THE ORIGINS OF M.A.S.H. 

Richard Hornberger at his MASH unit
(Wikipedia)

         In 1968 Richard Hornberger MD published a novel under the pen name of Richard Hooker, entitled MASH. It was a darkly humorous account of life in a mobile surgical unit during the Korean War. The book was the basis for a Hollywood movie and a long-running television series. Hornberger was part of the Mobile Army Surgical Hospital (MASH) unit 8055, one of several active during the Korean War. 

         Care of the wounded had concerned armies for years, especially since the introduction of firearms and canons, weapons that shatter flesh and bone. In earlier times, armies retrieved the wounded at the end of a battle, or, if in retreat, perhaps not at all. During the Napoleonic wars, the French military surgeon, Dominique Jean Larrey, sought to rescue wounded rapidly. He advocated early amputation to avoid infection, gangrene, and excess bleeding. He

Artist rendition of Larrey's "flying ambulance"
(Wikipedia)

created a “flying ambulance” service, employing horse-drawn wagons to transport the wounded to nearby surgical stations close to combat.  His prompt surgery improved survival rates and, knowing that rescue was available, troops felt protected.

         The American Civil War saw an extension of this concept. In early battles, wounded Union soldiers received almost no medical attention. A new Surgeon General, William Hammond, appointed Joshua Letterman, a physician with several years of experience in the west, Medical

Letterman, seated, left, at camp (Wikipedia)

Director of the Army of the Potomac. Letterman established a system of ambulances, similar to that created by Larrey, to transport wounded to nearby hospitals. Importantly, he insisted that the ambulances be strictly under the medical services to avoid any requisitioning of horses and supplies by regular army officers.

         When the U.S. entered World War One, the military organized “evacuation hospitals” 9-15 miles behind the fighting for major surgery and “field hospitals” closer to the lines for lighter injuries and immediate life-saving measures. Before long the Americans noticed a French innovation, consisting of two mobile units, the auto-chir and the groupe complémentaire. These were mobile surgical and hospital units transported by trucks that could be assembled (and disassembled) rapidly near fighting areas, forerunners of MASH. The Surgeon General of the Army approved the units for American use and Yale’s medical center staffed the first functioning one, Hospital #39, in late 1917. It included X-ray and sterilization equipment, generators, surgical instruments and personnel. Other units followed.

U S Mobile Hospital #39, Yale Unit, WWI (National Library of Medicine)

U S Mobile Hospital #2, WWI (from The Medical Department of the United States Army
 in the World War, vol 8. Internet Archive)

         During the interwar years the country lost interest in military affairs and the army medical service dwindled. When America entered WWII the relatively immobile field hospitals, requiring lengthy evacuation of wounded soldiers, were reestablished. The surgeon general asked the surgeon, Col. Michael DeBakey, and other consultants to devise a better system. Their recommendations gave birth to “auxiliary surgical groups” (ASGs), mobile units that resembled WWI units but were more mechanized and rapid, saving more lives. The first ASG supported troops in North Africa, and several were deployed during the Normandy invasion.

Setting up field hospital, WWII (Medical Department, United States Army: Surgery
 in WWII, v. 1, Internet Archive)

         After WWII, the Army organized five similar units, now named Mobil Army Surgical Hospital (MASH), three in the U.S. and two in Germany. Though most were still on paper, the plans called for 60-bed hospitals with greater mobility, equipped with radiology, pharmacy, operating rooms, a post-op area, and adequate personnel.

         In June 1950, the Korean War suddenly exploded. Both U. S. and U.N. troops from other nations suffered severe casualties. The semi-functional MASH units swung into action, the 8063rd arriving in Korea first. Overwhelming numbers of wounded forced the units to enlarge bed capacity from 60 to over 200 beds. Triage was instituted in battalion aide stations near the combat zone followed by a second triage at the MASH units. Inexperience at the aide stations cost lives at first, relieved by assigning more experienced medics who could place tourniquets and chest tubes. Another innovation accelerated evacuation even more: helicopters. The H-13 was the workhorse, on which the wounded were placed on skids outside the helicopter for “medevac” to MASH units or to hospitals further back, sometimes giving transfusions during flight.

