Health care in 18th-century America was radically different from today, and one of the greatest contrasts is in the role played by hospitals. The 18th-century hospital was a rarity, except in urban settings such as New York and Philadelphia where the poor needed inexpensive, readily accessible health care and could not afford to get it at home. In most cases, though, physicians saw patients in their homes, and only travelers needed medical facilities of a more institutional nature.
There was, however, one category of hospital that appeared with some frequency in the second half of the 18th century: the military hospital. While these facilities performed an essential function in treating soldiers and officers in the field, the mortality rate was so high that soldiers may have had a better chance of recovering by remaining in their huts and barracks. Military hospitals necessarily varied in the comprehensiveness of their services, ranging from mobile “flying hospitals” to the more permanent regimental hospitals and General Hospitals that housed substantial numbers of patients with fevers, dysentery, infectious diseases such as measles, and injuries of all types. Most such hospitals were in use for no more than a few months, or the space of a single campaign. Military doctors who owned a well-stocked medicine chest might have such therapeutic instruments as scalpels, amputation knives and saws, lancets and other bloodletting instruments, forceps, scissors, bullet probes, and bullet extractors.
Medicines were so difficult to obtain during both the French and Indian War and the American Revolution that physicians often spent more of their time searching for medicines than doing any actual healing.
One type of military hospital was somewhat more specialized; this was the smallpox hospital which served to isolate highly contagious patients. Soldiers who contracted smallpox in the 18th century were typically sent to central hospital facilities, such as Fort George in Lake George, New York, where as many as 3,000 soldiers lay dying in July of 1776. There was not a standardized design for military hospitals, and it appears that the smallpox hospital of the 1750s and 1770s was little more than a large, open barn that provided fresh air and perhaps a bed of straw for its patients. There was no cure for smallpox until Edward Jenner’s cowpox vaccine in the 1790s, even though quite a variety of opium-based medicines were available for treating other ailments. (See box on Smallpox in the 18th Century.)
RESEARCH AT MILITARY HOSPITALS
Unfortunately, little historical documentation survives for these enigmatic temporary hospitals, and in 1985 this prompted me to begin what has now become a 12-year search for the archaeological remains of military hospitals. It was in that year that I excavated the site of the American Headquarters at the Saratoga Battlefield (now Saratoga National Historical Park). However, a determined effort to find the adjacent American Field Hospital revealed only small clusters of stones that may have been the corners for a post-type barn. While the American hospital is known to have briefly occupied a barn that existed both before and after the Revolution, the failure of our excavation to turn up any medical supplies increased my resolve to find a more intact hospital site that still retained evidence for medicines, surgical implements, amputated body parts, and architectural remains. After all, almost nothing is known about how these buildings were constructed, whether activity areas—such as operating rooms, dining or storage areas, or rows of bunks—can be identified within them, and whether associated dumps have the potential to reconstruct the medical procedures that were employed inside.
My search has led me to the ruins of two of the largest and most intact military encampments of 18th- century America (Fig. 1). The first was the 1776-1777 fortification known as Mount Independence, a 300-acre mountaintop fortress in Vermont that overlooks Lake Champlain and faces Fort Ticonderoga on the New York shore. The second was the site of Fort Edward, a mammoth British installation of the French and Indian War (1754-1763), located on the Hudson River roughly 40 miles north of Albany, New York. Although separated by twenty years, both sites were principally hospital camps for the treatment of soldiers who had been injured or become sick during northern military campaigns, and each hospital complex saw the death of approximately 500 to 1000 soldiers.
Fort Edward, and the adjacent Rogers Island in the Hudson, was home to 15-16,000 soldiers in the late 1750s, briefly making it the third-largest city in America (after New York and Philadelphia). It was from here that British armies marched and rowed north to attack the French fortifications at Ticonderoga, with the sick and injured returning to hospitals on Rogers Island for treatment. Easily the best known of these casualties was Major Duncan Campbell of the Scottish Black Watch, who was wounded on the field of battle outside Fort Ticonderoga in 1758, carried to Fort Edward, and died eleven days later in one of the hospitals on Rogers Island.
Twenty years later, Mount Independence served the same function when its hospitals handled the American casualties from the disastrous 1775-1776 attack upon Quebec City. Mount Independence and its outlier—the older site of Fort Ticonderoga—contained regimental hospitals as well as a massive General Hospital, constructed at the order of the Northern Medical Department. Their combined population totaled 10,000.
