happily connected with suc- cess ; and that the regimental practice should i bear a great proportion to that of the general hospital; that a regimental surgeon and one mate to every regiment, and a hospital surgeon and two mates for every division or major ge- neral's command in the army, are a good pro- portion of medical officers; that it is of the ut- most consequence to the army to attain able (21) surgeons by a mode of appointment that is ho. fiorable ; and to retain them into long experi- ence, by sufficient pay t and that every surgeon ought to be interested, as much as possible, in curing the fcick; that a parade of titles and a high degree of subordination are unnecessary & inconvenient to the medical staff; & that num- bering the surgeons, according to priority of appointment, is sufficient for good order in the hospitals; I shall next proceed, with the strict- est regard to these established principles, to ^describe A PLAN OF ARRANGEMENT. There shall be one physician in chief to the . army and director of the military hospitals, » thirteen surgeons, and twenty six mates for the , general hospital; a surgeon and one mate to , ,every regiment; an apothecary and two assis- tants ; and a purveyor and one assistant. The physician in chief and any two or more r -hospital surgeons shall make a medical board, ; ,of which a field officer shall sit as president. Jt sliall meet once a month, or oftner if requisite, by general order. They shall appoint the Regimental and hospital mates; and shall ex- i«Dine and recommend the regimental and •hospital surgeons; and none but those recom^ ,anended by the board shall be appointed to ya- fip&ncics, It shall be their special duty, from time to time, to settle the proportion of regi- ■^mental and hospital practice; and to make re lobulations accordingly. They shall prescribe the measures for supplying the sick effectually with medicines, stores, provisions, &c. It shall a.hc (22) be their duty to make out proper estimates for the purveyor, inspect his accounts and transac- tions, anc" regulate his plan of issues, so as to prevent waste and extravagance. As often as required, the director shall report to the board a full state of all the hospitals under his direc- tion and receive their instructions. This board shall enquire into all complaints brought against officers of the department, and present to a court martial such as they may think deserving of censure. And this board 3hall be authorised to digest rules and carry into execution every thing relative to the medical department: providcd,- nevertheless, that no regulation of theirs be va- lid and take effect, unless issued in orders, with the consent and approbation of the commander.* The physician in chiefanel director shall have a general superintendency and direction of prac* tice, both in camp and hospitals. He shall ah| ways maintain an office near head quarters, so rs to be ready, at all times, to consult and ad- vise with the commander in chief; and to dis- tribute the necessary advice and direction to the surgeons ; with whom it shall be bis duty to- correspond. With the concurrence of the com-1 mander in chief, he may establish such hospitals as the service requires ; and shall make the ne-' cessary dispositions for conducting them. In time of engagement or any emergency, he shall call into the field as many hospital surgeons a*s the occasion may require ; and by order of the^ — - ——— — .. i ■ i. • Such a board as this vra» established in the Bri-, tish army, 1756, at the request and during the eonvj mand ©f his royal highness, the duke of Cumberland j whem Blocklesby celebratts for his systematical ideal nd aiost excellent regulations of discipline, (23) general, may have assistance in the hospitals, from the regimental surgeons. It shall also be the specirl duty of the director, frequently to inspect all the hospitals under his direction ; to see that they are managed with economy and 1 success; to correct all abuses ; to suspend and bring to trial all delinquent officers; and to make monthly returns of the sick to the commander. ' In the absence of the director from camp, the surgeon eldest in appointment shall do his duty. Every surgeon shall direct his own hospital, agreeably to the regulations, from time to time, adopted "by Congress, or the medical board and communicated to him by the director. He shall be authorised to order from the purveyor or his assistant, or from the commissaries or quarter masters of the army, or to be purchased from the neighborhood, whatever is necessary and convenient for the sick ; znd shall be accounta- ble for his conduct and success in the practice to the director; but shall not be dismissed the service, without due form of trial. When two or more surgeons are on duty in the same hospital, each shall act independently, with respect to all matters relating to his own particular charge, and shall be accountable to the director only, or the surgeon presiding in his stead. In case of dispute, with regard to any matter respecting the hospital, the surgeon of senior appointment shall control, until the mat- ., ter in dispute can be decided by the director, or ..-in his absence, the presiding surgeon. ' i The regimental surgeons shall give diligent attention to such regulations as may be establish- ed respecting their conduct; and chall manage the sl'jk of their respective regiments accord- m.^iy : and shall also be accountable to the phy- sician in chief, as the common head of the me- dical department. The hospital and regimental mates shall ob- serve the direction of the surgeons; and shall deligently perform all the reasonable duties re- quired of them, for the recovery of the sick.^ They shall also make out returns of the sick, for the surgeons respectively, agreeably to suck $brms as the director may require.- The apothecary i and his assistants shall re^ ceive, prepare and deliver medicines and dress-*., ings, and other articles of his department, to the' hospitals and army, on orders in writing, from* the director or surgeons. He shall appoint a*" proper number of males to assist him in his du- ty ; and shall furnish one to way hospital*, where one is required by the director. All the instruments delivered, by whose ordei* «oever obtained, shall be paid for, at prime cost,^ by the surgeons or mates receiving them.* The purveyor shall provide all necessary me-* dicines, utensils and stores of every kind, tha$ may be ordered by the medical board; for the delivery of which, a written order from the di-'( rector or a hospital surgeon, shall be his vouchers It shall also be his duty to pay all the officers of the hospital and every debt and expence of the' sick, after being duly certified. For these pur- poses, he shall draw money from the treasury,* agreeably to the estimates given him by the me-: dical board. He shall settle his accounts of ex-- penditures, in money, every three m-onths; andr * This wil! be attended with two good consequent* em, Great waste will be prevented, and the surgeon!4. mill b©furnished with better instruments- (25) 5r:2ea moiKfi, he shall lay a state of the expew- diture of etores, with the stock on hand, before the.medical board. The purveyor shall direct the conduct of his assistant; and by advice and order of the medi- cal board, shall appoint such other assistants, store keepers and clerks as the service may . require. In every hospital, the purveyor or his assis :tant shall appoint a steward, whose duty it shall '■be to purchase vegetables,.straw and other small articles, to receive the /Stores and provisions, \for the use of the hospital, and deliver them, a- greeably tothe ordersef theprescribingsurgeons. And although, in his purchases 6c.iss.ues, he is to .