Report of Surg. Charles S. Tripler,
Medical Director of the Army of the Potomac,
of the operations of the medical department of that Army
from August 12, 1861, to March 17, 1862.
O.R.-- SERIES I--VOLUME 5 [S# 5]

DETROIT, MICH., February 7, 1863.

Maj. Gen. GEORGE B. MCCLELLAN, U.S. Army.

       GENERAL: In compliance with your instructions, I have the honor to submit the following report of the operations of the medical department of the Army of the Potomac during the time I was connected with it as medical director:
       This time naturally divides itself into two periods: the first embracing the time from the beginning of the organization of that army to that of its taking the field; the second from the latter time to the completion of the change of base to Harrison's Landing, on the James River.
       I joined the Army of the Potomac August 12, 1861, and was immediately charged with the organization of the medical department. At that time the three months' volunteers were mustered out of service, and the new levies were being rapidly assembled in Washington and its vicinity. A number of camps were formed on both sides of the Potomac, and the construction of the field works had been commenced. There were some five or six hotels, seminaries, and infirmaries in Washington and Georgetown occupied as general hospitals, and one or two in Alexandria, the fruits of the exigencies of the three-months' campaign. These were under capable officers, well regulated and well conducted, but with no system in reference to the admission or discharge of patients. Every regimental surgeon sent what men he pleased to the general hospitals, without knowing whether there was room for them or not, and men were discharged from the hospitals with no means provided to insure their return to their regiments. It was not an unusual circumstance for sick men to pass the night in the ambulances, wandering about the streets from hospital to hospital seeking admission. I could find no information anywhere as to what regiments were present or whether they had medical officers or not.
       My first effort was to endeavor to find out who were the medical officers of the several regiments, how the hospital departments were supplied, what was the strength of the regiments, how many of the men were sick, and what were the prevailing diseases. For this purpose I applied for and had an order issued directing all the medical officers to report to me in person without delay. From them I required the other items of information I have indicated. A singular state of things was revealed. In General Orders, No. 25, War Department, May 25, 1861, the President had directed that a surgeon and an assistant surgeon should be appointed for each regiment of volunteers by the governors of their respective States, and that these officers should be examined by a board, to be appointed by the governors, as to their qualifications; the appointments to be subject to the approval of the Secretary of War. The third section of the act of August 6, 1861, required vacancies among the volunteer officers to be filled by the governors in the same manner as the original appointment. Some of the States had promptly appointed these boards, but many others had entirely neglected it. The Secretary of War had also accepted what were termed independent regiments, the colonels of which asserted a right to appoint their own medical officers, and, notwithstanding the act of Congress, to fill vacancies. In other instances colonels of State regiments refused to receive the medical officers appointed in conformity with the law and the orders of the President, and went so far as to put these gentlemen out of their camps by force when they reported in obedience to the orders of the governors and of the headquarters of the Army of the Potomac. The State authorities, especially of New York and Pennsylvania, remonstrated strongly against this course, and I used every effort to arrest it, but in vain. I was at last officially notified, on the 19th of November, 1861, that the medical officers of regiments accepted directly by the Secretary of War had acquired rights that could not be set aside by the governors of the States. These irregularities created great embarrassment and confusion in organizing my department, and many regiments were thus left to take their chances with Surgeons as to whose competency nothing was known.
       In other instances regiments or parts of regiments were sent on without their medical officers, the colonels assuming authority to leave them at home under various pretexts. To meet a case of this kind I addressed the following letter to the surgeon-general of Pennsylvania:

HEADQUARTERS ARMY OF THE POTOMAC,
Medical Director's Office, Washington, September 7, 1861,

       SIR: The First Regiment Pennsylvania Cavalry has sent seven companies to this city without a medical officer. I have the honor to request you will send a duly-commissioned surgeon and assistant to this regiment immediately. I am inferring Dr. Harlan is surgeon, but has never joined the regiment. The surgeons of regiments in the field are intended for service and not for ornament. The Government cannot wait the convenience of Dr. Harlan.

Very respectfully, your obedient servant,
CHAS. S. TRIPLER,
Surgeon and Medical Director Army of the Potomac

H. H. SMITH,
M.D., Surgeon-General of Pennsylvania.

       Another source of embarrassment was, that neither the law nor orders had provided medical officers for batteries or detachments of cavalry.
       In these cases I could only direct that such bodies should be attended to by the medical officers of the regiments nearest to them.
       To remedy the irregular and doubtful appointments made by colonels, and to give the troops confidence in their medical officers, I determined to assemble boards for the examination of all such as rapidly as their cases were brought to my notice. This I did under authority of General Orders, No. 35, War Department, June 20, 1861. September 7, 1861, I assembled such a board and ordered twelve medical officers before it for examination. From that time forward, whenever a medical officer was complained of for incompetency, a board was ordered. In many cases the complaints were ascertained to be well founded and the officers were discharged.
       The third section of the act of July 22, 1861, having provided for a surgeon to each brigade, a board was assembled in Washington to examine candidates for that appointment. A number of the appointees under that act were assigned to duty with the Army of the Potomac. The act had not defined the duties of these officers, nor had any regulation in reference to them emanated from the War Department. Their position was doubtful, and it was necessary to define it. The regimental medical officers were for the most part physicians, taken suddenly from civil life, with no conception whatever of their duties. These had to be taught them from the very alphabet. The line officers were equally ignorant with themselves in this respect, and hence confusion, conflicts of authority, discontent, and very seriously impaired efficiencies in the medical department. The general idea seemed to be that it was the duty of the doctor to physic every man who chose to report sick and to sign such papers as the colonel directed him to sign. To superintend the sanitary condition of the regiment, to call upon the commanding officers to abate nuisances, to take measures for the prevention of disease was in many instances considered impertinent and obtrusive, and the suggestion of the medical officers to those ends were too frequently disregarded and ignored.
       It occurred to me that the brigade surgeons, being very generally taken from those who had seen some service in the three-months' campaign, might be made useful in remedying these evils and in carrying out my views for increasing the efficiency of the department. Bearing the commission of the President, I was of opinion that they were the superior officers of the State surgeons, and had authority to control them in their own department; I therefore assigned these gentlemen to the staffs of the several brigadiers, and prepared an order defining their duties. (See Appendix A.)
       By conversation with the brigade surgeons I endeavored to impress upon them the importance of the trust confided to them, and show them how much the efficiency of the army depended upon the fidelity and success with which they should discharge their duties. Every item of the order was explained to them, and they were urged to be active and zealous in imbuing the regimental surgeons with a thorough understanding and just appreciation of the hygienic suggestions it contained. It was impossible for me to see and instruct such a number of regimental officers as our army included, and I was therefore obliged to rely upon the brigade surgeons to attend to the training of these officers in their routine duties. This arrangement was the most promising I could command, and I hoped its advantages would be readily seen and appreciated; still some were found to place impediments in the way of these officers in the performance of their duties. In reply to a complaint made by one of them I wrote him as follows:

HEADQUARTERS ARMY OF THE POTOMAC,
Medical Director's Office, Washington, September
20, 1861.

       SIR: Your duplicate report, which was very properly made, has been received. The brigade commander will no doubt issue the proper orders to correct the evils which you represent. In relation to your complaint that the colonel of the Thirty-third Pennsylvania Volunteers does not recognize your official relations to him, I have to say that those relations depend upon your commission from the President of the United States and not upon the recognition or non-recognition of any individual officer under the President's command.

Very respectfully, your obedient servant,
CHAS. S. TRIPLER,
Medical Director Army of the Potomac..

Brigade Surgeon PRINCE,
Graham's Brigade.

       I had thus established a hierarchy, which, though imperfect, enabled me to keep myself tolerably well informed of the condition of the medical department of the army. The irregularities prevailing in relation to the sending of men to the general hospitals and discharging them therefrom were corrected by paragraphs 4 to 9 of General Orders, No. 9, Army of Potomac, September 9, 1861. (See Appendix B.)
       In suggesting this order I had also another object in view, to control and to diminish as far as possible the number of men sent from the regimental to the general hospitals. The experience of all armies has shown, and my personal observation has convinced me of the fact, that the sick do much better in these regimental than in the general hospitals. I consider general hospitals general nuisances, to be tolerated only because there are occasions when they are absolutely necessary, as, for instance, when an army is put in motion and cannot transport its sick. It is a singular fact, but one as to which I believe all military surgeons of experience will agree with me, that the sick report of a regiment under ordinary circumstances is a constant quantity; that after a regiment has been in the field a month that quantity will be ascertained, and that if the regimental hospital is evacuated in a short time, it will be found to contain again its habitual number of inmates; so that we may have as many successive crops of sick as we choose by repeating the process of evacuating the regimental upon the general hospitals. A leading object with me was to keep up the fighting force to its maximum, and therefore, as well as for the more speedy recovery of the men themselves, I discouraged the practice of sending them to the general hospitals. If I had permitted the practice I found existing to continue --that of sending men promiscuously and without restraint to the general hospitals--the only limit to the number and extent of these would have been what was required to contain the whole army. I stopped it, and thus kept a healthy army in the field.
       Having thus established some order and system in the personnel of the medical department and some method in instructing the officers in their duties, my attention was turned to the means of keeping them supplied with medicines, instruments, stores, &c. In this I met with many difficulties. The volunteer medical officers being many of them country doctors, accustomed to a village nostrum practice, could not readily change their habits and accommodate themselves to the rigid system of the army in regard to their supplies. To meet this difficulty I attempted within reasonable limits to disregard supply tables, and to give the surgeons articles of medicine and hospital stores to suit even their caprices, if in my judgment such articles could be of any avail in the treatment of disease. In this effort I first felt the inconvenience of being in Washington. The medical purveyor was bound by the regulations, and although my order ought to have been sufficient to have relieved him from all responsibility, still, to be perfectly safe, he would refer such requisitions to the Surgeon-General. The consequence was my orders were countermanded, and I was finally ordered by the general not to issue anything not allowed by the supply table without his sanction, previously obtained.
       The pressure upon the purveyor consequent upon the influx of so large a body of troops caused great delay in the issuing of supplies. Complaints of this delay were made to me as early as the beginning of September. I offered the purveyor more assistance if it would expedite his issues. That officer replied on the 6th of September that "any additional aid to that now employed is unnecessary, and would in nowise facilitate the matter." Subsequently a different conclusion was arrived at, and additional aid was furnished.
       Another difficulty was encountered in getting the supplies to the regiments after they were put up. Ordinarily the purveyor turns over his supplies to the quartermaster, and it is the duty of that officer to transport them to their destination. It was soon perceived that this mode would not answer in the confusion then reigning in Washington. The regular quartermasters were charged with duties considered of more importance, and the volunteer quartermasters did not know how to perform what we required. We were therefore obliged to require the medical officers to call for and transport their own supplies to their camps. Much was accomplished in this way, though in many instances great negligence and indifference were manifested on the part of the surgeons themselves. Another difficulty to overcome was the supplying the regiments with hospital tents. I determined to issue three of these tents to a regiment. These would accommodate comfortably thirty men. The demand for tents and the scarcity of canvas made it necessary to reduce the allowance to the minimum that could be made to suffice. I approved of requisitions for this number whenever they were presented, and I ordered requisitions to be made in all cases where I discovered it had been neglected. These tents, however, were frequently taken by arbitrary authority for other purposes, such as store tents, guard tents, and the like. Whenever an abuse of this sort was brought to my notice I took every means in my power to correct it, and I believe, from the best information I could get, that when the army moved to Fairfax Court-House every regiment in it had its full supply of hospital tents. When the medical officers reported to me I required them to submit to me an inventory of the supplies of all sorts they had on hand. These were carefully revised, and whenever they were defective, requisitions were immediately called to meet the deficiencies. Great difficulty was experienced in enforcing obedience to this simple requirement. By firmness and patience I believe it was overcome, so that I had every assurance short of personal inspection, which was impossible, that nearly every regiment in the army was fully supplied for three months at the time we moved. A few had succeeded in neglecting this duty and escaping the vigilance of the inspectors and brigade surgeons. These applied for issues during the few days we remained at Alexandria after our return from Fairfax. My purveyor was then engaged in packing and shipping his stores for Fort Monroe. Of course I could not arrest this work to remedy the faults of half a dozen idlers.
       My next step was an attempt to improve the condition of the camps, so as to promote the health of the army, by correcting hygienic errors and by removing as far as practicable the causes of disease. On the 19th of August I directed all the prisoners at the Capitol Prison to be vaccinated, a bath to be fitted up for their use, and such outdoor exercise to be allowed them as was consistent with their safe-keeping. On the 22d of August I sent a surgeon to remedy the defects in the police of the camp of the Pennsylvania cavalry, on Seventh street. This camp at the time was a nuisance. On the same day I recommended the removal of the troops encamped upon the flats near Arlington to the higher grounds, if practicable. Thirty-three per cent. of some of the regiments there were reported sick with diarrhea, intermittent, and typhoid fevers. The chief surgeon of McDowell's division, who had been some weeks at Arlington, expressed his doubts to me, in a report on the subject, whether the flats were more insalubrious than the high woodlands of that district. I represented to the Adjutant-General that I acknowledged these doubts to be well founded within certain limits--that malarial fevers do prevail on the slope towards the river--but I thought it practicable to remove the camps beyond the first crest, so as to afford the protection of the hills against infected currents of air. Ascertaining by personal inquiry and inspection that the men were turned out long before sunrise and were hours waiting for their breakfasts, and feeling persuaded that this had much to do with the prevalence of malarial fevers, I asked for and obtained an order that reveille should not be beat till after sunrise, and that hot coffee should be issued to the men immediately after roll-call. Soon after this you directed me to provide a reasonable allowance of cots for the sick in the regimental hospitals. I ordered them to be purchased immediately, and as soon as they were procured I directed the regimental surgeons to send to the purveyor for their quota. Strange to say, I experienced a good deal of difficulty in making these officers send in. As late as December 27 I was obliged to compel some of the surgeons to supply themselves.