M.A.S.H. unit, Korea. Note multiple operating tables. (from The Medics' War, public domain)

         As Hornberger put it in an interview, the work was “meatball surgery,” patchwork operations to save a life or limb, with further repair/rehabilitation to be done further away. Dr. Otto Apel left a memoir of his time with the 8067th MASH. Although he relates humorous moments, he found little joy (and much satisfaction) in working around the clock with mangled bodies and broken bones, followed by periods of idleness. His fellow surgeons generally entered as draftees from internships or residencies and learned battle surgery “on the job.” But they learned quickly and the MASH system saved many a life and limb.

         Important innovations germinated in MASH units. Because of hemorrhage and unstable blood pressure, ether and chloroform for anesthesia gave way to nitrous oxide, thiopental, and opiates. Blood remained the main stabilizer of blood pressure. An extensive blood bank system developed to meet the high demand. Winter subzero temperatures made frostbite a serious problem, stimulating improved methods of care to save feet. Nonsurgical problems, such as dysentery, malaria, and hemorrhagic fever (from Hantaan virus, a new disease to U.S. medics) filled many beds and required new therapies and preventive measures.

         Probably the greatest surgical advance in MASH units was the repair of torn blood vessels, seldom performed in the past. Talented surgeons close to the action, using instruments designed for less delicate procedures, sectioned veins to repair severed arteries and restore vital blood to arms and legs that in prior wars would have been lost from delay. A new specialty, vascular surgery, was born. 

         Rescue and treatment of the war wounded began over 200 years ago, eventually developing into the MASH units of the 1950s, and has continued to evolve in more recent conflicts.

H 13 Helicopter. Note runners on which patients were placed for flight (Wikipedia)

 

SOURCES:

Apel O F and Opel P, MASH: An Army Surgeon in Korea. 1998, University Press of Kentucky.

 

King B and Matoi I, “The Mobile Army Surgical Hospital: A Military and Surgical Legacy.” 2005; J Nat Medical Assoc 97 (5): 648-56.

 

DeBakey M, “Military Surgery in World War II: A Backward Glance and Forward Look.” 1947; New Eng J Med 236 (10): 341-50.

 

Robb J C, “Baron Larrey (1766-1842): Napoleon’s Chief Surgeon and His Times.” 1952; Ulster Med J21 (2): 101-13.

 

McGaugh S, Surgeon in Blue: Jonathan Letterman, the Civil War Doctor who Pioneered Battlefield Care. 2013; Arcade Publishing, NY

 

Hooker R, M*A*S*H* A Novel about Three Army Doctors. 1996; Harper Collins.

 

Planer R, “MASH: Advances in Treatment and Triage during the Korean War.” 2024; Chronos: The Undergraduate History Journal 5 (1): 69-88.

 

Woodard C, “Forward Surgery in the Koren War: The Mobile Army Surgical Hospitals.” Chapter 7 in: Steahly, L P and Cannon, D W, eds, The Evolution of Forward Surgery in the U.S. Army. 2018; Borden Institute, Fort Sam Houston.

 

 Helling, T S, “First World War Catalyzes Forward Surgical Care.” 2023; Bull Amer Coll Surg 108 (11). Accessed at: https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2023/november-december-2023-volume-108-issue-11/first-world-war-catalyzes-forward-surgical-care/

 

Lynch C, Ford J H, Weed F W, eds, The Medical Department of the United States Army in the World War. Vol 3, chap 5, pp 184-207.

 

Cowdrey, A E, The Medics’ War. 1987; Center of Military History, U S Army, Washington.

 

A full index of past essays is available at:https://museumofmedicalhistory.org/j-gordon-frierson%2C-md

 

 

 

 

         

 

 

  XAVIER BICHAT COMES TO

AMERICA

 

         Revolution erupted in France in 1789, the same year that the newly independent Americans inaugurated George Washington as their first president. The uprising had a great effect on the world of medicine. By 1793 the National Convention, the revolution’s governing body, had abolished all eighteen medical schools and all fifteen surgical colleges as elitest institutions. Enmeshed in civil wars and wars abroad, the nation suffered high casualty rates (medical personnel included) and multiple epidemics. Demands went out for additional doctors and surgeons, but the schools to provide them were closed, forcing the military to begin direct teaching of apprentices in their own hospitals.