-obey the orders of ,the prescribing surgeon; yet, fur the faithful discharge of his office, he 'n :to be accountable to the purveyor ; and for this .purpose, he .shall keep separate accounts of all .he receives from the purveyor, quarter masters and commissaries, and of what he purchases .himself from the countpy ; and shall render ar * -account of all, his issues monthly, with his stock ton hand, to the purveyor : thus to enable the purveyor to lay the whole monthly expence of i the hospital before-the meelical board. The '* steward's vouchers -shall express, not only by whom ordered, but by whom received also.* In every hospital, the steward shall appoint a matron and a proper number of nurses, to be launder the direction ol the prescribing surgeons. It k*and paid by the purveyor. During the summer, when.the army is in the * M.»y we not thus *xpcc! a autisfdC ot y *r< oui»t of the stores, which have nevtrbctn obtain-t! .'by a.tvv plana ©f issues hiu>«ito practised. c ( 26 ) ..e!d, besides regimental infirmaries, die direc- tor may institute a flying or field hospital, in the rear of the camp, and appoint proper surgeons to conduct it: considering it always as a branch of the general hospital, and to have one common regulation with the same. One surgeon at least, whom the general may choose,* shall always reside near head quarters, to attend the general and staff officers, and to be in readiness for any emergency. When a division or detachment of the army is sent off," or in any manner becomes a distinct and separate body from the main army, the me- dical board shall nominate its proportion of the medical staff, over which the surgeon eldest in appointment, shall preside, with all the powers of physician in chief and director; and shall form a medical board, to be authorised as before mentioned. And when two armies unite, hav- ing each a separate board, one shall dissolve of course. When officers of the line do duty in hospitals, the medical board shall make rules for their conduct, that they may not interfere with the surgeons; and they shall receive their instruc- tions by general order. * It will doubtiets be a spur 10 every surgeon to excel, that he may b« the choice of the general, ECONOMICAL OBSERVATIONS ON MILITARY HOSPITALS, ckc- PART IT, ADDRESSED TO COMMANDING OFFICERS. It may seem strange at first view, that I should call upon commanding officers to take care of the health of the men under their Com- mand, or that I should expect they would pay any regard to the sickness incident to an army. I hope, however, in the sequel to shew that upon them especially depend the health and comfort of the soldiers; and that the medical staff are only to be regarded as adjutants, in the recove- ry of the sick. But before I proceed further, it may be pro- per to premise, that whatever may be the form of government in the state, whether znonarchi- chal or republican, the government of the i.rmy must be despotic. Although there may be rules and regulations for its better government, so much discretion must be left wi'h the comman- ders, as amounts to an authority that is arbitrary. The principle of honor, therefore, in an army is5 to obey implicitly the commands of superior officers. To abate the disgusting effects of this rigo rous though necessary mode of governing i/; armv, wise commands :s, in all :^esf have as- sumed to themselves a \ atrial chu! relation to a!! those under their command- Thus what could not be accomplished by for"e, was more effec- tually obtained by a parental influence. General Washington affords a notable ex.nr.ple. He wa.i (& ■ mdeed styled the father of his country, as ".veu as the father of his army ; and the probity and faithfulness of his character justly entitled him to the appellation. Marshall, in his history, re- marks : *5 happily for America there was in the character of Washington, some thing which ena- bled him, notwithstanding the discordant mate- rials of which his army was composed, to-attach both his officers and soldiers so strongly to his person, that no distress could weaken their af- fection, nor impair the respect and veneration in which he was held by them. To this sentiment is greatly to be- attributed the preservation of a respectable military force, under circumstances but too well calculated for its dissolution."* But generals are not the only characters* who should cultivate this fatherly disposition towards* their men. Colonels of regiments-and captains of companies are under equal obligations, both of duty and interest.—And even subaltern offi- cers should be excited, from like motives, to exert their influence, within the sphere of their authority. Every officer, witH.parentalrjenevcler.ee im- planted in his breast,- towards his men, will comprehend the follow ing remarks, and regard them as pertinent and proper. In a young and inexperienced army- espe- ciailv, the officers are too apt to consider mili- t:-ry duty as the only obligation upon them, re- , gardlehs of the condition of their men, whom, if they fall sick, are without further thought turned over to the care of the surgeons. The ' ignorance and irregularities of the men, in a xmw scene of life,, subject them to numberless. (29) diseases. The sick flow in a regular current to the hospitals; these are crowded so ss to pro- duce infection ; and mortality ensues too affect- . ing to describe. Our revolutionary army exemplified this mis- fo-jme in a maimer shocking to kumanity.— T«ie flying camp of 1776 melted like snow, in the field; cropped like rotten sheep en their straggling ro»it home, where they communicat- ed the camp infection to their friends and neigh- bours of which many died. The history of our military hospitals is an interesting subject, but not within the compass of my present design. I can only mention a few instances, which may serve a>s examples of the rest. After the battles of Brandy wine, Red- bank, &c. a general hospital was established iv the college of Princeton, wuere I was a pre- scribing surgeon. The sick and wounded, flow- ing promiscuously without restraint into the hospital, it soon became infectious and was at- tended with great mortality. I caught the jaii fever myself and narrowly escaped with my li>e. After a tedious illness, I got leave to return home for the recovery of my health. The ene- my occupying Philadelphia, at that time, it be- came necessary for me to take a circuitous rout to the state of Delaware, through Bethlehem, iii Penns\ Ivania. At Bethlehem was another hos- pital, and I found it convenient to rest therr a , day or two. During my stay, it was natural to enquire into the state of their hospital. The method I took was to propose a competition, not whojc liospital had done the most good, but whese hospital had done the most mischief. I was requested to gi\e *.n account of Princeton hospital; I stated with r 11 the exageration I could with truth, not only an affecting mortality among the skk and wounded soldiers, but that the orderly men, nurses and other attendants on ihe hospital were liable to the infection; that I had ' myself narrowly escaped death; and that fivat \ other surgeons and mates had afterwards been . seized. I was answered that the maligriancy and mortality of Princeton hospital bore no com- parison with theirs; that at Bethlehem not an * orderly man or nurse escaped, and but few of the ( surgeons; that one surgeon, Jos. Harrison, a ' Sne young fellow, distinguished for his assiduity, ' had died. And