       The want of military experience of the medical officers and their consequent helplessness made it extremely difficult to discover the real causes of disease, sometimes the nature of the diseases themselves, and to enforce the means of preventing these when discovered. A week after the hot coffee was ordered a regimental surgeon complained to me that green coffee was issued to his men, without the means of properly roasting it, and that they could not get the "extra" rations ordered. Colonel Clarke, to whom I referred the complaint, promptly replied that green coffee was always issued; that it should be roasted in a mess-pan, or a Dutch-oven, or other vessel, purchased with the company fund; that the quantity issued was fixed by law, and was deemed ample; and so it was, but it required the exercise of a little judgment to discover it. I made constant and diligent inquiries of the surgeons as to their opinion of the causes of disease in their regiments, and whenever an undue proportion of sick was reported in any regiment a special report was invariably called for. If I had had competent inspectors at that time the health of the army might have been more rapidly improved and myself saved much labor and anxiety.
       First among the causes assigned for the numbers on the sick report, and the one as to which there was a general concurrence of opinion, was the recklessness with which the men had been enlisted. General Orders, No. 51, War Department, August 3, 1861, commanded that when volunteers were mustered in they should be minutely examined by the surgeon and assistant surgeon of the regiment as to their physical qualifications. I doubt whether this most important order has ever received the slightest attention from the persons whose duty it was to execute it. So notorious was the neglect of its behests, or the incompetency of those who pretended to obey it, that another general order from the same authority was demanded and issued December 3 of the same year, which declares that the evidence was abundant that this duty was neglected, and threatens to make the derelict officers pecuniarily responsible for it if not amended. The effect of this neglect, incompetency, or dishonesty has been always to swell essentially the ratio of the sick to the whole force. The surgeon of the Sixty-first New York reported to me as a reason for his large sick report that he had a large number of broken-down men--many 60 to 70 years old, many affected with hernia, old ulcers, epilepsy, and the like. Another brigade surgeon reports that there had been no medical examination of many of the regiments before they were enrolled. Another that there were eighty men with hernia and epilepsy in the Fifth New York Cavalry.
       During the months of October, November, and December 3,939 men were discharged from the Army of the Potomac upon certificates of disability. Of these 2,881 were for disabilities that existed at the time the men were enlisted. These men cost the Government not less than $200 each, making nearly $200,000 a month out of which the people had been defrauded in a single army through the faithlessness of those to whom the duty of bringing none but able-bodied men into the field had been confided. It seemed as if the army called out to defend the life of the nation had been made use of as a grand eleemosynary institution for the reception of the aged and infirm, the blind, the lame, and the deaf, where they might be housed, fed, paid, clothed, and pensioned, and their townships relieved of the burden of their support.
       The general prevalence of the measles was another accident increasing the ratio of the sick. I know of no means of preventing the occurrence of this disease. In more than thirty years' experience and observation I can only say that I have rarely seen a regiment of irregular troops in which it did not appear sooner or later after they had been assembled in camp. In many of our regiments it broke out before they left their homes. Some were more severely scourged than others, but nearly all suffered to some extent. Among regular soldiers it is rarely seen. I do not doubt that it is due to the difficulty of securing the same attention to police, to cooking, to clothing, to ventilation of tents, &c., among volunteers that is habitual with regular soldiers.
       Complaints were made to me in several instances of the inferior quality of the blankets issued to the men. This was perhaps to some degree a cause of disease, but I knew it to be irremediable. It was impossible for the clothing department to furnish the heavy army blankets instantaneously to 600,000 men. The same remarks apply to a considerable proportion of the tents in use. Some regiments suffered for want of good and sufficient clothing. A singular circumstance presents itself in this connection. On the 8th of November, 1861, the surgeon of the Eighth Illinois Cavalry reported to me that 200 of the men had received no overalls from the United States. Many of them were reduced to their drawers. He had three hospital tents floored and furnished with stoves. His regiment was unusually healthy; no death had occurred in it for three months. The location of the regiment was afterwards changed. It was encamped in low grounds, that became intolerably muddy in the course of the winter. The part occupied by the horses was a perfect quagmire, never policed at all. The men became discouraged and careless, and in January, 1862, there were 207 cases of typhoid fever among them. These were removed to the general hospital in Alexandria, but the sick list remained large, and in March, when preparing to take the field, 132 men of that regiment were reported unfit for duty.
       Another cause of disease was the heavy details for labor in the field works and the severe nature of the labor; another, the exposure incident to picket duty. Regular officers and soldiers know how to make themselves comfortable on picket duty; volunteers do not. The frequent alarms in some portions of our lines were considered by some of the medical officers as a cause of disease. This was particularly the case in front of some of the Vermont troops in Brooks' brigade. It is possible this may have had an unfavorable effect upon men predisposed to disease from other causes.
       The principal causes of disease, however, in our camps were the same that we have always to deplore and find it so difficult to remedy, simply because citizens suddenly called to the field cannot comprehend that men in masses require the attention of their officers to enforce certain hygienic conditions without which health cannot be preserved. The individual man at home finds his meals well cooked and punctually served, his bed made, his quarters policed and ventilated, his clothing washed and kept in order without any agency of his own, and without his ever having bestowed a thought upon the matter. The officer in ninety-nine cases in a hundred has given no more reflection than the private to these important subjects. When the necessity for looking after these things is forced upon his attention, he is at a loss how to proceed. Too frequently he lacks the moral courage and the energy to make his men do what neither he nor they stipulated for or understood when they entered the service. To bad cooking, bad police, bad ventilation of tents, inattention to personal cleanliness, and unnecessarily irregular habits we are to attribute the greater proportion of the diseases that actually occurred in the army.
