After the Continental Army was established on June 14 , 1775 , Congress authorized the establishment of other branches to support Army activities , ranches such as the infantry , the adjutant General's Corps , the Corps of Engineers , the Quartermaster Corps . But on July 27 , 1775 , the Congress established the first Army hospital to be headed by a director general and chief physician . This became the Army Medical department . So what were the challenges this new Army hospital faced in organizing ? What services did they provide to soldiers for answers to these questions and more Army history insights . Stay tuned . Welcome to the US Army History and Heritage podcast , the official podcast of the United States Army's Center of Military History . The Center of Military History writes and publishes the Army's official history , manages the US Army Museum Enterprise , and provides historical support throughout the US Army . Hello everyone and welcome to the United States Army History and Heritage podcast . I'm Lee Reynolds , the strategic communications officer for the Center of Military History . In this episode , we're discussing the establishment of the Army Medical Corps . Joining me for this discussion is the historian for the Army Medical department , Sanders Marble . So welcome , Sanders . Hey Lee , how are you ? I'm great . Thanks so much for being here to uh share your insights about the uh the establishment of the Army Medical Corps during the Revolutionary War . Uh , so before we get into the discussion , let me just let our our listeners know who you are . So Sanders Marble is the senior historian for the US Army Medical Center of History and Heritage . He earned his bachelor's degree at uh in history at William and Mary in Virginia and his PhD at King's College at the University of London . Previously he worked for an online history company . He worked for the Smithsonian Institution and in various capacities for the Army Medical department since 2003 . So Sanders , anything I'm missing there ? No , I think you wrapped it up nicely . All right , great . So uh looks like you have tremendous background here , not just in history , of course , but uh with army medicine . So that brings us into the topic . So the beginning of army medicine , here we are , we go all the way back to July of 1775 . So can you , uh , discuss , you know , I mentioned in the opening how the Continental Congress authorized uh the first Army hospital . Um , so what did that really mean ? Uh , you know , how , how and when was the medical department established ? That is a great starting point . I think it's actually kind of a misleading starting point because before the medical department , before Congress said , let's have in hospital , the phrase they use . There's there were doctors in the army , the militia regiments that had assembled outside Boston . had doctors with them . Some of them were in the ranks as private soldiers , some of them were company officers because they're patriotic , and some of them were working as the regimental surgeons . But what Congress said is , OK , that's , that's necessary , but it's not sufficient . We need to have a hospital and a medical structure in the rear . So that the regiments are free to move around so that they can evacuate their wounded and they're sick and be ready to move and fight . And there's going to be a lot of problems during the Revolutionary War coordinating those two parts , the regiments that are moving , the brigades , the armies , and then the hospitals out in the rear . And some of that is structural and I think we would have an analog of that today . The colonies or the states as they start calling themselves pretty quickly . are responsible for the regiment . It's not just the first regiment of infantry . It is the first North Carolina infantry and then there's the first Pennsylvania so This the colonies , the states are responsible for providing a lot of The support , uh . And a doctor who is the regimental surgeon for the North Carolina , a North Carolina regiment could well write back to the state legislature and say , Hey , please send me some medical supplies . And he could also go over to a continental Army run hospital and say , Hey , I'm right here . Please give me some medical supplies . Whereas that hospital , which is answering to the Continental Congress , can Just say go up their chain of command . So they don't necessarily get along well because they have competing chains of supply and responsibility . Yeah , so the , so the establishment of this medical department um uh by the Continental Congress that Yeah . I I guess just for for clarification so we had the , the continental Army basically was was up in Boston at at this time was the medical department uh initially formed in Boston and then um you know all these different states and all these other regiments uh throughout the the colonies or the states at the time . Um , that they , they began formalizing their own medical hospitals . I don't know if the states did so much . It would Imagine there were some , there was a real shortage . There were maybe 3000 , 3500 . People who practiced as doctors in the colonies , uh , yeah , not very many . Most of them hadn't been to medical school . Um , they would have , it was pretty common in those days to apprentice as a doctor , so you would . Um , at age 18 or so , you might have purchased for 5 or 7 years . A learning By doing , first by observing and then by doing . And honestly , given the really limited medical understanding and capabilities that they had at the time , going to medical school and going to apprenticeship or just saying , I think I know how to cure people , all