to give me some idea of the mor- tality of their hospital, one of the surgeons asked me if I were acquainted with that fine volunteer regiment of Virginia, commanded, I think, by coi. GibsOn. I answered I knew it only by reputation". He then went on to say that forty of that regiment had come to their hospital, and then asked me how many I supposed would ever join the regiment ? I guessed a third or a fourth part. He declared solemnly that not three would ever return, that one man had joined his regiment; that another was convalscent and might possibly recover; but that the only re- maining one besides, was in the last stage of the colliquative flux and must soon die. I was obli- ged to acknowledge the hospital at Bethlehem 1 had been more fatal than that at Princeton ■ The hospitals of the American army, although a striking example of their mortal effects, are riot jO singular as might at first view he im- agined. Dr. Pringle tells us, that tf aiter the battb of Dettingen the village of Feckenhtim was employed for an hospital, into which, be- (31) sides the wounded, about 1500 sick were sent from the line ; and of that number the greatest part was ill of the dysentary. By these men the air became so-much vitiated, that not only the rest of the patients, but the apothecaries, nurses and others employed in the hospital with most of the inhabitants of the place were infect- ed. To this was added a still more alarming distemper, namely the Jail or Hospital fever, the common effects of foul air from crowds and animal corruption. These two combined oc- casioned a great mortality in the village ; white such of the men as were seized with the dysen- tary and not removed from the camp, though wanting many conveniencies that others had in the hospitals, kept free from the fever and com- monly recovered."* The Doctor proceeds to iidd, that the camp breaking up, on moving, •; 3000 sick were left in Germany, there the 3iospit.il fever and dysentery grew daily worse. Few escaped ; for however mild or bad the flux was, for which the person was sent to the hos~ pital, this fever almost surely supervened. The petechial spots, blotches, parotids, frequent mortifications, contagion and the great mortali- ty sufficiently shewed its pestilential nature. Of fourteen males employed about the sick, five died, and excepting one or two, all the rest had been ill and in danger. The hospital lost near half of the patients. But the inhabitants of the village having first received the flux and afterwards this fever by contagion, by the two were almost entirely destro>ed."t And in sue- • Diseasrs of the Army, p. 22. t Diseases of the Army, p. 25, (32) seeding pages the same ingenious author fur- ther adds that when soldiers were taken ill where there was no common hospitals, the hos. pital or jail ft ver was unknown ; that in the campaigns of 1745 &>46 "most of the deaths were from the Jail fever ; and advist-s car. jingat all times as many of the sick along with the regiment as can easily be transported.*'3 Net only hospitals filled with sick, but whole encampments of well men may become infec- tious. War and pestilence are proverbially con - necu d together. Jricmer in describing a plague that infested the Grecian camp, according to the mythology e>f his day, attributes this mis- fortune of the greeks, to the junger of the gods, whom, with poetic licence, he engages on hoth sides, in this ten years siege. With the light of modern times, there can be no hesita- tion in concluding, that from the long continu- ed occupancy .of the same ground, their camp nhad become infectious. The plague of Athens is recorded by Thucidides as a monument of human misery, perhaps urparalled in the his- , tory of the most cruel wars. Pringle sets this matter in a strong point of view by describing two encampments, or rather j two divisions of the same encampment, at a small distance from each other and under like circum- stances, in etery respect, except that one was , infected and the other was not.* ■'Many melancholy instances might be adduced of infection in the American encampment. I vvill mention one. In the year 1776, when the army * Disease* of ihe /v-rrr»y. p. 105, *'Di*ca8cs of the Ami), p. 21. f33) was encamped at King's Bridge, in the State of New York, our raw and undisciplined con- dition at that time, subjected the soldiers to great irregularity.- Besides a great loss and want of clothing, the camp become excessive- ly fiithy. Ail manner of excrementitious matter vvas scattered indiscriminately through the camp insomuch, that you were offended by a disa- greeable smell, almost every where within the lines. A putrid diarrhoea was the consequence. The camp disease, as it was called, became pro- verbial. Many died, melting' as it were and • running off by the bowels. Medicine answered * little or no purpose, A billet in the'country was only to be relied upon. When the enemy moved up the East river, our army moved to White Plains, and left their infectious camp and the attendant diseases behind them. It was remarkable, during this disorderly campaign, before our officers and men could be reduced to strict discipline and order, the army was always ^ more healthy when In motion, than in fixed camps From all the conversation I have had wirh some of the most sensible officers of General Wilkinson's army, there is no doubt upon my mind, but that the great mortality at terre aux boeuf in the then territory of New Orleans and now State of Louisiana, proceeded from an infec- tious encampment. It is impossible to account for the obstinacy and fatality of those bowel complaints which affected the soldiers, either from the nature of the crime or the soil, but from a poisonous infection. Brocklesby observes, "that theregisterkepto£ the mortality produced by fevers of various kinds (34) in military life, shews, that full eight times the number of men have been lost, in this manner, of late, more than fe 1 immediately by their vour.ds, or in battle."* I have no register or record (roan whence to prove the proportion cf deaths in the American army ; but have no * hesitation in declaring it as my opinion that we < lost not h ss than from ten to twenty of camp diseases, for one by the weapons of the enemy. I might proceed to add a long list of quo- tations from different authorities, to the same point, evincing the malignancy and dangers of mi'itary hospitals and infectious.camps ; but as brevity is essential to my design, I shall, with- out furtluer delay, advert to those ways and means, by which military officers have it much in their pov.tr to prevent and alleviate the or- dinary sickness and distress of an army. „ Fpr these purposes, discipline is of the first sensequercc. Without' if, there can be nei- ther health nor comfort in an army* Waste .and want follow of course, with ail their atten- dant evils.—But more is comprehended under the word discipline than the mere exercise of arms. It may therefore be proper to specify some prominent articles. All authorities agree, that in subserviency to health, the military exercises ought to be per- formed in the mornmg, before the heat of the dyy, especially in warm weather. But in fixed camps, the ordinary exercist d£ i»rms is not sufficient to keep the men in good plight. Some have advised plays; hut the indiscretion of * OUaeiva.li.ors, j:. 