       My attention was given to these evils from the beginning. By precept and by orders the necessity and the methods of correcting them were urged upon the commanders and the medical officers of the several regiments. When the brigade surgeons were assigned, the first paragraph of the order defining their duties impressed the paramount importance of hygienic morality upon their consciences, and no occasion was let slip by me of urging upon both commanders and surgeons their obligations in this respect. Some of the regimental surgeons I know faithfully performed this duty. Copies of reports made to their commanding officers, creditable alike to their intelligence and their zeal, were sent to me. The attention of commanding officers is earnestly called in these reports to the drainage of their camps, the clothing and cleanliness of their men, to the situation of their sinks, and the like. One surgeon reports that he cannot strike the tents as I had enjoined, because they were too old, and urges his colonel to get new ones, if possible.
       The prophylactic use of quinine and whisky having been suggested as a means of preventing malarial disease, I determined to try its efficacy. There being no warrant for such an issue in the Regulations of the Army, I procured a small quantity from the Sanitary Commission, and received favorable reports of its effects. Upon representing this to the Surgeon-General, I was authorized to issue it in reasonable quantities to regiments whose condition seemed most to demand it. I required reports as to the effect. These reports were generally favorable; so much so, that I was induced to keep it constantly on hand afterwards in the purveyor's store. The surgeon of the Cameron Dragoons reported that by its use he had reduced his sick report from 126 to 74 in two weeks. The surgeon of the Sixty-second Pennsylvania reported equally favorably, and stated that two companies of the regiment who had used it faithfully for two weeks presented a sick report of only four men. Much prejudice and aversion, however, had to be overcome in inducing the men to take it, and I scarcely think it would have been practicable to have forced it upon the whole army. Fortunately there was no necessity for this.
       In order to secure some comforts for the sick in the regimental hospitals I attempted to show the surgeons how to create and to use a hospital fund. The regimental commissaries strenuously opposed this, on account of the inconvenience to themselves. The first paragraph of General Orders, No. 9, Army of the Potomac, September 9, 1861, however, enjoined this upon them as a duty, and in the course of some four or five months we succeeded in getting the system pretty generally established.
       As cold weather came on I judged it necessary to make some provision for warming the tents. A very ingenious plan having been proposed by Brigade Surgeon McRuer, which had received the approval of General Heintzelman and other officers of experience, I directed Dr. McRuer to visit every division of the army, and to construct one of his furnaces for a model. This duty he performed. Some of course were found to object to it, but it was generally well received and found to contribute much to the comfort of the men. Some, however, still used the Crimean pit, and others succeeded in getting stoves. A cheap and convenient stove, and one readily transported, the make of Mr. Hainsworth, of Newport, Ky., was introduced into the army and found to answer well. It was the general understanding that the army was not to go into winter quarters, and therefore I did not recommend the housing of the men until the middle of January, 1862; but in December, 1861, learning that some of the regiments were excavating pits in the ground and covering them with their tents, I hastened to object strenuously to this plan. I suggested inclosures of rails or palisades some three feet high, to be roofed over with the tents. The excavations could not be kept dry or well ventilated, and certainly would not be kept in good police; all of which objections would be obviated by the above-ground inclosure. This plan was adopted in a number of camps I visited, and they presented an air of comfort that was very gratifying. Later in the season I recommended the Chester hut, with roof ventilation, as used so successfully at Balaklava.
       Protection of the men against the contagion of small-pox of course received constant attention. While the Army of the Potomac was in process of organization small-pox was prevailing rather extensively in several of the districts from which the troops were being drawn. It was unsafe to travel without protection over any railway in the country. The city of Washington was infected, as I knew from the number of applications made to me by the authorities for the use of our small-pox ambulances to convey city patients to the pest-house. An eruptive-fever hospital had been established before I took charge of the army. Under the excellent arrangements made in that establishment by Dr. Thomas, the surgeon in charge, but little risk was incurred of the propagation of the disease to the camps. Orders were issued and reiterated for the vaccination of all volunteers unprotected. I also recommended that an order should be published requiring that all recruits for the Army of the Potomac should be vaccinated before they were put en route from their rendezvous, and that they should be carefully inspected as to this immediately upon their arrival. Not satisfied with what had been done, I asked for and obtained another order, in December, 1861, requiring the division and brigade commanders to cause the brigade surgeons to rein-spect all the men, vaccinating such as were still unprotected, and to report the results to me. At this late period most of the brigades were found to have some men unprotected; in a few the number was serious. In Slocum's brigade there were 1,500, in Blenker's 1,250, and in Sickles' 750. Crusts were furnished and the vaccination completed. As the result, small-pox, though rife in the community, never gained any foothold in the army. A sporadic case would occasionally occur, sometimes in the most unaccountable way. There are individuals so susceptible, that neither vaccination nor a former attack of smallpox secures them against the disease. An alarming report of the dangers to which the army was exposed from the system adopted at the hospital, having been made by the Sanitary Commission, with suggestions of some few modifications to suit their views, I inquired into the statistics of the disease in our army up to that time, and found that in seven months we had had but 168 cases, the majority of whom were ill with the disease when they reached Washington. I adopted such of the suggestions of the Commission as were not already in use, but with no perceptible effect. In fact, the precautions always adopted had made the cases, considered in reference to the size of the army, too insignificant to give the least uneasiness to any one at all informed on the subject.
       I had always been solicitous to get possession of a few experienced regular medical officers, to be employed as inspectors of the field hospitals, through whom I might be assured that the measures devised for the preservation of the health of the men were faithfully and intelligently carried out. This was accomplished at last. In the middle of November, 1861, two officers were assigned to me for that purpose and some weeks afterwards a third. I prepared instructions for them and set them at work at once. (See Appendix C.) These inspections extended from Budd's Ferry to Cumberland. They included Lander's division at Cumberland and Burnside's expedition fitting out at Annapolis. From the reports made by these officers I was enabled to correct many errors in hygiene, as well as to improve the discipline of my department and to keep it always in readiness for an advance. All faults in police, cooking, clothing, location of camps, &c., were promptly reported by me to the Adjutant-General, and by him as promptly ordered to be corrected.