Pierre-Joseph Desault (Wikipedia)

         Compelled to modify their egalitarian views, the Convention established three new medical schools, one of them in Paris. In Paris, the city’s exceptional surgeon, Pierre-Joseph Desault at the Hotel Dieu hospital, became the new Professor of Clinical Surgery and Jean-Nicolas Corvisart the new Professor of Clinical Medicine. Hospitals were now the classrooms, and promotions were earned by competitive examinations. “…little reading, much seeing and much doing will be the foundation of the new teaching,” wrote one planner (Fourcroy).

       A young medical student, Xavier Bichat, born in a village near Lyons in 1771, moved to Paris in 1794, where he enrolled as an apprentice on the service of Desault at the Hotel Dieu. Bichat displayed such intelligence and energy that Desault brought him into his home and encouraged his career. 

Xavier Bichat (etching made from a
deathmask, in Additions to the General
Anatomy of Xavier Bichat. Internet
Archive)

Tragically, Desault died one year later, but Bichat worked on, focusing on anatomy. He taught courses and performed thousands of autopsies. His brilliance and originality in formulating a new approach to anatomy impressed both colleagues and students. Bichat, acknowledging antecedent ideas obtained from Philippe Pinel (see blog essay of Nov 2024), identified 21 different tissues in the body, such as serous tissue, lymph tissue, nervous tissue, etc., studying their properties in detail by submitting them to boiling, acids, digestion, chemicals, animal experimentation, and more. His first publication, Traité des Membranes, outlined the new approach.  His major work, Anatomie Générale Appliquée à la Physiologie et à la Médecine, in three volumes, followed in 1801, summarizing his new conception of anatomical study. For example, “carditis” could now be reclassified as pericarditis, myocarditis, or endocarditis. By studying physical properties of the tissues, Bichat also joined anatomy with physiology, form with function. His final work, Anatomie Descriptive, summarized this approach and related clinical symptoms with postmortem findings. Subsequent French contributions to physical diagnosis and the invention of the stethoscope added support to the new clinical-pathologic method.

Hotel Dieu, 1750 (Wikipedia) Despite appearances, inside it was dirty and overcrowded.

 Bichat’s prodigious output was tragically cut short in 1802 by his death from a rapidly progressive, undiagnosed illness. He was 30 years old, yet he had established a new view of anatomy and physiology and proved the value of postmortem findings in documenting disease evolution.

         Back in the new United States, few doctors spoke French and only a small number had studied medicine in Europe. Many, however, were aware of new trends in medicine in France and the need for improved medical education in America. They welcomed English translations of European writings. 

A Boston surgeon, George Hayward, whose name has escaped much notice, began a translation of the Anatomie Général. Hayward, a graduate of Harvard Medical School, had visited surgeons in England and spent the winter of 1812-3 in Paris, before most

George Hayward (Wikipedia)

American physicians made the journey and before Laennec introduced the stethoscope. Hayward was next in seniority to John Collins Warren at the Massachusetts General Hospital. He was present when Warren performed the first operation under ether anesthesia in October 1846 - the removal of a small tumor from the neck. A few days later, Hayward was the first to perform a major operation under ether – the above-knee amputation of a leg of a young woman.

    Hayward’s reputation also rests on another procedure: repair of vesicovaginal fistula. A tear in the bladder wall resulting from a prolonged labor produced this miserable condition that condemned the sufferer to permanent leakage of urine from the vagina. Hayward was the first to report a successful repair (1839). He later reported several other cases with generally good results (1851). Hayward’s case preceded the publications of J. Marion Sims, usually credited with inventing the procedure. Sims perfected his technique on enslaved women from 1845-9.

Photo of reenacted first operation under ether 
Present are: John Collins Warren, George Hayward, Solomon Townsend, John Mason Warren, James Johnson, a Mr. Holman, Morton, and 2 others. Faces not paired with names. (Library of Congress)

 That Hayward’s name is less well-known is possibly due to his reticent character in comparison to the self-promoting Sims. As Hayward’s obituary notes, “Disgusted with the too frequent hollowness of posthumous eulogy, he scrupulously destroyed everything that might lead to it… The future biographer may therefore lament the loss of valuable documents…”

Hayward halted the translation Bichat’s work when he learned of a translation underway in England. After six years with no British results, in 1822 he completed the three volumes, reviewed favorably as faithful to the original meaning. In 1823 he translated a subsequent volume, Additions to the General anatomy of Xavier Bichat by P. A. Beclard. 