300-r (35) soldiers is not to be trusted. They woiAd pro- bably err both as to time and degree in amuse- ments of this sort. The best advice 1 hava at- tended to is that of short marches and other military exercises at the discretion of their offi- cers. Under the next article will also be sup-- gested a variety of exercises. Cleanliness is essential in all conditions of life, but especially to soldiers. Without the necessary cautions on this score, an army is literally poisoned, and dwindles into insignifi- cance. Officers, therefore, should be very solicitous to protect their men, ai well as them- selves, from the dreadful effects of filth and Has- tiness. The utmost cure should be taken that the men appear not only neat and ciean in their persons, but that their bedding is sweet and comfortable. For this purpose their straw and blankets should be brought out of the tent and aired twice or three times a week. They should be employed at leisure times, in m.tking small trenches round their tents, more effectual- ly to guard against excessive moisture in their floors. Bathing should be encouraged in warm weather, with this caution however, that the v men shou'd remain no longer in the water than is necessary to make their skins clean. That the camp may be kept free from excre- .mentitious filth of every kind, a penalty should be annexed to dropping any thing of this kind y within the bounds of the encampment. If ad- jacent to a river or running stream, tvtiy thing of this sort mav be thro n into it and swept , away. Even the privies might be binn* over it " to great a 1 vantages. Otherwise deep pits should lie sunk and all excrementitious matters and (26) ^Slth of every kind thrown into them and covered with a layer of dirt every day. When privies are sunk in the earth, they should always be to the northward and eastward of the camp: for the winds blowing from these quai ters being cool, neither raise the effluvia in the same quan- tity nor exalt them in the same degree, as do the warmer southern and western breezes. JBrock- lesby, to enforce the importance of cleanliness, quotes the divine lawgiver, Moses, for his in- junction on the .Israelites, when.he says, "thou shalt have a place without the camp, .whither thou shalt go forth abroad ; and thou shalt have a paddle on thy weapon, and it shall be when thou shalt ease thy self abroad, thou shall dig therewith and shall turn buck and cover that which cometh from thee. For the Lord thy >God walkethin the midst of the camp ; there- fore shall thy camp be holy, that he see no un- clean thing in thee, & turn away from thee."* Here it may be observed, that this wise lawgiver enforces this duty, by the obligations of religion and morality: for he reminds his people of the omnipresence of the deity; and as we are commanded to do no murder, so ate we re- quired as we would expect the blessing of hea- ven to use all lawful means to preserve our own lives and the lives of others. Br sides excrements, a variety Of other mat- ters require to be cleansed from the camp. Dead horses, carron of every kind and every thing of a putrid nature sliould without delay, be buried in the earth, which by a law of nature, has the power of correcting and sweetening, every thing putrid. Keep the Camp clean and you run no nsk of infection, otherwise it be- * Duzu Chm his feet. Any where to the south ward of the Carolines, I have a strong impression, that col t (38) ton will make more salutary-garments -for sol- diers than wool, allthe) ear round. 1 have been told, upon authority which I believed, that the French soldiery in St. Domingo suffered im- mensely from their European cloathing ; that it was no uncommon thing when a party marched out of garrison, to disperse the negroes, for carts to be sent to bring in such as had failed and fainted from the heat of the sun aided by the oppression of their clothing. The regular muster of clothing is of im- mence consequence to an army. Before the introduction of this measuie, our army was kept bare and naked, by multitudes of soldiers selling their clothes for drink and otherwise • wasting them. When the Baron Stuhen was appointed inspector General, besides the muster of clothing, he introduced a number of salutary regulations, which contributed more to the health and comfort of the troops^ than the utmost efforts of all the medical staff ✓-* t Diet is another article of immense conse- quence to a soldier. The ordinary ration is sufficient if well managed. The soldiers ought to eat in messes ; and it would be of impor- tance if an old well educated soldier cowld be associated in every mess. An-old .soldier would make good and wholesome food of materials that a young recruit would spoil, in such a manner, as hardly to be fit to eat. The British soldiers are paiel weekly and there are stoppages of pay appropriated to the messes. This enables them to furnish'vegetables and every thing necessary to good awel wholesome living. Every regiment •ought to ha"ve a regulation of this sort.' for with out goexf living their.heithhcaunot.be maintain.. (3!>) ed nor force and energy expected from them in the day of. trial. Cares houl Ibe taken that the bread of an army be properly fermented and well baked. I recollect, in the campaign of '76, while our army was on the peninsula of New Yerk, we were so deranged as to be depriv- ed of ovens ; and flour was set ved to the troops instead of bread. We could only make sodden bread and dumplins. Some baked their bread on Hot stones and otheis in the ashes. The consequence wa& that many were afflicted with the Jaundice. Being a regimental surgeon at that time, I shared the fate of the rest, and shall ftever. forget my fatiguing march from the north river to Brunswick, with the jaundice upon me. To guard against accidents of this sort, a suf- ficient quantity of biscuit should always be in store. The Germans make great use of them, and I believe the French also. They would be particularly convenient for parties, when under the: necessity of providing themselves with several days provision at once. Judge Peters, in the memoirs of the Philadelphia society for promoting agriculture* has given a learned es- say on the importance of this kind of bread. He shews, by a chemical analysis, that biscuit h improved by leaving-ail the finer parts of the bran in the flour of which they are made ; and he proves, on the-authority of Baron Stuber, that the peculiar health of the Prussian soldiery was in a great measure to be attributed to their ammunition broad. Hardihood is another article the American v * vol. 1. ( -M) ) soldiery are not sufficiently attentive to. A delicate soldier is ven ridiculous indeed. Har- dihood sufficient to resist smaller accidents, is essential to the safety of a warrior, as well as his efficiency in duty. What ofjficer or sol- dier can read the speech of the sage Nestor with indifference. Homer makes him tell the story of an old man admirably. He begins by a declaration that he had seen three or four gene- rations pass before him , and then describes the heroic companions of his youth who harkened to his counsel and calls upon the men of succeed- ing and more degenerate ages to listen to his advice. What comparison would our soldiers make with Roman or Grecian troops? What comparison would they make with Russians or even Britons? These are enquiries worthy of attention. In other services, insteael of adorn- ing themselves like pettit maitres, it is not un- common for officers and men to wear whiskers, and by every appearance of rudeness and hardi- hood, to present as terrible a front to the enemy as possible. Even savages have a just appre- hension of the importance of measures ot this sort. They not only paint their skins to forti- fy and protect them from harm ; but they dis- figure themselves in such a manner, as is most likely to dismay their