       I come now to speak of the regimental and brigade hospitals. The Regulations of the Army recognized only regimental and general hospitals. The regimental hospitals in the field were established in tents or in such buildings as might chance to be within the limits or in the immediate vicinity of each camp. The general hospitals available for the Army of the Potomac were the few old hotels or other similar buildings occupied as hospitals in the cities of Alexandria, Washington, Georgetown, and a small portion of the Naval Academy building at Annapolis. There was no authority for any hospital establishments in the vicinity of the divisions or brigades that might relieve the hospital tents if crowded or that might keep the men near their camps, so that they could be readily returned to duty when sufficiently recovered. It is true I might have authorized such establishments, but I was dependent upon the provisions of the regulations for the necessary stewards, cooks, and nurses for the service. Several intelligent and zealous brigade surgeons pressed these hospitals upon my attention. Their advantages were obvious, and I determined, when I could get the buildings, to put them in operation. I required, however, that the necessary personnel should be furnished from the regimental details authorized by the regulations, and that the brigade hospitals should be considered and conducted as aggregations of the regimental hospitals; that their stewards, &c., should be mustered on the regimental rolls. In this way a number of them were organized and served. Brigade Surgeon Suckley organized one for Kearny's brigade near Alexandria, another was fitted up for Blenker's brigade at Hunter's Chapel, another in Hooker's division at Budd's Ferry, afterwards others in Fitz-John Porter's division, and several more. A very nice building was put up at Poolesville for Stone's command, upon plans furnished by Brigade Surgeon Crosby and approved by yourself.        About the 1st of February, 1862, my attention was called by General Williams to the condition of Lander's division at Cumberland. This was the first intimation I had had that there were any troops there. I sent one of my inspectors immediately to examine into the facts, with authority to provide at once for their necessities, to hire buildings, or to put up hospital huts if required.
       On the 5th of February Brigade Surgeon Suckley was assigned to Lander's division, and instructed to use every exertion to put things in order. He was informed that the condition of the sick in that division was represented as scandalous, and that no effort must be spared to re-fibrin it. On the 8th I received the report of the inspector. It confirmed all that had been reported as to the shocking state of affairs. The regiments composing the command were scattered in all directions for some 40 miles over the hills. The sick, numbering 1,200, were abandoned in the city of Cumberland, and were in a wretched condition. They were "quartered in close, compact, ill-ventilated rooms, where the police is bad, food badly cooked and improperly served out; men of different regiments reeling and staggering through the streets with fevers, seeking shelter and medical attendance." The inspector had succeeded in getting comfortable and roomy quarters for 500 of the sick at the time of his report, had employed a number of women in making bed-sacks, and had contracted for some hundred bunks.
       Dr. Suckley was in position on the 7th. On the 9th he had collected 1.079 of the sick; on the 11th he had 1,400. He found things in the town in a wretched condition; no discipline, no system. The commissary had no funds. There were nineteen regiments of infantry, besides cavalry and artillery, in the division. On the 18th he asked authority to build two shanties, to contain 50 patients each. This was immediately granted. On the 20th he had succeeded in making things more comfortable, had procured eight Sisters of Charity for nurses, had classified his patients, and had provided proper medical attendance. He reported also that the mortality and the gravity of disease were diminishing. He had received authority to build as many shanties as were necessary.
       Measures were taken by me upon receipt of these reports to provide instantly for all the necessities of the case. I applied to the Commissary-General to place funds in the hand of the commissary. On the 19th Colonel Taylor informed me he had sent $5,000. I ordered a supply of ambulances to be forwarded, loaded with bedding, from Baltimore. Medical and hospital stores were also forwarded by myself as well as the Surgeon-General. March 3 I received a telegram from the railroad agent at Wheeling, informing me that 149 boxes of hospital' stores would be at Cumberland the next day. There was no more trouble with that establishment. The brigade and field hospitals of the Army of the Potomac were at last organized and in working order.
       The next subject I shall glance at is that of ambulance transportation. Previously to this war the Army of the United States had never been supplied with carriages expressly designed for the transportation of the sick and wounded. A board assembled by the Secretary of War some two years before the rebellion had adopted a four-wheeled carriage and two models of two-wheeled carriages for experiment. The four-wheeled carriage had been tested upon the plains in an expedition to New Mexico, and had been favorably reported upon by the medical officer in charge of it. The two-wheeled carriages, though a few had been built, had never been tried. Some doubts were entertained as to their suitableness for their purposes, but they were adopted and recommended as the best for "badly-wounded men." Experience, however, has shown that they are utterly unfit for any such purpose. When the present exigencies came upon us, the Quartermaster's Department lost no time in having the carriages built as rapidly as possible. They were of course ordered in the proportions recommended by the board--i.e.,5 two-wheeled to 1 four-wheeled. The two-wheeled were the basis of the system--a most unfortunate decision. It was my duty, however, to supply the Army of the Potomac with as many of these carriages as would suffice for probable necessities if they could be had. A considerable number of the two-wheeled had already been accumulated in Washington before my arrival and had been distributed to the several camps. I found them in general use as pleasure carriages for idlers and accommodation cabs for conveying officers and men from their camps to the city of Washington. A large number of them had already been broken down in this service. This was immediately stopped. An order was promulgated directing all ambulances, with the exception of I two-wheeled to each regiment, to be turned in to the Quartermaster's Department in Washington, and the use of that One was strictly limited to the service for which it was intended. We were enabled by this means to find out what we had and to keep most of them in order.
       October 5, 1861, the depot quartermaster reported 109 two-wheeled and 12 four-wheeled ambulances in use, and 224 two-wheeled and 38 four-wheeled not in use. The unphilosophical idea of a two-wheeled being an easier carriage than a four-wheeled had been exaggerated in providing the vehicles. The quartermaster had issued 228 two-wheeled since July 1; 119 of these carriages had disappeared in a little more than three months, showing both how recklessly they had been used and how incapable they were of standing the hard work of our campaigns. December 31, 1861, there were in Washington 314 two-wheeled and 71 four-wheeled ambulances. Each regiment had its own two-wheeled in addition to these.
       The two-wheeled carriages being so generally condemned, I endeavored to have a number of cacolets collected to replace them in the Army of the Potomac. The Quartermaster-General had already procured some of them, made after the French model. They weigh 140 pounds. I thought this too heavy, and that their weight might be materially reduced without compromising their strength or durability. This I recommended to be done. Several other models were presented to me afterwards that were much lighter, and I requested the Quartermaster's Department to procure a limited number of 2 of them. I thought I had secured 200 altogether for our army, but I received but 40, and most of these not until we had reached the Chickahominy. As early as August 21, 1861, I requested the Quartermaster-General to introduce these litters in the proportion of 1 to a regiment. On the 8th of October I asked for 50 of Davies' plan, and on the 19th of November I recommended Kohlen's to the attention of General Van Vliet. I instituted some experiments with these, from which I was led to doubt whether they could entirely replace the two-.wheeled ambulances. There was more motion than I expected when the litters were placed horizontally ; in a sitting posture the wounded man could ride very comfortably. They have the advantage of being readily carried wherever a horse or mule can be led, and the disadvantage of affording no protection against the weather.
       In a report upon the distribution of ambulances, dated January 7, 1862, I recommended that a suitable number of horses should be trained to carry these litters, and February 13 I repeated this suggestion. This was approved and ordered to be carried into effect, but for some reason it was not done.
       I append my report of January 7 to show the policy pursued in relation to ambulances while we were in Washington and the reasons for it. This report was approved by yourself, and its suggestions directed to be observed. (See Appendix D.)