What has made Mount Independence and Rogers Island unusually well suited to a study of early hospitals is that both were occupied by a vast force for only a brief period, and the ruins of both were never built upon after abandonment. In 1990 I excavated the foundation of the General Hospital at Mount Independence with a field school from the University of Vermont. At Fort Edward/Rogers Island I sought the smallpox hospital for several seasons with field schools from Adirondack Community College, before we finally found and excavated it in 1994.
In July 1776, in anticipation of a British assault from Canada, a rocky Vermont promontory was cleared, and hundreds of huts, barracks, storehouses, lookout posts, and blockhouses were constructed at what became the northernmost outpost of American forces in New England. Within this complex were one or more regimental hospitals that immediately took in casualties from Canada. Many of them died from disease—chiefly measles and smallpox—in the months that followed, while others froze to death at night that winter. While none of these hospital sites have yet been located, it is probable that considerable supplies were left behind at each, given their intensive use.
It is difficult to imagine life inside one of these hospitals. While documentation is scant, a 1776 drawing has survived that shows a regimental hospital at Mount Independence (Fig. 2). In addition, a sick soldier hospitalized at Mount Independence wrote home to his brother on October 11,1776, stating that
I inform you that I am and have been in a low state of health for some time past and don’t imagine I shall get well very soon. Wherefore I earnestly intreat you not to delay coming for me or if you can’t come yourself. Send a man that you can confide in and a horse for me; let whoever comes; bring some butter and Indian meal with him to serve me on the way home. I can get discharged as soon as one comes for me; but am as frail at present that I could not venture home alone.… (Matthew Kennedy 1776)
Regrettably, Kennedy was one of the many who did not survive his hospital stay.
Small regimental hospitals would not have been adequate, however, for coping with the heavier casualties from a major battle. Such was the thinking of the Continental Congress in early 1777 when it authorized the construction of a General Hospital on Mount Independence, in anticipation of the advance of General John Burgoyne’s army from Canada. While no drawings survive that document the hospital’s layout, a 1776 letter from Dr. John Morgan, then Director-General of Hospitals for the Continental Army, specifies that hospitals ought to be floored above, so as to make two stories each, and to have a stack of chimneys carried up the middle…. It is further required that bed bunks be made, and straw he always in readiness, for the sick, and a carpenter or two to be employed solely in the business of the general hospital in making coffins, tables, and utensils of various kinds. (Duncan 1931:165-66).
Smallpox in 18th-Century America
Smallpox has often been described as the most dreaded disease in human history. Once pustules developed on the surface of the skin, death typically followed between 10 and 14 days later. The smallpox virus left most of its traces, the characteristic poclanarking, on the victim’s face, where it destroyed the sebaceous glands. Afterwards, the wounds in the skin often became infected, resulting in additional deaths.
The 18th century saw important steps toward the curtailment of this disease, and smallpox inoculation was introduced into Europe and North America in 1721. Self-inoculation was common among soldiers on the frontier, although this practice was frequently banned because of the risk of spreading the virus. One of the most severe outbreaks of the disease was in 1775-1776 as the Continental Army lay siege to Quebec City. In the following year General George Washington wrote to William Shipped, the newly appointed Director-General of the Continental Army Medical Department, insisting that the army be inoculated.
Not long afterward, an English physician, Edward Jenner, noticed that milkmaids had very clear complexions and did not get smallpox. In his subsequent experiments he vaccinated using the cowpox virus, and thus established that milkmaids’ contact with cows’ udders had, in effect, inoculated them (through cracks in their hands). Jenner published his Inquiry into the Causes and Effects of Variola Vaccinae in London in 1798, but it took much longer to eradicate smallpox altogether. The world’s last reported case of endemic smallpox, Variola was discovered in Somalia in 1977, and the Global Commission for the Certification of Smallpox Eradication finally certified the eradication of the disease in 1979. It required much systematic effort and willpower to conquer the smallpox virus, and doctors today tend to compare it with the HIV virus that causes AIDS, suggesting that it will take just as much effort to eradicate this new killer. Still, the smallpox virus is remarkably resistant to extermination, even outside the body, and traces of the disease may yet be out there in the world, waiting to be reintroduced.
The General Hospital
Construction of the Mount Independence General Hospital began in March of 1777, and Dr. Jonathan Potts, a student of America’s preeminent physician, Dr. Benjamin Rush, was assigned to the hospital on April 14,1777. By June the hospital was essentially completed. It had a maximum capacity of 600, although it appears that fewer than 100 patients actually resided there when the fortress came under siege in early July. In the days that followed, James Thacher, one of the surgeons’ mates, removed most of the medical supplies and all but four of the patients, and then Burgoyne’s attack wrested the site from American hands. After rather brief use by the British, the General Hospital was deliberately burned in November so that it would not fall back into American hands, and the entire mountaintop was allowed to revert to forest.