adversary. With the re- putation Of a bold hardy race of men, our armies would certainly be more important in the view cf their enemies, than if regarded as composed of delicate and weakly creatures. jt Jn cultivating this essential qualification in a soldier, the skin is especially to be regarded, as the avenue through which most diseases assail us. According to Sanctorious, whose experi- (41) ments and authority have been deemed correct and valid by all his successors, five eights of all we eat and drink must pass the skin. His ex- periments were made in the moderate climate of Italy. In our summers, probably, the propor- tion would be greater. This single circum- stance shews the skin to be the most important emunctory in the body • And although the dis- charge is insensible, defects and irregularities in this excretion, shew themselves, in colds, coughs, fevers, fluxes and all m inner of eliseas- es. For if the skin fails to do its office, an ex- crementitious matter is retained in the habit and perhaps thrown upon the lungs or some other viscous, w hich thus becomes loaded with matL-r not on ly superfluous in quantity, but corrosive in quality, producing inflamation, ulceration &c. whence plurisy, consumption and a thou- sand modifications of diseases too tedious to mention. From the preceeding view of the nature and function of the skin it must appear, that by keeping the skin in good order, you are exempt from colds, coughs and their whole train of con- sequences. Every lockey can tell you the im- portance of currying his horse frequently. Any body that will trv it, will find friction of eoual consequence to the human body. This is most conveniently performed with a flesh brush ; but is equally efficacious with the corner of a blank- et.—It is best done every morning bef re iash g out of bed. The shirt being stripped up to the arm pits, the whole surface of he bo 'y miy be rubbed, except the arms and neck ; »i $ as often as a clean shirt is put on, the arms aid neck may be well rubbed also. The soft parts 1)2 (42) of the belly should be specially dwelt upon and rubied with the mest pressure. The whole process m:'.y be performed in one or 2 minutes. I have myself been in the habit of this salu- tary practice for many years past; and can boast of an exemption from cokls, coughs &c except when the influenza prevails. That most subtle. of all contagions seizes upon me, in common w ith other folks. But except from contagion, I have no apprehension of cold or cough. Any officer who will try the effects of friction, on his own person, will soon be led to regard it as an indulgence rather than a troublesome task ; and will not hesitate to enjoin it upon his corps. Although friction on the skin contributes more to salutary hardihood than any thing else lam acquainted with, yet there are many other things which deserve the attention of officers, as contributing to the bea.lth, vigor and activity of soldiers. If it were practicable, it would be dangerous for soldiers to sleep en soft beds. Straw is the best material for bedding. Officers should not trust themselves on any thing softer than hair mattresses. Flotk bed, should be re- jected, as adapted to retain irfection Super- fluous clothing is equally injurious with vvaim and relaxing beds. They both coi-spire to sof- ten the skin and to r?n('er it delicate aid sus- cc p-able of various imj ressions {torn the common air. rJ heir injurious effects upon the skin should male officers and men very guarded aginnst superfluous cfo'hinp, especially in warm sea- sons : for the skin is li jfc-le to excessive dis- sharpes, as well i=s to oiminifched and surpiesst d ptrsj ira ion. A man m;y be exhausted see■» tr by the poresof the skin, than from any excrtt en («) of the body besides. After the battle of Mon- mouth, I heard of more complaints arising from the heat of the weather, than from the weapons of the enemy. ^ Cold bathing, jn warm climates and the sum- mer season, is also of excellent use. It serves not only fqr cleansing the sjun, but to strength- en and fortify the numerous nerves that termi- nate on the surface of the body, so as to render the skin less sensible and not so easily impressed by external causes. For this and other accom- modations, wise commanders always chuse the banks of a river for their encampment, when they can make it convenient. Not only the body, but the mind of a soldier should also be trained,in subserviency to health. The influence of the mind upon the body is / astonishing. A sense of honor and reputation phould, therefore, be cultivated, in every sejdier, by all possible means. The French armies fur* mVn a rotable example of this measure. During* the winer succeeding-the campaign cf 1731,'J. • was quartered in the French garrison, to super- * intend the American hospital at Williamsburg,, I remember that the maxim with the French« soldiers was, Jirst the king and then the soldier ; that a French soldi*, r despised all menu.l ser- vices; that waiters k solditrs were very different characters ^.nd were badged by different uni- forms ; tliHtE. French officer Inning any thing in market, would not ask a soldier to cany it home for him ; that drunkenness was regarded as equally disgraceful as sterling, so th;t I never saw :< French soldier drunk. The young Vis- count Kcchamberu on act) lair occasion, struck rn old soldier with the flat of his swerd. The { 44 )o veteran ret'rred, and unable Wtocarthe reproach shot himself. The French officers did not hesitate to reprobate the rashness of the yowng viscount. The effect of this discipline appears In the present French armies. According to their bulletins, theiT soldiers maintained their usual gaiety and cheerfulness, amidst the dis- astrous events of their retreat from Moscow. I have heard Gen Smallwood reprove his offi* cers very severely for striking the men under their command ; a practice too common in the American army. Little or no comment is ne- cessary to shew the importance of this article of discipline. A soldier with seif esteem and ambitious prospects before him, will net only be neat and clean, but prompt in all his duties. WhiJst a fellow without any respect for him- self, is slovenly, careless and often desponding to such a degree, as to be regardless w hether he serves in camp or dies in the hospital Besides the above prominent articles a variety of ordinary and less important matters will naturally suggest themselves to well disposed officers, such as temperance,order, decorum &c\ And for carrying their rules and regulations into effect, they can be at no loss r>r if they wish for advice in relation to the health and hardihood of their men, they can at all times consult the medical bor.rd describcel in the first part of this w r\. Brocklesbx observes, * t a* if any regiment or corps has tl e fortu- e to h. ve only one judici- ous humane s id sufficiently able field officer, it may always Se wisely re^rt lued and discreetly managed. But where the three field (jfficers together happen to be perfectly we 11 appointed, . ctive, judicicus h deM.ro.us of every useful infor mntion,from literary men, as well as from those of their own profession, one may safely pro- nounce, that such a regiment w ill be fit for ser- vice at any time, on very short notice ; and on . the hardest service, the soldiers *c w-ill not shed away from their officers, as sickly feathers, tho% never sa often supplied'.'