Curing the Continental Army's IIIs: Declaration of Independence signer, noted physician, teacher, and political writer Benjamin Rush led the reform of many medical problems in the Continental Army.

Wartime hospitals are rarely the epitome of cleanliness and organization. The popular TV show M.A.S.H. fairly accurately depicted a Korean War field hospital where a group of doctors never got enough sleep, never had enough supplies, and never had enough help. If conditions were like this in the early 1950s, think what they must have been like about two centuries earlier, during the American War for Independence.

   I have made a discovery--a sure
   and certain method of destroying
   Howe's whole army without
   powder or ball or without any
   of the common implements of
   death. Lead them through any of
   the villages in Lancaster county
   where we have a hospital, and I
   will ensure you that in six weeks
   there shall not be a man of them
   alive or fit for duty.

These sarcastic words were penned by Benjamin Rush, then Physician General of the Continental Army's Middle [Medical] Department, to General Nathanael Greene in 1777.

Some of the army's medical department's woes were due to circumstances outside the army's control, such as the fact that the New York permanent hospital was in the hands of the British, and for a time there was only one other permanent hospital, located in Philadelphia. Medical supplies and funding were scarce; there were few instruments or hospital beds. "Hospitals" were often hastily erected shacks with dirt floors, poor ventilation, and virtually no heat. Oftentimes, the wounded and ill were crowded into a house, tavern, church, or barn, where as one historian put it, "if a man didn't have a disease when he entered the hospital, his floormates soon provided him with one."

Dr. James Thacher, a surgeon during the American War for Independence, wrote in his Military Journal During the American Revolutionary War: "The suffering of the poor soldiers can scarcely be described.... [A]t night they now have a bed of straw on the ground, and a single blanket each." He wrote further: "It has been estimated, that the loss of lives [from all causes] in the various armies of the United States, during the war, is not less than seventy thousand." Louis C. Duncan, who studied smallpox and other diseases during the American War for Independence, used Thacher's figure of 70,000 for total deaths, and subtracted from that the estimated 1,000 soldiers who were killed in battle or died of wounds each year, to conclude that "ten men died of disease to every one whose life was taken by the enemy."

Exposing Medical Corruption

Rush entered the army as first surgeon general and soon became physician general. He saw much unnecessary loss of life that was caused by inadequate organization, wanton profiteering, and nonexistent discipline. And when Rush saw something he disagreed with, he wasted no time in making sure everyone knew about the problems. He was a prolific and witty writer, a signer of the Declaration of Independence, a friend of Thomas Paine, Benjamin Franklin, John Adams, and other notable Americans--and a capable physician of his day.

Rush personally attended the wounded on the battlefields of the second battle of Trenton and at Brandywine, where he saw firsthand how bad the conditions at the hospitals were. In an attempt to remedy the problems he found, Rush wrote several letters--first to General Greene, then to John Adams, then to Congressman William Duer from New York. "'Our hospital affairs grow worse and worse," he wrote to Adams. "The fault is both in the establishment and in the Director General. He is both ignorant and negligent of his duty." Here he was referring to several evils. One was the inadequate staffing of the medical department. At that time, a hospital plan for an army of 20,000 men called for only a single director general, one chief physician, a mere four surgeons, twenty surgeon's assistants, one apothecary, two men in charge of materials, and one nurse for every ten patients.

A second problem, according to Rush, was that the director general, Billy Shippen, Jr., was also purveyor general, who was in charge of furnishing supplies. Rush thought this concentrated too much power in the hands of one man. Indeed, Shippen, who rarely set foot anywhere near a wounded or sick soldier, was accused of plundering medical supplies for his own profit. Eventually Shippen was court-martialed, but he was acquitted, even though the court record stated that "doctor Shippen did speculate in and sell hospital stores, that is, stores proper for hospitals, whilst he was purveyor general: which conduct they consider highly improper, and justly reprehensible."

Getting no action from his original letters, Rush then wrote directly to General Washington, telling him of the dangers and overcrowding in the hospitals, the inefficiency of the medical department's organization and all-powerful director general, and the lack of discipline and safety precautions. The latter problem resulted in patients wandering about the town getting drunk and spreading disease, not to mention trading what little clothing they had for liquor. Rush closed his letter to Washington with these words: "If these reforms are carried out, I am sure it will add 3,000 men to your army in the spring who must otherwise perish in our hospitals." Washington did dispatch a special field officer to visit all the principal hospitals and to set up disciplinary regiments at once, but then simply passed the letter on to Congress, which sided with Shippen.

Rush, although a talented doctor, teacher and writer, was also impetuous and hotheaded. When Congress refused to dismiss Shippen, Rush resigned from the Continental Army. But he left behind a legacy that would eventually bear fruit.