In estimating the number of ambulances required for the Army of the Potomac it was at once apparent that the army allowance was altogether in excess of what could be obtained or what could be managed, even if it were to be had. This allowance would have made a train of four-wheeled ambulances 5 miles in length, and of two-wheeled ambulances about 20, making a total train of 25 miles. To mention this shows how preposterous the thing would be. The schedule was never intended for an army of 100,000 men, but for a regiment or detachment, making a long march over the plains or in an Indian country. Still, great discontent was manifested by a number of officers, whose responsibilities Were limited to a single regiment or brigade, that the whole number was not furnished. After a careful consideration of the matter I made a report on the subject, which will be found in the appendix marked E. Here I estimated for 250 four-wheeled. I hoped this number might be obtained. It was, however, never reached, and I was obliged afterwards to contrive the best I could to make the number actually furnished go as far as possible. The events on the Peninsula convinced me that my original estimate was the minimum that would have enabled us to get along without serious discomfort. The atrocious roads in that region destroyed a considerable portion of those we had, embarrassing the operations of my department very materially.
       General Van Vliet having reported the number of ambulances of both sorts he had in depot and in the possession of the troops, after comparing the latter with the reports of my inspectors I found he could furnish only 12 of the four-wheeled and 22 of the two-wheeled to each division of the army, with a proportionate number to commands of less size. I accordingly submitted that plan of distribution to General Williams on the 5th of March, and in the same letter I repeated an estimate I had made on the 27th of February for 1 ordinary transportation wagon to each regiment, for the conveyance of medicines, stores, mess-chests, and hospital tents. The latter was ordered and very generally furnished. On the 10th of March, 1862, having received orders to move the ambulances to Fairfax Court-House, I called upon General Van Vliet to make the distribution according to my plan, and inclosed him a copy of my letter to General Williams as his guide. I moved with the headquarters to Fairfax Court-House the next day. When the army was assembled there the ambulances were not in position.
       The army being ordered to fall back upon Alexandria, I hastened to Washington, and had an interview with General Van Vliet on this subject. He informed me he had ordered 36 four-wheeled ambulances from Perryville to Fort Monroe, and that he would send on 86 more from Washington. That would have given us 177 for the whole army, including McDowell's corps and Blenker's division. This was too few, but it was the best that could be done with the number reported on hand. Colonel Ingalls being under the impression that there was still a large number at Perryville, I telegraphed to Washington to have 50 more added to our allotment, but I did not get them. In fact, the last of the original 86 did not reach us till the 1st of May; 12 were received April 9, 16 April 15, and 58 May 1.
       In the mean time the divisions of Stone at Poolesville, Banks at Sandy Hook, Lockwood on the Eastern Shore of Maryland, and Lander at Cumberland, had been furnished with as many carriages of each sort as we could spare and they were likely to need. Stone had 59 two-wheeled, 7 four-wheeled, and 67 transport carts. They proved amply sufficient to remove his wounded after the action at Ball's Bluff with the greatest speed and safety to his hospitals. This affair was misrepresented by some volunteer philanthropist to the Sanitary Commission. My report from Brigade Surgeon Crosby, who conducted the hospital administration on that occasion--an officer who has no superiors in the corps to which he belongs--shows that his carriages were promptly as near the field as they could be brought. He could not very well cross either the canal or the Potomac River with his train.
       The most feasible plan for organizing a force to act as an ambulance corps engaged my attention at an early period. Several propositions were made by foreigners to raise and command such a corps. They were mere repetitions of the Continental systems, and however serviceable they might have promised to be, they could not under the then existing laws have been raised for our army. The only plan that appeared to be within my reach was that adopted and established by the sixth paragraph of Orders No. 20. The regulations of the army authorized a detail of 10 men from each regiment for hospital attendants. The bands of regiments had long been used for the purpose I wanted them for in time of action in our service, and I could by the plans indicated expect to command about 25 men to a regiment to serve as ambulance attendants when wanted. They required, however, to be instructed in that duty, and with that view they were ordered to be drilled regularly every day by the medical officers under the superintendence of the brigade surgeons. Whenever this order was obeyed, the progress of the men in the drill was quite satisfactory. It was at least a beginning of an ambulance corps. Perhaps a distinct ambulance corps may yet be made a part of our military establishment. I am satisfied it would contribute essentially to the efficiency of the hospital department. The surgeon-general of Pennsylvania, under date of September 19, 1861, requested authority to organize such a corps at Camp Curtin for the troops of his State. I indorsed his proposal favorably and referred it to the Secretary of War, but no action was taken upon it. An elaborate project for an ambulance corps was submitted to the Surgeon-General by a Mr. Pfersehing, and by him referred to me for examination in March, 1862. Upon this plan I made the report marked F in the appendix.