Hayward was not the first to bring Bichat’s teachings to America. Dr. John Gorham Coffin, a Boston physician and medical educator, in 1813 translated Bichat’s Traité des Membranes. Coffin was a founder the Boston Medical Intelligencer in 1823, an early journal that five years later merged with a precursor to the New England Journal of Medicine. 

Additionally, a prominent Maryland physician, Tobias Watkins, had translated Bichat’s Recherches physiologiques sur la vie et la mort in 1809. Watkins founded The Baltimore Medical and Physical Recorder, Maryland’s first medical journal and the fifth in the U.S. 

Many more American physicians traveled to France, soaking up new medical knowledge, their efforts enhanced by available translations. Medical education at home continued to improve, though sluggishly, aided by the valuable "French connection".

 

SOURCES:

Haigh, E, “The Life of a Young Physician.” 1984; Med Hist Suppl (4): 2-14.

Ackerknecht, E A, Medicine at the Paris Hospital 1794-1848. 1967, Johns Hopkins Hosp. Press.

Vess, D M, Medical Revolution in France 1789-1796. 1975; Univ Presses of Florida.

 

Cofone, L, et al, “Xavier Bichat (1771-1802): Architect of Modern Histology.” 2025; Intl J Morphol43 (5): 1767-70>

Wall, L L, “George Hayward (1791-1863): a Forgotten Pioneer of Reconstructive Surgery.” 2005; Intl Urogynecol J 16: 330-33.

Anon, Review of Hayward’s translation of Bichat. 1822; North American Review 15 (36, July): 132-63.

Perdicoyianni-Paleologou, H, “Xavier Bichat and the Renovation of the

Pathological Anatomy.” 2024; J Med Biog 32 (1): 89-96.

 

Hayward, G, “Remarks on Anesthesia and the Agents Employed to Produce It.” 1859; Boston Med Surg J 61: 319-25.

 

Obituary of George Hayward, 1866; Med Communications Mass Med Soc 10: 342-3.

 

Jones, H W, “A Hospital Inspector's Diary, Being an Account of the Journey of Tobias Watkins…” 1939; Bull Hist Med 7: 210-235.

 

Beecher, H K and Altschule, M D, Medicine at Harvard: The First 300 Years. 1977, Univ Press of New England.

 

Coffin, J G, “A Dissertation on Medical Education and on the Medical Profession”

1822; in Medical dissertations delivered at the annual meetings of the Massachusetts Medical Society, 1829; Massachusetts Medical Society.

A full index of past essays is available at:https://museumofmedicalhistory.org/j-gordon-frierson%2C-md

 

 

 

 

 

 

 

FROM PRISON TO PROMINENCE: A FOUNDER OF

AMERICAN PEDIATRICS

 

         At four o’clock in the morning on July 9, 1853, in Manchester, England, a servant roused a grumbling Friedrich Engels from his bed to greet a shabbily dressed caller. The visitor, Abraham Jacobi, a young German physician of short stature and unkempt hair, produced a letter from Karl Marx asking Engels to accommodate him. Engels, though peeved, found Jacobi lodgings and helped him open a practice in Manchester.

         The disheveled visitor, born in 1830, had received his medical degree at the University of Bonn in 1851. He had been a student radical during the 1848-9 revolution, was part of the communist underground, and knew Karl Marx. His subversive activities had earned him two years in prison, after which he fled to Engels in Manchester.

Abraham Jacobi (from "Festschrift" in honor
of Jacobi, 1900. Internet Archive.)

Dissatisfied with Manchester, Jacobi opted for a try in America. He settled in “Kleindeutschland” (Little Germany), an area in the lower east side of Manhattan, and opened a general practice. German immigration to New York at the time was heavy; only Berlin and Vienna hosted larger German populations. Little Germany was notable for poverty, overcrowding and stifling tenements. Thirty percent of its population was under ten years of age. Many would not reach adulthood.