When the Vermont Division for Historic Preservation, the owner of the southern half of Mount Independence, asked me to dig the hospital in 1990, all that remained on the surface was a rectangular outline of foundation stones (Fig. 3). A British map drawn by Lt. Charles Wintersmith in July 1777 clearly identified this as the site of the hospital, and a Lively oral tradition among local Vermonters gave further support to the identification. Also, Vermont game warden Thomas Daniels had dug there intensively in the 1950s and discovered a modest cache of medical supplies, including several medicine cups of white salt-glazed stoneware, knife blades, and medicine bottles and stoppers (Fig. 4).
We excavated over 60 test pits within the hospital site in an effort to determine the locations of doors and fireplaces, as well as any evidence for the overall appearance of the building. In doing so, we found numerous shingle nails but no window glass, suggesting that the hospital was shingled but may otherwise have had a rather unfinished appearance. As we uncovered four piles of stone rubble running down the center of the foundation, it became apparent that we were exposing the bases of four fireplaces (Fig. 5). We also found hundreds of fragments of melted wine bottles inside the foundation, as well as sherds from additional medicine cups (Figs. 6, 7). Just outside the wall, we found a trash pit that contained a single knife blade, the lid from a creamware jar (Fig. 8), and a delft ointment pot or jar. About 46 meters to the north, we found an extensive garbage pit full of butchered leg bones from at least 17 cows (Fig. 9). This represented fresh meat (rather than salted), probably consumed by officers and men in the hospital.
The resulting impression is that the hospital was popular as a dining hall, even if it may have seen minimal use as a house of healing. Our discovery of only limited medical supplies was most likely the combined result of Thacher’s systematic removal of the hospital stores and the long-term digging of the site by collectors such as Daniels. When we examined historical records and excavated many of the small cabins of the soldiers, it also became clear that the soldiers must have taken their medicines with them back to their cabins whenever possible, rather than risk the very real danger of being exposed to contagion in the hospital. We discovered fragments of medicine bottles in a great many of the soldiers’ hut sites, suggesting that the General Hospital may have principally served as a giant dispensary.
FORT EDWARD AND ROGERS ISLAND
As the excavation of the hospital at Mount Independence came to a conclusion, permission was obtained from landowners in upstate New York to conduct a long-term project at Rogers Island, one of the premier sites of the French and Indian War (1754— 1763). Fighting between the French and the British in New York State began with the Battle of Lake George in 1755, followed by a period of fort-building as both sides sought to solidify their positions. While Fort Ticonderoga represented the southernmost advance of French forces on Lake Champlain, it was Fort William Henry at the southern end of Lake George and Fort Edward on the Hudson River that represented the most northerly advance of the British.
Fort Edward was by far the larger of these British sites, constructed at a total cost of more than 42,000 pounds (Fig. 10). Most of the British forces at that installation were based on Rogers Island, named after the famed Major Robert Rogers. From 1757 to 1759 Rogers Island was the principal base camp for about 400 of Rogers’ Rangers as they conducted raids upon French and Native American settlements in the north, including the Abenaki village of St. Francis. The Rangers were accompanied by thousands of British Regulars and American provincial soldiers, and the island and Fort Edward served as a massive supplies depot, training camp, and hospital complex for soldiers traveling north from Albany.
Fort William Henry, 15 miles closer to the French fort and garrisoned by only about 2,000 soldiers, was much more vulnerable to attack and was ultimately destroyed in 1757. The so-called massacre described in James Fenimore Cooper’s great novel, The Last of the Mohicans, was one of many actions in the fall of Fort William Henry that provided casualties for the hospitals on Rogers Island. The complex of barracks, huts, tents, storehouses, and hospitals in Fort Edward was never attacked, and most of the casualties from the British assaults upon Ticonderoga in 1758 and 1759 were sent to Rogers Island. The hospitals there were of several types, including a blockhouse that was converted into a hospital, assorted barracks’ rooms that were used for patients, and a smallpox hospital that was positioned at the southern end of the island, as far from the main barracks complex as possible.