GENERAL HOSPITALS.

       When I took charge of the Army of the Potomac I supposed that the general hospitals within the limits of that army were under my control, and that it devolved upon me so to extend their capacity as to provide accommodation for the number of sick and wounded that we should be likely to have. The buildings already provided and occupied were seen at once to be totally inadequate. The entire hospital establishment in Washington, Georgetown, Alexandria, Baltimore, and Annapolis contained but 2,700 beds. The Sanitary Commission being in session in Washington about the 1st of September, an invitation was extended to me to assist, which I accepted. They were then discussing the subject of general hospitals. They seemed to be of the opinion that there should be as many as 5,000 beds in Washington. I explained to the gentlemen at some length my views on the subject, and endeavored to show them that 20,000 beds at least would be required. After several days' consideration the Commission appointed a committee to wait upon the Secretary of War, to request him to have frame buildings erected sufficient to accommodate 15,000 men, and to request your approval of the same. The subject was brought to your notice in a letter from Mr. Gibbs, one of the Commission, which letter was referred to me, and was the occasion of my first report to you in reference to general hospitals. This report, dated September 9, 1861, will be found in the appendix, marked G.
       I had at that time taken some steps to increase the existing establishment to meet immediate wants, when I was informed by the Surgeon-General that the Secretary of War had charged him with the superintendence and control of this matter, and that he should have all that was necessary provided in due season. My report, however, with a letter from the Sanitary Commission, was submitted by you to the Secretary of War, accompanied by a letter from yourself. In the course of the month it was returned to you, with authority to make your own arrangement for providing hospitals. I was then directed by you to go on with this work, but first to submit my plans to you. I was, as I stated in my first report, decidedly in favor of putting up cheap frame buildings, expressly designed for hospitals, in preference to relying upon hotels, schoolhouses, and the like, as seemed to be the existing plan. I fully believed suitable buildings could be erected at a cost not exceeding $25 per bed. I had seen such a plan in the possession of Dr. Harris, of the Commission, and had been promised a copy of it. The Commission, however, objected to his furnishing it, agreeing to send me a much better plan, and one sufficiently economical to suit my views. After tedious delays their drawings were at last sent to Washington. They were the design of an architect in New York, taken from the general plan of the Lariboisiere in Paris, excellent in itself, but too costly I feared for our purposes. The expense, as estimated by the architect, was $75 per bed. Time pressing, and it being too late to wait for other plans, I reluctantly determined to adopt it, after having made certain modifications that would not impair its advantages, but would reduce the cost to about $60 per bed--i. e., if the architect's estimate could be relied on. I submitted the plan to you, accompanied with a report. (See Appendix H.) I adhered in this report to my original estimate for 20,000 men as a minimum. To the plan proposed you objected on account of the expense in the then condition of the Treasury, but you thought that one-fourth of the buildings I had recommended might be put up. I then proposed to go to Annapolis, Baltimore, and Philadelphia, to see what could be done there to increase our accommodations, hoping that by evacuating all our hospitals in the vicinity of Washing. ton, with the addition of the 5,000 beds to be provided in the new buildings, we might be able to get along with tolerable comfort in the event of a battle. Upon my return I submitted the report in Appendix I.
When the Quartermaster-General advertised for proposals to put up the new buildings, instead of $15,000 for each 200 beds, as estimated by the architect, the bids ranged from about $30,000 to $80,000. This expense could not be incurred, and two only of the buildings, sufficient for 400 men, were attempted, and it was many months before they were completed. In the mean time some of the Philadelphia hospitals were put in order. In February, 1862, 900 beds were ready in that city. In November, 1861, a new hospital in Alexandria was prepared, capable of receiving 900 patients. In the same month Minnesota Row was taken and ordered to be fitted up, and I succeeded in securing 200 beds in the Saint Elizabeth Asylum. These hospitals were fitted up with great care, and made as comfortable as such buildings could be made. They were well organized, and provided with competent medical staffs and good nurses. They gave us a total accommodation of about 6,000 beds, and were sufficient to receive the sick of the Army of the Potomac when it was put en route for the Peninsula. It was a source of deep regret to me that I was unable to accomplish at least so much of my original plan as had received your approval, but at that time such a thing was impossible in Washington. Anywhere else it could and would have been done. Subsequent events have shown that if it had been done, much inconvenience and suffering might have been spared.
       The sanitary condition of the army during this period was very satisfactory. My records show a constantly-increasing immunity from disease. I regret that I am not in possession of the retained copies of my monthly reports of sick and wounded made to the Surgeon-General. I left a locked chest, containing my official documents and correspondence, in one of the military stores in Washington when we took the field. Through the kindness of General Meigs what remains of those records has been transmitted to me. The assistant quartermaster in whose care the chest was left informs me it was ordered to the Surgeon-General's Office, opened, and some of the papers removed. I miss from it the reports of my inspectors, the duplicates of my sick reports, my records of killed and wounded in the skirmishes in front of Washington, and various other papers. Fortunately what has been permitted to remain will suffice to give a very good idea of the sanitary history of your army up to March 1, 1862.
       The Army of the Potomac during this period included the divisions. of Stone at Poolesville, Banks at Harper's Ferry and Frederick, Dix at Baltimore, and the forces in the vicinity of Washington. August 22, 1861, 33 per cent. of the troops encamped on the flats near Arlington were reported sick with diarrhea and malarial fever. I have already alluded to the action taken in reference to these men; they belonged to McDowell's division. On the 13th February, 1862, this same division had but 9 serious cases in a force of 10,000 men; there were, in addition, some 200 cases of catarrh and a few of measles. There had been in the mean time, as in other portions of the army, some typhoid fever, but at the last date it had almost entirely disappeared.
       I have already remarked upon the constantly-recurring outbreaks of measles among the volunteers. We had more or less of it among different commands during this whole period. In February, 1862, it was prevailing in the Railroad Brigade. In January it was rife in Dix's division, in Baltimore. September 14, 1861, Stone had 6,000 men at Poolesville, with but 54 sick in hospital, one-fifth of whom had measles, the remainder typhoid and intermittent fever. September 21, 9,000 men are reported at Poolesville, with 91 in hospital and 254 in quarters. February 3, 1862, measles alone kept up the number of men in hospitals in Fitz-John Porter's division. On the 8th of the same month measles are reported as having disappeared, while the number of sick in quarters is reported as materially reduced, notwithstanding the inclemency of the weather. Typhoid fever appeared in some of the camps during the autumn, but gradually disappeared as winter advanced. This disease is now and has been for years endemic in the United States. We could not hope to escape it altogether. In some few regiments, under peculiar circumstances, there were a good many cases, but taken as a whole, and considering the number of men in the camps, the cases were so few, we might almost ignore it altogether. In Hunt's artillery reserve during the last quarter of 1861 it prevailed to some extent, but in January it had entirely disappeared. This command had during this time one of the largest sick reports in the army. On the 31st January, 1862, the prevalent diseases in it were reported to be catarrh and bronchitis, attributed to the effects of the rains and thaws.
       In October and November, 1861, with an army averaging 130,000 men, we had 7,932 cases of fevers of all sorts. Of these about 1,000 were reported as cases of typhoid fever. I know that errors of diagnosis were frequently committed, and therefore this must be considered as the limit of typhoid cases. If any army in the world can show such a record as this, I do not know when and where it was assembled.
       The most striking contrasts were exhibited in the relative health of the troops from different States and sometimes among regiments from the same State. Thus, in November, 1861, with a mean ratio of 6.5 per cent. sick in the whole army, twelve Massachusetts regiments gave an average of 50 sick each; five Vermont, an average of 144 each, and thirty-five Pennsylvania, an average of 61 each. In January, 1862, the Twelfth Massachusetts, 1,005 strong, had but 4 sick; the Thirteenth, 1,008 strong, but 11; while the Fifteenth, 809 strong, had 68. In the same month the Fifth Vermont, 1,000 strong, had 271 sick; the Fourth, 1,047 strong, had 244 sick; while the Second, 1,021 strong, had but 87, and the Third, 900 strong, had but 84. All these regiments were in the same brigade and encamped side by side. The Tenth Pennsylvania Reserves, 965 strong, had 7 sick; the First Pennsylvania Rifles, 889 strong, had 67 sick; and the First Pennsylvania Cavalry, 890 strong, had 96 sick.
       The health of some of the regiments, under adverse hygienic circumstances, seemed to set all reasoning at defiance. Thus, in February, 1862, Colonel Geary's Pennsylvania regiment, of Banks' division, that had been serving all summer upon the banks of the Potomac and the canal had but 2.5 per cent. sick. There was a constant improvement in the health of the whole army as the season progressed, and at the time the march to Fairfax Court-House was ordered, with a very few exceptions, every regiment in it was in the most satisfactory condition. Some of them showed a most extraordinary improvement. Thus, in four regiments of Pennsylvania troops in McCall's division, there were but 68 men on the sick report on the 1st of March, 1862.