         Jacobi, true to his communist leanings, also cared for the indigent, established contact with trade unions, and was a contact for Marx. The high child mortality rate convinced Jacobi and his colleagues to view disease as a social and political problem, as their contemporary Rudolf Virchow had proclaimed in Germany. Inadequate sewage disposal, contaminated water and milk, Tammany Hall inaction, and other problems generated malnutrition, epidemics and disproportionate deaths. Finding that older physicians paid little attention, Jacobi and six other 1848-refugee physicians founded their own dispensary and medical association. They reviewed current European medical literature, discussed cases, and wrote articles. Jacobi focused on eliminating adulterated and contaminated milk and water, evils that were killing so many infants.

         Jacobi’s activities and writings caught the eye of the sanitary reformer Elisha Harris and of Stephen Smith, an editor at the New York Journal of Medicine. Smith had helped found

Stephen Smith (Wikipedia)

New York’s Metropolitan Health Board, focused on public health measures. He solicited journal contributions from Jacobi, emphasizing European literature.  Smith’s brother, Job Lewis Smith, was another pioneer in child health who published an early text on childhood diseases in 1869. These contacts brought Jacobi and colleagues into academic circles, such as the New York Academy of Medicine and the New York Pathological Society. The latter elected Jacobi its president in 1864. The newly organized New York Medical College offered Jacobi, in 1860, a chair in diseases of children, the first such appointment in the U.S. (J. Lewis Smith became Clinical Professor of Diseases of Children at the Bellevue Hospital Medical College the following year.) Jacobi instituted bedside teaching, home visits, and attracted patients from surrounding areas. He continued to translate European literature; two journals in Germany already dealt with childhood pathology.  

Text by Job Lewis Smith, 8th ed. 
(Internet Archive)

         He railed against institutional orphanages as death houses. At a large orphanage in New York, Jacobi noted an extremely high mortality. After careful study, he concluded that the institution should be closed. Instead, Jacobi himself was ousted. “The younger the child, the larger the institution, the surer is death,” he said later, pleading for home placement of abandoned children, even in the poorest of homes. In general, Jacobi stressed the preventive nature of the care of children: breast feeding, uncontaminated milk and food, and a clean environment.

         His influence widened. The College of Physicians and Surgeons appointed him Clinical Professor of Diseases of Children in 1870. In 1893, the University of Berlin, forgetting Jacobi’s earlier jail time, offered him the chair of pediatrics when Eduard Henoch, known for the description of Henoch–Schönlein purpura, was retiring. Jacobi preferred the U.S., though, and declined. He was elected president of the American Pediatric Society (which he helped found), president of the New York Academy of Medicine, and, at the age of 82, president of the A.M.A. He helped found the German Hospital, later named the Lenox Hill Hospital, and the pediatric section of the Jewish Hospital, later renamed Mount Sinai Hospital. 

The German Hospital, opened 1869. Renamed Lenox Hill Hospital (Wikipedia)

         His writings, the majority by hand, amounted to hundreds of papers and letters, collected later into eight volumes of over 4000 pages. He wrote a popular text, Therapeutics of Infancy and Childhood and contributed to others. His primary interests focused on safe infant feeding and diphtheria (his only son died of it at age 7). He helped Macy’s owner Nathan Straus set up charitable clean milk stations in New York, a major step in curtailing deaths of young children. He was an early proponent of laryngeal intubation to relieve fatal obstruction of the throat in diphtheria, a technique devised to replace the more dangerous tracheotomy. He continued to see adult patients throughout his life, shunning overspecialization.

Mary Putnam (Wikipedia)

In 1893 he married Dr. Mary Putnam, daughter of the publisher George Palmer Putnam. (Two previous wives had died.) Mary was the first woman to graduate from the École de Médecine, Paris, and the sixth woman in the U.S. with an MD degree. The marriage was a happy one, marred only by the death of their son, Ernst.

         At the age of 88 Jacobi was writing an autobiography in his summer home at Lake George, N.Y. when fire, from which he barely escaped, destroyed the cottage and his remaining papers. He died the following year, 1919.

         At the time of his death virtually all medical schools had established pediatric professorships, children’s hospitals were growing, and research in childhood health and disease was active. From dubious beginnings, Abraham Jacobi had risen to be a celebrated founder of pediatrics in the America he called home.

