“Army doctors paint a sorry picture of grim hospitals and desperate shortages.”

By Martin Howard

THE AMERICAN Revolutionary War has been very well documented, but surprisingly little has been written on the role of medical services during the conflict, particularly those of the armies of the rebellion. In fact, at the outset of hostilities, there was no medical arm of the Continental Army; patriot soldiers at the battles of Lexington and Concord paid local doctors to treat their wounds. Yet, with Washington’s vital patronage, a proper service took shape remarkably quickly.

America’s first foray into military medicine followed European lines with regimental surgeons in the field and doctors staffing the general hospitals. Progress was only slowed by Congress’s weak financial support, confusion regarding the command structure, and vitriolic feuding between senior army doctors.

When the competent Dr. John Cochran became surgeon general of the Continental army in January 1781, he still faced considerable challenges, including a shortage of surgeons and medical supplies. The fourth officer to hold the post, his corps would face one of its greatest tests at the Battle of Yorktown.  

The medical department’s performance at the battle reveals both the significant improvements made and the unresolved shortcomings. Also, the campaign is a reminder that the spread of infectious disease was not always entirely a matter of chance.

The combined American and French forces of Washington and Comte de Rochambeau at Yorktown were more than twice the size of Charles Cornwallis’ besieged Anglo-German army. Despite Franco-American numeric superiority, an immediate assault was nevertheless judged to be impractical. The attackers instead employed the traditional arts of siege warfare, digging trenches, saps and parallels out of the Virginia soil. The fate of the British and German garrison was sealed.

Sorties against the rebel lines on October 16 and 17 saved the King’s besieged forces only a little honour. By October 19, Cornwallis marched his troops out from behind their ruined ramparts at Yorktown to surrender. The British brigadier Charles O’Hara performed the grim duty of finalizing the terms; Cornwallis claimed to be ill and remained in his tent. Washington refused O’Hara’s sword, directing him instead to General Benjamin Lincoln, the American second-in-command.

The British and Hessian defenders suffered around 500 casualties at Yorktown. The attackers lost about 700 men. John Cochran remained on the banks of the Hudson and Dr James Craik took control of the Continental Army medical department.  The Scottish-born Craik had served with the Redcoats in the French and Indian War. He was ordered to keep close to Washington’s trusted French officer the Marquis de Lafayette ‘to pay the first attention to him, in case he should be wounded’. The extent to which this restrictive instruction impeded his wider duties is uncertain.

The American medical provision at Yorktown included a mobile medical unit known as a flying hospital. Contemporary maps show a field hospital as well. General hospitals had been opened at the Governor’s Palace in Williamsburg, and in two nearby churches. The Vineyard Hospital was outside the town and there was also a facility at Hanover.

During the siege, the hospitals at Williamsburg were the responsibility of Dr. Thomas Tucker but after the surrender, Dr. James Tilton was left in charge of the American sick and wounded. There were approximately 400 inpatients at Williamsburg and more than 200 at Hanover.

Regimental Surgeon James Thacher provides the best eyewitness account of the American medical services during the siege.

The following is his journal entry for October 7:

Every officer and soldier knowing his particular station, orders were given to advance in perfect silence, the distance about one mile. My station on this occasion was with Dr. [Aeneas] Munson, my mate, in the rear of the troops; and as the music was not to be employed, about twenty drummers and fifers were put under my charge to assist me in case of having wounded men to attend. I put into the hands of a drummer… my instruments, bandages, & c., with a positive order to keep at my elbow, and not lose sight of me a moment; it was not long, however, before I found to my astonishment that he had left me, and gone in pursuit of some rum, carrying off the articles which are indispensable in time of action. In this very unpleasant predicament, unwilling to trust another, I hastened with all speed to the hospital, about one mile, to procure another supply from Dr. Craik; and he desired that if the Marquis de la Fayette should be wounded, I would devote to him my first attention. On my return I found Dr. Munson and my party waiting, but the troops had marched on, and we knew not their route. We were obliged to follow at random, and in the darkness of the night, hazarding our approach to the enemy. Having advanced about half a mile, of a sudden a party of armed men in white uniform rose from the ground and ordered us to stop; they proved to be the rear-guard of the French. The officer demanded the countersign, which I was unable to give, and as we could not understand each other’s language, I was detained under considerable embarrassment till an officer who could speak English was called, when producing my instruments and bandages, and assuring the French officer that I was a surgeon to the infantry, he politely conducted me to my station.

Thacher later attended the hospital, most likely the field or flying facility, where he dressed wounds and amputated a man’s arm.

We have no good eyewitness accounts of the functioning of the British medical department at the siege. The medical officers, present at the surrender, perhaps wished to forget their involvement in the debacle.

Malaria and dysentery were the commonest diseases in the Continental Army. A return for October shows a total of 1,815 men sick or wounded in the American general hospitals. The rate of infection was so striking that accusations of biological warfare resurfaced at Yorktown.

As early as June 1781, American soldiers suspected that Cornwallis’s retreating army was using the smallpox-infected Black population to propagate the disease. Josiah Atkins’ regiment was pursuing the British near Richmond. He saw the dead by the side of the road, their bodies “putrefying with the smallpox.” Cornwallis, Atkins believed, had inoculated up to 500 Black inhabitants to spread the disease through the country. In early October, James Thacher makes the same allegation. Washington advised his soldiers to avoid communicating with the locals.

“Our ungenerous enemy, [has], as usual, propagated the smallpox,” he wrote.

Was this a malicious design or an inevitable consequence of the war? The British might have argued that it was impossible for them to support so many camp-followers and that the American charges were propaganda.

A letter written by British General Alexander Leslie to Cornwallis from Portsmouth in July 1781 is not conclusive, but it does suggest a degree of intent. Leslie admits deliberately sending 700 smallpox victims to rebel owned plantations.

The assertion of an American historian that after Yorktown the Continental army marched away and the sick and wounded were “practically abandoned” may be exaggerated but, at the end of the war, the American medical services were still compromised by many of the deficiencies first experienced in 1776. Army doctors paint a sorry picture of grim hospitals and desperate shortages.

Washington had remained highly supportive of the medical department through the years of fighting, and he was well informed at Yorktown. Two days before the British surrender, he wrote to a local governor telling him that the number of sick and wounded was increasing so fast as to exhaust the room necessary for their “cover and conveniences.” At his moment of victory, the American commander could only hope that captured funds would allow the necessary improvements.

Martin Howard is the author of The Fevered Fight: Medical History of the American Revolution, 1775-1783. A former hospital consultant and honorary visiting professor at the University of York in the United Kingdom, he is a Fellow of the Royal Colleges of Physicians and Pathologists, and of the Royal Historical Society. His main interest is 18th- and 19th-century warfare, with a particular focus on the human dimension of these conflicts and the lesser-known campaigns.