The Smallpox Hospital
The smallpox hospital appeared the most promising for archaeological research because the barracks’ sites had been deeply buried under dredge from the Hudson River early in the 1900s. Moreover, the smallpox hospital had stood alone, on top of a high terrace that reduced the hazard of flooding, and its isolation meant there was little danger of confusing its remains with those from any surrounding buildings. We knew from historical sources that it had been hurriedly constructed by a soldier named Jabez Fitch and about twenty of his comrades. Construction began on May 31, 1757, and an addition was made in 1758. The hospital’s approximate location was later indicated on an historical map drawn in 1772. Because the hospital was in use for a couple of years, we had reason to believe that considerable evidence might have survived. But while there were about one hundred patients at a time housed there, we did not expect to find medicines for treating smallpox. None are known to have existed at that time, and it was not until the American Revolution that inoculations against smallpox began on a more regular basis.
No traces of the smallpox hospital had survived on the surface of Rogers Island, and it ultimately took four field seasons to find the remains (Fig. 11). The first evidence was a sizable dump discovered on the eastern edge of the raised terrace in 1993. The dump contained a large brush (or fascine) knife, buttons, knives, the bowl from a pewter spoon, a 1751 Spanish one-real piece, gun flints, and more (Figs. 12-14), but the only artifacts that suggested a hospital function were small fragments of glass medicine bottles.
The 1994 season proved much more rewarding. Dark linear stains began to be defined beneath the topsoil atop the terrace, outlining a trench or palisade line that ran for over 130 feet north-south along the western side of the terrace and for over 58 feet east-west across the terrace (Figs. 11 and 15). While the outlines of individual posts were not discovered within this staining, it appeared that this had been a ditch into which palisade posts were set. The staining was full of rosehead nails and charcoal flecks, and the complete blade from a spade was discovered at the end of the western stain. In the center of the northern stain there was a gap of about 3 feet that suggested a possible doorway or entrance, and a key was discovered just outside the opening.
Using the lines of staining and the eastern dump as outer limits for the hospital building, extensive testing ultimately revealed two north-south rows of postmolds, forming the eastern and western sides of a building whose weight had rested upon posts. This type of temporary construction seems appropriate to a building that had been thrown up hastily by soldiers. The large, square postmolds were positioned at 5-foot intervals, outlining a foundation that was 15 feet wide. We uncovered six posts on either side of the building, so we had exposed just the midsection of the hospital, an area that measured 15 feet east-west by 30 feet north-south (Fig. 16).
In the fine yellow sand of Rogers Island there was no evidence of room divisions within the smallpox hospital, nor did we discover any medicines for treating smallpox. However, we did find that the artifacts in the associated dump were essentially no different from those found in any other hut or barracks on the island. They were an assortment of kitchen artifacts (utensils for food consumption), clothing artifacts, and arms. Even the medicine bottle fragments in the dump did not prove the proximity of a hospital because we knew the soldiers would have taken medicines back to their cabins. However, we do feel confident that this long, narrow building raised on posts was the smallpox hospital, and we left enough of it intact that future archaeologists may someday continue exposing its outline and the associated dump.
CONCLUSIONS AND FUTURE OBJECTIVES
After 12 years of searching, it is becoming clear that finding the fairly intact remains of an 18th-century military hospital is far more difficult than was first anticipated. Unlike urban hospitals for the poor, military hospitals were not built for permanency, and buildings of post construction that were occupied for only weeks or months simply do not leave substantial remains behind. Also, the medicines or medical instruments that were used inside military hospitals were sufficiently rare that associated dumps now contain only minimal amounts of medical trash. Nevertheless, when given the opportunity, I would like to return to Mount Independence to examine its smaller regimental hospitals—which saw much more use than the big General Hospital—and I plan to continue searching for the rest of the hospitals at the Fort Edward encampment. We have already devoted two seasons (1995 and 1996) to looking for the West Barracks inside the main fort as that was the building that contained the fort’s principal hospital.
Efforts are also underway to examine additional hospital sites. Chief among these is the hospital complex at Fort George located in Lake George, New York. The very largest smallpox hospitals of the American Revolution were constructed there, as well as a General Hospital established in 1777; and it was in March of 1777 that the Continental Army began doing smallpox inoculations at the Fort George hospitals. While permission has not yet been obtained to conduct intensive testing, I nevertheless headed a team that began mapping the surface of Fort George in 1994. We are hopeful that in time it will be possible to begin a long-term effort there, and it may well prove to be the hospital complex we have been seeking—with intact foundations, dumps, and sufficient medical supplies to adequately reconstruct the American military’s medical procedures in the late 18th century.