•' as Milton finely ex- presses it: but it will be free (all other circum- stances being alike) from at least one half of those miseries and disasters which are usual- ly incidental to military life'. £Ie mentions the seventy-second regiment of foot as such a corps; * where all the regulations of its interior • orders and the hidden springs of all its move- ments and actions, were so well contrived, anel the mechanism was so exquisitely adjusted, that the whole as wTell as every part of a system,con- taining 900 human forms, appeared at all times, in their tents, their hospitals, under arms, and on a march* to be actuated and put in motion, merely at the volition, and by the command of the noble colonel, lieutenant colonel anel major 1 each in his department co-operating with one mind, to effect that entire, beautiful and harmo- nious arrangement.'* Lieut. Col. Henry Lea was distinguished in our Bevolutionary army, for the health and vi- • gor of his corps. I never saw one of his men in ( the general hospital ; and it was proverbial in t camp, that Lee's men and horses were always , reaely for action. From what has been said, I trust it will be sufficiently apparent that the health, hardi- \ * Observations, p, 7. (4(>y hood and efficiency of an army depend very much, if not entirely upon the wise aid pru- dent conduct of the commanding officers. A nd' it mav reasonably be inferred that the public will mike a just discrimination between those w ho govern their men with so much discre- tion as to have them always fit for duty, and' such whose men are constantly falling from- them, hkt the sickly feathers of a bird* Honer and preferment will be the grateful rewards of the former ; while the least the latter can ex*. pect is to be consigned to oblivion. ECONOMICAL OBSERVATIONS ON MILITARY HOSPITALS, Sec PART III. ADDRESSED TO THE MEDICAL STAtF. To enter into a laboured account of all the diseases incielent to an army would swell this Work to an useless volume. All I propose, there- fore, is to advert in a concise manner,.to those mam points which distinguish hospital practice and the diseases of an army, from those of com- mon life. The cardinal point or principle to be observed, in the direction of all hospitals, is to-avoid in- fection-. When this can be done, the practice of hospitals differs little or nothing from private practice. Biit where infection^ or foul air is suffered to prevail, no skill or address in prac* tice can much avail* The cause must be re- moved, before the patients can be relieved by medicine. .And-while a poisonous atmosphere is constantly operating on the patient,- the most powerful remedies, which act only pro tempore, must be constantly baffled. To avoid infection, it will be necessary to.adwrt 1st. To the construction of hospitals. 2d. To (personal cleanliness -.and treatment >of the patients* As to the constntetion of hospitals* I wonkl observe that wxxxl, above all other materials Of which they are made> retain infection most per- (48) manently. Wooden houses, therefore, and es- pecially wooden floors should be avoided. Earthen floors are best; and tents are better than sheds or wooden houses. The influence of the ground in neutralizing and correcting all manner of puO-ifaction is well known. Even putrid meat is sweetened, by burying it m the earth. The surface of a tent floor may be !• craped off, or a new covering of fresh eartli spread over it, a.> often as occasion may fc- quire ; or wrut is still more expedient, a tent may be removed to a fresh surface, as often as you please. The walls of a tent may be sluic- , ed in water and thus freed from all infection, as often as you shall think it necessary. A wooden building cannot be so cleansed. The best expedient hitherto discovered for cleansing wooden buildings, is founded on the mitchillian doctrine, by white-washing. This may serve for the walls; but wooden floors once infected are irreclaimable. The more you wash them with water the worse they are ; you must aban- don them. , Tents, 1 should suppose would be particular- ly proper in warm climates as well as in our warm summer seasons. They may be opened at ; pleasure so as to admit the most •free current of air. It is much easier to pitch the number of tents requisite, than to prepare houses. The , number of tents may ako be proportioned to the number of sick, so as to run no risk of crowding them. I have used common horse- man's tents, ahd,long tents formed like the roof pf an house prepared expressly for hospital r.ur poses. But in cold climates and winter seasons, (49) some better protection than tents afford may be^ necessary. In such c ises, the best hospital C have ever contrived was upon the plan of an Indian hut. The tire was built in the midst of of the ward, without any chimney, and the smoke circulating round about, passed off thro* an opening about four inches wide in the ridge of the roof. The common surface of the earth served for the floor. The patients laid with their heads to the wall round about, and their feet were all turned to the fire. The wards were thus completely ventilated. The smoke contributed to combat infection, without giving the least offence to the patients: for it always rose above their heads, before it spread abroad in the ward. And more patitntscould be crowded with impunity in such wards, than in a>;y others I have seen tried. This was the expedient T employed in the hard winter of 79, SO, when the army was hutted near Morris Town, ' and I was well satisfied with the experiment. ' But the plan of this hospitd hut will be bet- ter understood, by turning to the elevation and ground plan, on the succeeding pages. '1 he fir t of thet'e shews the elevation, in this it may be ol^ei v.d, that the smoke passes off through funmlti elev^ud above the roof; tudt cne window is open an ! the others shut; that all the air and light arc let in from ihe south front. In the grounel plan A. represents the doors, B.-the fire places, e. c. he. the bunks or bed- steads, in which the patients were placed It shou!d be noted also that the walls of this hut were built of rough logs, without hewing; that the chink3 were daubed with mortar made of common clay and water only ; that the mid-, (50) die or main ward 31 .-2 feet by 19 1.2 in the clear was asigned to febrile patients; i:nd the smaller end wards 35 1-2 by 10 feet clear were occupied by the wouneled and other cases of topical affection. I am aware that Sir J. Pringle inveighs against ground floors. It may therefore be necessary to obviate the weight of his authority by shewing that his experience and mine are not so incon- sistent as might appear at first sight. Prin- gle's observa ions were made in the marshy and swampy district of Holland ; mine were made in the high and dry lands of the American con- tinent. Pringle too denies the occult qualities of the air which, according to Sydenham, pro- ceed from the bowels of the earth and have great influence n the prevailing constitution of the atmosphere. Sir John attributes all the vices of our atmosphere to its sensible qualities, such as heat, cold, moisture, dryness &c. I am the more surprised at the opinions of this great authority, as he is the grand advocate and champeon of contagion or infection, as you may please to call it. Why not vicious exhal- ations from a bad and corrupted soil, as well as from putrid substances above ground ? If mois- sture were to be regarded as the most noxious qualitv isi the air, the sea ought to be considered as more noxious than the land ; and yet every sailor can tell you it is not so. Surely there can be no comparison between the air of an open surface, even on low and swampy grounds, & ihe damp and foul air pent up in old waste buildings such as are gevei.illy taken for hospitals. All igree that the