 

Another example:Thomas Morgan Rotch, first full Professor of
Pediatrics in the U.S. at Harvard Medical School, 1893.
(Wikipedia)

SOURCES:

Leopold, J S, “Abraham Jacobi,” in Veeder, B S, ed., Pediatric Profiles. 1957; C V Mosby.

Nadel, S, Little Germany: Ethnicity, Religion, and Class in New York City, 1845-80. 1990; Univ of Illinois Press.

Halpern, S A, American Pediatrics: The Social Dynamics of Professionalism, 1880-1980. 1988; Univ California Press. Chap. 3.

Cone, T E, History of American Pediatrics. 1979; Little, Brown.

Ligon-Borden, B L, “Abraham Jacobi: Father of American Pediatrics and Advocate for Children’s Health.” Seminars Ped Inf Dis, 2003; 14 (3): 245-9.

Viner, R, “Abraham Jacobi and German Medical Radicalism in Antebellum New York.” Bull Hist Med1998; 72(3): 434-65.

Link, E P, “Abraham and Mary P. Jacobi, Humanitarian Physicians.” J Hist Med All Sci. 1949; 4 (4): 382-92.

Mahnke, E B, “The Growth and Development of a Specialty: The History of Pediatrics.” Clin Pediatrics 2000; 39: 705-14.

Faber, H K, “Job Lewis Smith, Forgotten Pioneer.” J Pediatrics 1963; 63 (4): 794-802.

Truax, R, The Doctors Jacobi. 1952; Little, Brown.

A full index of past essays is available at:https://museumofmedicalhistory.org/j-gordon-frierson%2C-md

 SICKNESS AND MEDICINE AT

VALLEY FORGE

        

         In the late fall of 1777, the outcome of America’s Revolutionary War was uncertain. Washington’s Continental Army had not fared well, and the British had occupied the new nation’s capital, Philadelphia. Washington chose Valley Forge as a place to winter his approximately 12, 500 exhausted troops. The area was situated on an elevated plateau, bordered by rivers and hills for defense.

Diagram of Valley Forge (From Duncan, Medical Men of the 
Revolution, Internet Archive)

 Ample trees provided firewood and small farms dotted the area. And being close to Philadelphia, Washington could keep an eye on the British.

Washington's Army marching to Valley Forge (painting by William Trego. Wikipedia)

         On December 19, the troops marched in over an icy trail in frigid weather. About 2,000 arrived barefoot but the soldiers otherwise in generally good health. Snow blanketed the ground, food supplies were limited, and meat sources sparse. The main fare was “fire cakes,” a mixture of flour and water baked in fire to produce a hard, blackened biscuit. Clothing was threadbare and shoes wearing out. The French patriot, Lafayette, who commanded a division, wrote to his wife that, “The unfortunate soldiers are in want of everything: they have neither coats, hats, shirts, or shoes.” The men shivered in tents until wooden cabins were built, the latter with a fireplace.

Soldier's Hut, reproduction (Wikipedia)

        
         Washington knew the value of health in troops. Early in the war he had insisted that medical officers receive pay comparable to upper-level officers and he restrained army brass from interfering with measures ordered by medical officers. Congress had established the Medical Department of the Army, but chaos ruled in the institution much of the time. The first two medical directors had been dismissed, one on charges of spying for the British. The third, Dr. William Shippen, Jr., a highly educated surgeon and gynecologist,

William Shippen, Surgeon General (Wikipedia)

was medical director during the Valley Forge layover. But disorganization, lack of funds and supplies, constant turnover of personnel, and frequent pilfering continued to hamper the medical-surgical aspect of the war.
        Three available works on military medicine provided information on prevention of “camp diseases,” a major cause of death and disability in armies of the time: Sir John Pringle’s Diseases of the Army, Baron van Swieten’s The Diseases Incident to Armies with the Method of Cure, and John Jones’ manual of military surgery that included a section on preventive measures. Without knowledge of germ theory, all furnished sound advice on preserving troop health.