In 1780, Congress finally took Rush's suggestions to heart and separated the administrative and supply functions of the director general. They also gave more authority to the physicians and officers in charge of the hospitals and required a more accurate accounting of finances and figures on the number of sick and the dead.

Spearheading Reform

Besides successfully, although belatedly, creating a better organized military medical department, Rush also contributed to the more immediate needs of Washington's troops' health. After touring some of the military camps and hospitals soon after his commission, Rush saw that ignorance of preventive medicine was leading to disease and ill health among the soldiers. He therefore took the opportunity to publish an article in the Pennsylvania Packet, entitled "Directions for Preserving the Health of Soldiers, Addressed to the Officers of the Army of the United States." This article soon came to the attention of General Greene, and on September 5, 1777, the following was noted in the Board of War minutes:

   Ordered, that Dr. B. Rush be requested
   to republish, in a small pamphlet,
   certain Directions for preserving the
   Health of Soldiers; published in the
   Pennsylvania Packet, No. 284, with
   such additions and alterations as he
   shall think proper.

In his pamphlet, Rush made points that might seem obvious to us today, but at the time were pioneering thoughts in American military hygiene. Rush's main point was that a soldier does not contract diseases specific to being a soldier. He contracts the same diseases that afflict civilians, but "through overcrowding and lack of simple sanitation, his death rate is much higher."

The preface of the pamphlet gives ample evidence of Rush's talents, not only as a doctor, but also as an emphatic and fervent writer:

   Fatal experience has taught the people
   of America that a greater proportion
   of men have perished with sickness
   in our armies than have fallen by
   the sword.... The gallant youth who
   had torn himself from the arms of
   his parents, or the partner of his joys,
   who had plighted his life to his country
   in the field, and who perhaps, in
   the enthusiasm of his military ardor,
   has courted death from a musket or a
   cannon ball, was often forced from
   the scene of action and glory by the
   attack of a fever, and obliged to languish
   for days or weeks in a hospital;
   and, at last, to close his eyes, deprived
   of the sweet consolation of a dying
   soldier, the thoughts of ending his life
   in the arms of victory, or in an act of
   just resentment against the enemies
   of the liberties of his country.

After this moving opening, Rush went on to suggest five categories of health: dress, diet, cleanliness, encampments, and exercise. We might smile at Rush's directive that soldiers wear their hair "thin and short in the neck," but in his day, many soldiers had long hair--with attendant lice and disease. Regarding diet, Rush waxed eloquent on the evils associated with drinking "spirituous liquors" (rum). He also proposed replacing rum with water laced with vinegar, claiming such a habit "effectually resists that tendency to putrefaction, to which heat and labour dispose the fluids." Interestingly, General Francis Marion, the "Swamp Fox," who routinely drank vinegar-water, was very rarely sick. One possible reason why this worked may be that the consumption of vinegar causes perspiration to smell like vinegar--and mosquitoes, the carrier of many illnesses, are repelled by it. Rush, like the rest of the doctors of his day, didn't understand that diseases were caused by bacteria, parasites, and other organisms--but his powers of observation enabled him to often get the answer right even if his reasoning was erroneous.

Regarding cleanliness, Rush was adamant. "If soldiers grew as speedily and spontaneously as blades of grass on the continent of America, the want of cleanliness would reduce them in two or three campaigns to a handful of men," wrote Rush. He encouraged frequent hand washing and baths, changes of clothes, and careful dishwashing, as well as airing blankets in the sun daily.

It seems Rush would hardly have to mention keeping animal excrement, dead bodies, and other filth out of the encampment. But, on the contrary, even Washington himself had once penned a reproach to some of his officers, ordering them to clean up their camp and adhere to regulations regarding cleanliness. The missive started off as follows: "The Commander-in-Chief: Out of tender regard for ye lives & health of his brave Soldiery, and with surprise that so little attention is paid to his orders, He again in ye most positive terms, orders & commands...."

Rush also advised against setting up camp near swamps and marshes. Although he incorrectly reasoned that such wet areas produced "miasma" and fevers by their very essence, his advice was good. The fewer mosquitoes in camp, the less the chance of outbreaks of yellow fever and other diseases carried by the insects. And finally, Rush noted that "idleness is the bane of a soldier." He recommended regular exercise, because "our soldiers pass from the extremes of labour to the extremes of idleness, than which nothing can be more destructive to the lives of men."

Rush concluded his "Directions" by appealing to logic:

But if it be meritorious to save the lives of soldiers by skill and attention in the field, why should it be thought less so to preserve them by skill and attention of another kind in a march, or an encampment? And on the contrary, if it be criminal in an officer to sacrifice the lives of thousands by his temerity in a battle, why should it be thought less so to sacrifice twice their number in a hospital, by his negligence?