ordinary endemics of our countiy proceed from \icious qualities in the air f'!lill§ijpfi Hiiii'iiiiir/ llPff' (53). we breathe. Some have expressed an opinion that this vice of our atmosphere producing in- termitting and remitting fevers &.c. is a mere negative quality, proceeding from a defect of oxygen or vital air. Others are of opinion that this noxious quality is positive uv! proceeds from chemical combinations in the atmosphere that are poisonous to the human body, Li a con- versation I had with Dr. Priestly, he gave it us his opinion, that this vice of our atmosphere was positive and not negative. He said he had made experiments, with the eudeomete-r upon air taken from all situations, from the depth of infectious prisons, low marshy districts and airy mountains ; and that he had found the propor- tion of oxygen and azote nearly the same. He added, that the precise nature of this noxious poison was not yet ascertained ; that it prob ibly never would be discovered by a direct en- quiry ; but that some lucky fellow might hit upon it, by accident, as he did upon the method pf ascertaining the proportion of oxygen to that of azote, in our common atmosphere. But let Sydenham or Pringle be correct, I have a right to plead my experience as well as . sir John. I know that I found tents the mot convenient and successful hospitals. They not , only allowed of better ventilation but ens>b ed . me to assort the sick and wounded more effi c- tually than coulel be done in houses. Infec- tious cases, such as jail fever, dysentery and putrid diarrhoea could be placed at any dis- tance I chose from other patients. By raising the walls opposite to the sun. the patients recevide the full benefit of a free vtrtihiticn. In case of great malignacy a patient may b^* placed in a (54) small tent by himself, so as not to endanger hia fellows. 1 he only objection 1 have met with and which I think more plausible than solid, is, that, in very v. arm weather they do not suffi- ciently exclude the heat of the sun. This may at all times be obviated by covering the tents with green boughsor arbours: thoughlmtist con- fess, I was never reduced to this kind of expe- dient. The British writers appear to be very much bound down by the authority of Sir John Pringle. Nevertheless, Brocklesby is obliged to confess he had astonishing success, by em- ploying some fly stents in the rear of the camp.* As to personal cleanliness, the best devices aie to be provided with the means of washing and cleansing every patient that enters the hos- pital. A clean shirt and bedding should be provided fir every patent ; and his foul clothes thrown, without delay, into water. It may be hazardous to omit this in one single instance, since one infectious patient, iike one scabby sheep, may spread the contagion through any number collected togaher. 'JTheir bedding and ether clothes should be frequently changed. Washing the face and hands in water or vine- ?i*r and water, every morning, will always be found refreshing and salutary. The bedding of a sick soldier in the Ameri- can hospitals, in houses as wcls as in tents, as- sisted of a bunk or cradle, a palias or bedth k of coarse linen filled with straw and one or more blankets The same bedding should r.ever be used for more than ope patient with- out cleansh g. The best method of cleansing •Observations, p. 248. /.. (55 ) the bunks is to turn them out of doors to re- ceive the full benefit of air, rain, frost &>\;. All manner of clothing should be washed. The utmost care should be taken to remove all excrementitious matter from the wards, so as to leave no smeli behind them. If there be no running stream at hand, every thing of this sort should be sunk deep in the earth and cover- ed every day. The necessaries should be to the northward and eastward of the hospital, for • reasons mentioned in the second part of this ! work. The importance of separating those ill of fevers, fluxes &c. from the wounded and such as have only slight topical affections, will readi- ly be preceived. Many a fine fellow have I seen brought into the hospital, for slight syphilitic af- fections and c.irried out dead of a hospital fever. The coavi Iescents, as soon as put upon the analeptic . 01 rse, should be removed as far as convenien f.om the sick. i\ ilk is the grand restorative for convalescents, and vegtiablesgen- erally arc useful, in combating that putrid ten- dency to which all hbspital patients are so liable. it was suggested in the first part of this w ork, that the hospital practice of an army should be compressed within the narrowest compass pos- sible. While in camp or quarters, all acute dis- eases should be treated in regimental infirmaries. < Wounds and chronic complaints alone should be permitted to enter the general hospital. The medical board should procure a general order to this effect. By a measure of this soil the hospital will be secured from ciowding, except t>n the breaking up of the camp and march of the army, or after a battle. On such occasions, (56) the best possible means of making re m and ta avoid crowding is to employ tents. They may be pitched to any extent required. On such occasions it is customary to summon all super- numerary surgeon*, from the regiments as well as the hospital, to give their assistance. With these precautions duly regarded and diligently practised an army has the best chance of escaping diseases of a malignant nature., Nevertheless incidental hardship, accident of misfortune may proeluce those complaints more peculiar to camp life. These are chiefly the jail fever, dysentery and putrid diarrhoea. I will advert a little to each of these. But with my u*ual brevity, I shall only attend to prominent features, without descending to minutiae. The jail fever generally gives some days notice of it approach, by a languor and listless- ness of the whole body, and a peculiar sensation of the head as if it were tightened, or compress- ed in a hoop. The febrile attack is very much in style of the Synochus, as described by Cul- len. It is not uncommon for the symptoms to run pretty high in the beginning, so as to war- rant blood letting and an antiphlogistic course. But after some days, more cr less, in different patients, the pulse begins to sink ; a dry tongue, delirium and the whole train of nervous and putrid symptoms supervene. If I ever saw the petechias, so much dwelt upon by Pringle and Momo, I have forgotten all about them. This I am sine of, they were not regarded as essential to the disease. Although often- compelled to let blood in the commencement 01 ikis fevtr, we were cautious ol'repea'ing this operation ; and were disposed to avoid it altogether, when not d< manded by a full pulse and other pressing ciicumstance . After bleeding, if that operation should be thought necessary, a vomit was deemed of ex- cellent use, by opening and squeezing all the glands of the body, and thus shaking from the nervous system, the contaminating poison, be- fore its impressions are fixed. With this view the earlier the vomit is administered the better. During the prelude or thoce marks of approach- ing danger above described, a vomit may pre- vent the fever altogether. When the fever is formed, mercury is of the greatest importance, so long as any signs of an inflamatory diathesis remain. This Sampson- ian remedy has the power of subduing all man- ner of contagion or infection that we are yet acquainted with. Thus, besides syphilis, itch &c, without fever, it is regarded as specific in small pox, measles, scarlatina, influenza, yellow fever &c. and is found to be not less succesful in the