        Washington ordered hospitals, called “regimental hospitals,” to be built. They housed men with short-lived medical problems, while more serious cases went to a middle stage, the “flying hospital” and the most serious to “general hospitals” outside Valley Forge*. Medical supplies were scarce. As the cold weather ground on, many doctors disappeared on unauthorized leaves, cattle and grain had to be “requisitioned” from local farmers, and soldiers caught fish in the nearby rivers.

Hospital, Valley Forge (from Gillette, The Army Medical 
Department)

         Washington enacted several measures to prevent “camp diseases.” He ordered latrines and holes for fecal matter to be dug at least 200 feet away from living quarters and any man found defecating elsewhere was subject to five lashes. The frosted ground made this difficult and time-consuming, and camps needed to be moved occasionally due to offensive smell. The troops were to wash and shave regularly and launder their scanty clothing. In the hospital, straw from discharged patients was burned and their bedding washed.

Washington (left) and Lafayette at Valley Forge (by John Ward Dunsmore. Wikipedia)

       One of the surgeons, Albigence Waldo, serving since mid-1775, left a diary of his experiences at Valley Forge. The entries in December and January focus on the biting cold weather and scarcity of food. On Christmas day, he writes, “We are still in Tents – when we ought to be in huts – the poor Sick suffer much in Tents this cold Winter. We give them Mutton and Grogg and a Capital Medicine once in a While…. but very few of the sick men die.”
         By mid-January most of the men had left the tents for smoke-filled huts and the hospitals were functioning. Frostbite was common, requiring amputations for many. Respiratory illness, including pneumonia, predominated during cold weather. Simple lack of clothing occasioned three to four thousand men to be reported as unfit for duty. With warmer spring weather, dysentery and “putrid fever,” probably a mixture of typhoid and typhus, appeared. A major problem affecting most of the troops was “the itch,” or scabies. Caused by a small mite, it is highly contagious in close quarters. Constant scratching leads to open sores, secondary abscesses and other infections. Sulfur applications, in lard, along with bathing and laundering of clothing generally resolved it. Venereal disease, as usual, was another problem, though the records do not suggest it as a major one. Scurvy was not recorded, possibly related to large amounts of lime juice ordered.

Schoolhouse converted to a hospital (from Gillette, The
Army Medical Department)

         Washington had seen the devastating effects of smallpox on fighting ability earlier in the war and determined to prevent future cases. All soldiers who had not had smallpox underwent compulsory inoculation with a small amount of material from an active lesion. Many of the roughly 4,000 inoculated soldiers sickened with the disease, creating a great strain on the hospitals, but only 10 died.
         During the stay at Valley Forge, France entered the war as an ally. By April and May 1778, shoes, clothing, and supplies began arriving from French ships. Finally, on June 18 the rehabilitated army left Valley Forge for new maneuvers, in generally good condition, though many were still recovering from inoculated smallpox. The overall mortality for the winter stay is quoted as 3,000 men (out of 12,500), but an accurate figure is not available.
         Life was harsh and uncertain at Valley Forge that winter, but the hygienic measures and smallpox inoculations ordered by George Washington saved many lives.

*The hospital terminology is from Pringle. A quote from the 1775 edition, “Among the chief causes of sickness and mortality in an army, the reader will little expect that I should rank the hospitals themselves…”

 

SOURCES:

Reiss, O, Medicine and the American Revolution. McFarland & Co. 1998.

Gillett, M C, The Army Medical Department 1775-1818. Center of Military History, United States Army. 1981.

Trussell, J B B Jr, Birthplace of an Army: A Study of the Valley Forge Encampment. Pennsylvania Historical and Museum Commission. 1976.

Duncan, L C, Medical Men of the American Revolution, 1775-1783. The Medical Field Service School, Pennsylvania. 1931.

Middleton, W S, “Medicine at Valley Forge.” Ann Med Hist 1941; 3, 3^rd ser (6): 461-486.

Waldo, A, “Valley Forge: 1777-1778, Diary of Surgeon Albigence Waldo, of the Connecticut Line.” Pennsylvania Magazine of History and Biography, 1897; 21 (3): 299-323.

Atkinson, R, The Fate of the Day: The War for America, Fort Ticonderoga to Charleston, 1777-1780.

Pringle, Sir John, Diseases of the Army. 1775; London.

A full index of past essays is available at: https://museumofmedicalhistory.org/j-gordon-frierson%2C-md