       The records in my possession show that in:

September, 1861, among 84,788 men, we had 6,007 sick=7 per cent. October, 1861, among 116,763 men, we had 7,443 sick=6.07 per cent.

November, 1861, among 142,577 men,we had 9,281 sick=6.50 per cent.

January, 1862, among 181,082 men, we had 11,225 sick=6.18 per cent.

       Of these the men sick in the regimental and general hospitals were less than one-half; the remainder were slight cases, under treatment in quarters. The health of particular regiments was at this time very remarkable. Thus, the Second Rhode Island had but .45 per cent. sick, the Seventh Massachusetts 1.99, the Ninety-eighth Pennsylvania 1.21, the First Long Island 1.46, and the mean of Keyes' division was but 3.29. During this time, so far as rumor was concerned, the Army of the Potomac was being decimated by disease every month. The reports from the regimental headquarters were only less erroneous than rumor. The statistics I have given are from the weekly and monthly reports of medical officers. It was ascertained to be the general habit of the captains to report every man sick who found it convenient to report himself so. The difference between these reports and the facts is illustrated in my letter to General Williams of January 28, 1862, a copy of which is appended, marked K. I append also a report in relation to that subject made to the Surgeon. General of the Army January 4, 1862 (L).
       During this period there were frequent skirmishes, giving a number of wounded men. Two affairs of importance took place: On the 21st of October, 186l, the battle of Ball's Bluff, and on the 20th of December, General Ord's affair at Dranesville. In the former, 280 men were reported wounded; in the latter, 34. Of the wounds at Ball's Bluff 93 were in the head and face--a very large proportion--showing the accuracy of fire of the enemy, as well as the skill with which they availed themselves of the advantage they possessed on that occasion.
       This concludes the first period. I hope to resume the subject and to report upon the second period in a few days.

Very respectfully, your obedient servant,
CHAS. S. TRIPLER,
Surgeon, U.S. Army.

Source: "Official Records of the War of the Rebellion"

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