Legacy

Benjamin Rush spent only 10 months in the Continental Army. However, in those 10 months he sowed the seeds of much-needed reform throughout the U.S. military medical department. His "Directions" pamphlet, for example, was used by the military medical service in the War of 1812, and in 1865 the Massachusetts Temperance Alliance reprinted the text for distribution to Union soldiers.

Even after the War for Independence, Rush maintained an interest in the organization of the army's medical department. In 1798, he wrote to the newly appointed Physician General of the Army of the United States, Dr. James Craik:

   I admit with General Washington
   ... that the physician general of an
   army "should be one of the limbs of
   a commander in chief." ... No order
   for marching, encamping, eating,
   drinking, or even fighting (as far as it
   relates to the time of a battle) should
   be issued without his knowledge or
   concurrence. [Emphasis in original.]

Rush was cutting straight to the heart of a matter that has been a point of contention ever since. According to The Evolution of Preventive Medicine in the United States Army 1607-1939 (by Stanhope Bayne-Jones, M.D., published by the Office of the Surgeon General Department of the Army), involving the physician general in all major decision making was "neglected or disapproved at various times" and was bitterly disputed.

Besides his efforts on behalf of the soldier, Rush is famous for much more--his was the first name entered into the Medical Hall of Fame, he helped found five universities and colleges, he suggested to Thomas Paine the title of his famous work, Common Sense, and he worked selflessly during Philadelphia's yellow fever epidemic of 1793. He was also a member of the Pennsylvania state convention that ratified the U.S. Constitution, was a member of nearly every medical, literary, and benevolent institution in the U.S. (as well as of several foreign societies), taught chemistry at the first medical school in America, and is considered the "father of American psychiatry" in honor of his pioneering and sympathetic work with the mentally disturbed patients at the Philadelphia hospital.

Like any human, he was also disliked and ridiculed by many who disagreed with him. Some of the criticism was merited: he was prone to rush ahead with things without considering consequences, and he could sometimes be indiscreet and somewhat rash in his own criticisms of people--including even General Washington, although they later mended fences. Some contemporaries harshly criticized Rush's belief in the benefits of "bleeding and purging" as cures, although their alternatives were hardly more effective.

But despite having made enemies through his fearless writing and bullheadedness, Rush was an esteemed physician and friend of many--both rich and poor alike. John Adams wrote to Rush's son, Richard, the following eulogy: "[I]n the estimation of unprejudiced philosophy, he has done more good in this world than Franklin and Washington." Thomas Jefferson had similar sentiments, writing to Adams: "Another of our friends of seventy-six is gone, my dear Sir, another of the co-signers of the Independence of our country. And a better man than Rush could not have left us, more benevolent more learned of finer genius, or more honest."

RELATED ARTICLE: A founder weighs in.

In addition to his endeavors in many professional fields, Benjamin Rush authored treatises on many different subjects throughout his lifetime. In the early 1770s, he wrote copiously about colonial rights and the evils of tyranny. Later, he turned his attention to slavery, education and discipline, religion, the death penalty, morality, Pennsylvanian commerce and social structure, botany, and more. Rush especially devoted time to trying to assure that American society was grounded in strong Christian ethics. This is important to note because the Supreme Court is presently considering the legality of allowing religious symbols to be located in public places and because Rush was a Founding Father whose views ought to be considered by the court.

Rush very clearly remarked on this issue. He recommended to have the following inscribed over the doors of "every State and Court house in the United States": "The Son of Man came into the world, not to destroy men's lives, but to save them."

Similarly, Rush encouraged the reading of religious material as a guide for governmental governance: "I maintain that there is no book of its size in the whole world that contains half so much useful knowledge for the government of states or the direction of the affairs of individuals as the Bible." He also pointed out that "the Bible, when not read in schools, is seldom read in any subsequent period of life," again insinuating that religion was never meant to be stripped out of public institutions.

He also made commentary on prayer in schools: "I beg leave to remark that the only foundation for a useful education in a republic is to be laid in religion. Without this, there can be no virtue, and without virtue there can be no liberty, and liberty is the object and life of all republican governments."

Rush did not restrict his Christianity and ethics to mere writing--he lived what he wrote. According to Charles Goodrich's Lives of the Signers to the Declaration of Independence, Rush prayed both with his family and alone, attended church regularly, and devoted much of his medical practice to the treatment and betterment of the poor. In defense of church attendance, he wrote, "Rest from labor in the house of God winds up the machine of both soul and body better than any thing else, and thereby invigorates it for the labors and duties of the ensuing week." Even his last words on his deathbed spoke of Rush's lifelong devotion to Christian principles: "Be indulgent to the poor," he told his son, Dr. James Rush.

--JODIE GILMORE