early stages of JaV fever. The manner in which this remedy sets all the secretions afloat, may serve in some measure to explain its bene- ficial effects. Hence it is that in yellow fever, remitting or any other fever, if we can only touch the patients mouth with mercury, we re- gard him as safeit In the American hospitals,we were accustom- ed to give Calomel, in various, forms, according to circumstances : sometimes alone, or mixed with opium, tartar emetic, neutral salts &co. The following prescription will be found of extensive use and should always be kept as an official. (58) Take of Calomel two drams ; Opium one dam; Tartar jimetic fJ teen gt am. ; Syrup enough to make s xty fills.. litre it ma\ be ob- served that each pill contains two grains of calomel, one grain of opium and one fourth of a grain of tartar emetic Of these one pill m<:y be taken every night, or night and moining, according to the exigency of the case. This form of medicine may be used, not only in all contagious and infectious diseases, but in all fevers whatsoever, where the inflamatory dia- thesis prevails ; and may be regarded as the most powerful of all antiphlogistic remedies. 1 have given it in inflammations of the lungs, liver &.c. to the greatest advantage. I do not recol- lect to have seen it tried in inflammations of the stomach and bowels; but in ordinary colics it may be regarded as specific. The neutral draught will always be found a goo ; adjutant remedy, administered more es- pecially in the exacerbation or rise of the fever. : It is idle, however, to talk of lemon juice in a camp. Even good vinegar is not easily obtain- ed. Cream of Tarter is portable and answers i as well or better than either. One dram of ; . salt of tartar anel two or three drams of cream of tartar rubbed together and dissolved in a quart of boiling water, forms one of the best neutral mixtures. Of this the patient may take twoounces, every two, four or six hours, accord- . ing to circumstances. But the antiphlogistic course, and especially calomel, must not be continued longer than the irflammatory diathesis prevails. As soon as the pulse sinks, and a dry tongue, delirium and • I other typhous symptoms predominate, we must have recourse to bark, wine, volatile salts, blisters &c. It would be impossible to take notice of all the combinations and contingencies that may be connected with jail fever. It may be observed, however, that in the typhous g-ade of this fever, we gave the sal cornu cervi liberally and to ad- vantage ; especially in sue!* cases where we had doubts of the bark ; and in severe cases they were both tmployed. A dry tongue generally warranted the use of the bark ; and this medi« ine was used liberally by tasking the patient, from half an ounce to an ounce in the isrtili hours, according to the magnitude of the disease. Wine was deemed a capital remedy, in every stage of typhus. In my own case before men- tioned*, besides an obstinate delirium, I had a crust on my tongue as thick as the blade of a knife, and bhick as soot. The skin was worn off my hips and dorsal vertebrae, so as to make it necessary to patch those parts with common , plaisUr. At the acme of my disorder, eleven surgeons and mates belo:.ging to the hospital, all gave me over, and only disputed how many hours I should live. Providence ordered other- wise. My friend Doctor Hush paid kind at tendon tome; and a benevolent lady of the neighborhood sent me several gallons of excel lent wine. I drank freely of this liquor, and took, at the same time, liberally of Huxham's tincture. My tongue soon after began to mois- ten on the elges; anel in the course of some • Page 29* < 60) days, the whole crust fell off and left it so raw and irritable, that I was obliged to hold s&inueil almoiicis in my mouth to abate the irritation of so tender a part. When so-fir advanced in convalescence, as to be able to stand, I could hardly walk for the sorent ss ot my feet. All the cuticle scaled off from my skin: and all my hair gradually combed off from my head : so that instead of my former straight hair, I had an entire new suit th.t curled beautifully. Being reduced to skin and bones, I had a v racious appetite for filling up the waste ; and in a mode- rate space of time recovered a more than oidi- nary plump habit; but it was n< t less than nine months, before I gained the usual elasti- city of my muscles : insomuch, that I could not cross a gutter otherwise than by steping over it: tor I could exert no spring. I am the more particular in the narration of this my own case not merely to exemplify the efficacy of wine ; but to shew, thdt a patient thus severely affected, cannot be fit for duty, afterwards, during the campaign. Blisters were used in local affections, 2nd in the low and depiessed state of jail fever, with manifest advantage. Opium was alv> rated among the first of sti- mulants ; and was particularly useful, in case of a lax stare of the bowels. The Dysentary, besides bleeding, frequently required a vomit in the first instance, especially when the stomach was sick. Afterwards, our ordinary practice was to keep the bow els freely open with small drops of calomel given ; t bed- ti :■> ine repeated dV *ar pre- scribing physicians I observed a gr«*at number of their ■patients in a languid and puttiid condition, and asked, 'occasionally, if the bark would not he proper in s>>rh rases ? The uniform answer was no too much infta* Tnafion. And when they attended mv round of pre- scription end saw me frequently prescribe the bulk, 'in (04) febrile eases, and even fn ine .vmnded, they lilted, ud tiuir bunds »n attonishmhnient. Frw or no chemicni rcm.lir* were euvl.ivtvl nv ;liem. On; ottn-w rtgi. , mental v,j:>;c.>i»3 declared, that he it ver u%ed < pium. Tn-ir hns.ni il pli.u ,hjiupcea con-i-sicil ibieMy ul i/iis- ans, «'*<•(>. tions ..ik! Witiii) d inks, ii nd omy tor in- fiaui .i ainry .n;.le aicoinm>- (ialions ijjvp , h in r.o advant tt^e of o->, v. the icsuit of • prtciicc. 1 vTt-.ihe mors turpi ised, a» Doctors Cost I and B'irgclii Hot h -ippiaied to be iii.ii ol science, well { q.ijliticd to ur iit- . >.»ea«cli. iMv l>rc hun of the faculty will probably thitik it an ililenslin^ lact, ihil ;n re our^eons died, in the Amc» lie.-id in-.ro in |>«-op->ruon to their nutnbrr, than officers oi fie Inn ! a vi'o!i^ evidence this that infection it more d.ingr run-<, in ai.\ i -ry life, than the weapons of war ; i and ^hou'd he a po-.vcrlul excitement, with u'l concern- til, bun motives of self preservation, as well as hon- or »r-e»siB.» a hope and expectation, tlial measures will be J^kcti )-']■ huoding down to posterity, acompltie history pi ou nnlltjiy hospitals, during the present war. We D >w abei-ions night be appointed to col'aie and c*i|;tst the whole into due form. It is acknowledged by all who have wtittcn on the subject, that this branch of military »< ienc i has been »ham«fnlly neglected' We have rea- son to conclude, from dreadful experience, that Eu- ropean plans do not suit us. Our countrymen have distinguished themsehes in the cultivation of the arts and science* generally ; and here is the widest field for ciiltivation, that has at any urre presented itself. I have ventured to otTer some new ideas, from my own experience. 1 with the opinions I have advanced to be proven and a sxslem established, adapted to our own luuntiy, and for the common benefit of makind. FINIS. ErT*lum,-r-U the first page of the Preface, lQth li*e from the bot'om, lor modes read mode. ■''"g* 24. 16ta lint b«m ihe top, for mates read mates. V-i- 41, i5th lute noin the top lor visctus read uncus. M