of those roots . Uh , had pretty comparable patient outcomes . Um , you either got better or you didn't , and the doctor didn't make that much difference . Uh , but with the , the coming back to your question of sort of medical . Organizational structure . The Continental Congress pretty quickly says , hey , we're going to have a Northern department , which is sort of New York and New England . There's a middle department in New Jersey down to Maryland and maybe Virginia , uh , then there's a Southern department because it's just too big an area to to try and run centrally , sending out handwritten notes from . Philadelphia and , and waiting for the horse to courier to get down there and get back . So they divided up and there are continental Army hospitals in each of those areas . Um , some of it is providing medical care for recruits as they're training . Some of it is providing care for sick and and wounded who have , let's say you're a Virginia soldier injured up and fighting around New York City . They would move you down towards Virginia so that you could recuperate closer to home , um , and Uh , especially when the army is in quarters around New York City or around Philadelphia , there would be a bunch of hospitals , 35 , 45 , 50 miles away from where the main army is so that If the British come out and start Trying to mess with us , uh , and the army has to maneuver to prepare to fight , then the wounded are not the sick and wounded in the hospitals are not . Getting in the way that Washington doesn't have to , oh , I need to protect Bethlehem , Pennsylvania because the British are threatening that the hospital there and that will be embarrassing . When these hospitals were established , um , where , what model did they use ? Did they base it on like so much of the continental Army on the way the British army was formed and operated ? Yes , the British in the past . About 30 years of of nearly constant fighting in Europe , had realized that if they organized their medical system and provided staged care , including Getting the sick and wounded away from their units so that the units can maneuver . Then you get somewhat better medical care for the individual , but it helps the force overall , you know , it enables maneuver to use sort of modern phrasing . So they say , hey , let's do this . Let's have the hospitals under medical command so that a doctor is running the hospital , not some infantry captain who Let's be honest , was a poor enough company commander that the regimental commander said , you , I don't need you around , go run the hospital . So those were things that we had picked up from the British , uh , and not just from books and , and the British had some British doctors had started writing books about this thing . This is the best structure we've got , um , this is what you should do in the future . But also , of course , the French knitting war a lot a good number of American doctors had worked with the British forces in North America and had seen it and lived it and said , this is what I remember , this worked as well as anything . This is what we should do . And the Congress said , yes . And as the war progressed , what kind of , um , you know , from lessons learned , what kind of changes were , were made to that system ? Not really much , uh , Proof of concept , basically . Yeah , it , it wasn't too broken . Um , the , the thing that that they kind of make up to fill the gap between the the regimental medical care under the regimental surgeon . Which we still have , we call it a battalion aid station . That would that provides sick call and short-term sick care . Uh , with the unit , and we have hospitals further in the , you know , outside the battalion , outside the division now . Ah , what Washington and others invent , and I don't mean to say that this is a brilliant idea that George Washington had . I don't know if anybody , I don't know who created this , but um they had what they called a flying camp , a flying camp . Yeah , which sounds weird . Um , well , it's like movement when you say flying to me it means it's just bingo . So if you think , you know , Valley Forge is the most famous example , but Valley Forge is actually a fortified camp . Um , so then if you're bringing some of your supplies with you as a sort of mobile depot and you bring some quartermaster guys and some repairer ordinance which we now classify them . you know , bring some of your logistical support with you . They call that the flying camp . And there was a flying hospital that traveled along with , and I , I haven't seen that , I haven't heard of that with the British forces out of the or at least at the British doctrine before the war . The British may have been doing that at the same time , but they , they do . End up with this intermediate step between the the converted church that's being used as a hospital in the rear and the barn that is being used by An infantry regiment for its sick and injured so that they'll have this flying hospital in between . Yeah , so that's something that's closer to the battlefield because as you mentioned , the , the , the bigger hospitals would be further back , but clearly they had to have something that could , you know , provide you um immediate . Uh , medical care or , or at least triage somewhere on the battlefield and , and sounds like that's what one of these flying hospitals would have done . I think so . They're really poorly documented , uh , and they're Not really I don't think they're really fully staffed . I think they're staffed when needed , so maybe Smith , Jones and Anderson were told , hey , if we need to form a flying hospital , you 3 will be part of it , um . Um , but that's , that's an additional duty . So this , uh , I really haven't seen records and there may have been records at the time that haven't survived . There may still be out there somewhere , and if anybody listening knows where they are , please get in touch . Cole Sanders Marvel . Yeah , and you know , it's interesting too is as we're discussing this flying camp , it , it's , it almost sounds like a precursor to the mass units that that we've come to know , mobile army surgical hospitals . I don't know if there's a direct correlation there , but it sounds it sounds very similar to something like that . I would say maybe more like uh uh . Division support command where you're you're bringing elements of all your logistics support uh along with you uh they would have um because they're at this time they're not . Saying Uh , Dr . Jones is a surgeon and Dr . Brown is an internist , and Dr . Ledbetter is a cardiologist . Everybody is everything . No , they're not particularly good at any one of those . Yeah , and any dentists . Uh , there were people that pulled teeth , but I don't think anybody had yet invented the drill , which may or may not , may be a good thing . I don't enjoy having my teeth drilled . Especially on a battlefield . Yeah . Right . So , so throughout the war , um . What , what were some of the , the biggest medical challenges that the medical corps faced ? Most of the war , uh , sickness is a big problem and that's because there's not so many big battles to generate lots and lots of casualties that people are getting sick all the time . Um , so they have to treat patients , and they have to treat patients . At a time when medical knowledge was Really barking up the wrong tree . They were still using medical concepts that go back to ancient Greece . The Greeks thought that there are 4 elements in the world , uh , earth , air , fire , and water . And each of these somehow aligns with fluids in the body , blood and yellow bile and black bile and what they call phlegm , which I think is more than just like nasal secretions . I think it , but I'm not entirely sure because . Didn't go to medical school and they certainly don't teach this medical school anymore . Uh , so their idea of medicine is just going down the wrong path entirely . Um , they're still doing , yeah . Yeah , leeches were part of bloodletting , um , and actually . Occasionally leeches are still used . A mostly so if they reattach . To say your pinky finger , um , while they'll hook up the major blood vessels , but then minor blood vessels , you'll get more blood going in and coming out . So it use leeches to take some of the excess out . It's kind of wacky . Yeah , I hope I never have to live through that . Um , I think looking at it would be kind of weird , uh . Uh , but they don't have any diagnostic equipment other than touching the patient and Sniffing , you know , the , the five senses . They don't have stethoscopes . They don't have microscopes . They're , yeah , they don't even have a thermometer , so they are left really guessing what's causing these diseases . Uh , so , you know , without a microscope , you're not seeing bacteria and you're not correlating any kind of any particular bacteria with a particular disease . You certainly can't see viruses . So they're left really guessing what's going on . And so their treatment methods are really Of pace they will make patients sweat . They will make people throw up . They will make them . Um , go to the bathroom . They will bleed them , as you alluded to . They're trying . According to the science that they were taught , trying to balance for humors , and that will restore the body to harmony . You you mentioned these about these diseases I know smallpox was prevalent in in this time period , and I , I believe that General Washington required soldiers to be vaccinated and is that first , is that correct ? And then that's a new concept at this time , wasn't it ? You've got the right idea . Um , technically vaccination comes along about 20 years after the Revolutionary War , but they , what they did then was inoculate . yeah , um . I don't mean to split hairs too too much I guess um . Vaccinate was with a different disease called cowpox , which was not fatal , whereas smallpox killed between 3 and 30% of people that got what was called a wild case , a wild spread . Um , so yeah , smallpox was a big deal . Um , at the time , there there was . We don't know why , but there was an epidemic in North America that's happening slightly before , slightly after the Revolutionary War . So it's , it's very much in Washington's mind . Washington himself had had smallpox as a young man . had been sick for Several weeks , uh , and , and knew what that felt like , uh , knew , you know , during those weeks , I'm I'm sure he was contemplating whether he was going to get better or not because he didn't know . Uh , there was nothing they could do for him other than You know , pray and give him food so that he could maybe get better , and but he can , he's lived with that and thought about that and when he takes command . He turns up on the afternoon of the 2nd of July . Out outside Boston and Introduces himself and says , you know , here's my orders from the Congress . I am not the commander , and they say , OK , sir , you're not the commander . And the next day , as he's looking around and setting his priorities , one of the things he does is put the smallpox isolation hospital out of bounds . So troop troops do not go see your friends if they are or family members or whomever , if they are in a smallpox hospital . That's how like day one he's paying attention to smallpox . But he also says , do not get inoculated . This is against orders . Oh really ? Yeah , there were a variety of towns and some of the colonies did not . want inoculation because inoculation was with actual virus . They would take a pus is growth , or a scab from a smallpox pustule would also growth , they would take that from a patient who was recovering , and then poke a hole in somebody else and infect them . Oh wow . Inoculation had generally less than a 1% mortality rate , so I think that the towns and cities are thinking , oh , we don't have numbers , but we don't , we certainly don't want to be spreading the disease . And because they're , they don't , their understanding of science is a little different from ours . Um , but there's also a school of thought at the time , and I think there's still people in America that think this that . You don't mess with what God intended . And if God intended you to get smallpox , you'd get smallpox . And if God intended you to get better , you'd get better . And if God didn't , that's part of God's plan too . Um , so that you know that that . That train of thought is still prevalent today . The uh the measles outbreak that we're seeing now in the spring and summer of 2025 is largely out of a religious community that doesn't believe in , in , and here vaccination is the right term that doesn't believe in vaccination . Um , so , uh , it's something that Americans are free to believe has consequences . Right . But yeah , Washington was aware he he puts the the smallpox isolation hospital off limits , but he , he also bans inoculation because it is , and , and I don't think he says this specifically , ah , because it's politically controversial . And I think , I don't think there's a whole Class lesson in civil military relations around this , but I think Washington is thinking . the science is , you know , I'm paraphrasing , but the science is equivocal , um , it is politically controversial . I'm not going to do that . And that holds through for about 2 years , during which time , a lot of troops actually break orders and get themselves inoculated because they know the risk , and they know I would rather have , you know , a much lower chance of dying than getting it a wild case . But Washington also sees hundreds of people die . He's not there , but , but he knows , especially in the American . attempts to conquer capture I suppose sounds nicer , capture Montreal and Quebec in the winter of '75 , 76 . There's a lot of sickness , a lot of which is smallpox , and there's hundreds of people dying from smallpox up there , and the army is so that force is so sick that they can't muster a strong attack . So He sees the effect that smallpox has on the force and says that's a problem . Um , I'm , if I ever want to maneuver and I hear that there's , you know , my army and I hear that there's a smallpox outbreak in Smithville or , you know , Brownboro . I do I take the risk of moving my army through that smallpox outbreak ? That's a problem . Do I want my army to spread smallpox when we march around the colonies ? I don't want that either . So in 1777 , he says , OK , I'm going to do this in a planned methodical way , and he has , he sets up a schedule . He knows there's a lull in the action , and he will take brigade by brigade by brigade and have them inoculated in rotation so that he's in control of the schedule . And if something happens and the British come marching out of Philadelphia . He can cope with that . Yeah , because once they were inoculated , um , were they , were they sick for a short period of time ? Um , yeah , yeah , they would be sick for a few weeks , um , and Washington is very aware , uh . Commander's critical information . He did , he , he wanted censorship of the news that the Americans were inoculating . So the British wouldn't think , Aha , their chaps are going to have 1000 fewer men ready to fight . Let's go attack them now . Yeah , so , uh , he inoculates in phases , um , and then from then on continental Army recruits are supposed to be inoculated before they arrive in the main army . So there's sort of a Kind of sort of recruit depots . And and they're inoculated before they arrive . And that actually helped recruiting because they were getting reports from the colonies that people were interested in joining the army , but didn't want , but they were aware of the risk of smallpox because like if you're coming from a small farm village of 100 people , um , There's a good chance that nobody in your village has had smallpox , and you know that if you go to a big city or The army was the equivalent of a big mobile city . You're gonna get smallpox because it's out there . They don't know how it spreads , but they know it spreads person to person . So you knew that you'd get smallpox and people were not joining the army because they would get sick . So , so inoculation actually increased recruiting . Fascinating . And when Washington made some of these decisions , uh , especially regarding medicine , medical issues like this , did he rely on the medical department at all for for advice ? Yes , they had been . Giving him advice , saying , especially about inoculation , saying , medically , this is smart . There is a there is a mortality rate to inoculation . It is less than 1% . It is substantially less than the number of people you will get sick . You will have died if you wait and see . And I they had been saying that consistently and I think the experience that he got . Of having guys randomly get sick and also that the The reports he got back from Canada expedition . where it's a big problem . Uh , and the realization that this is not going to get better unless I do something , uh , all contribute . And I , I also think he's well aware that An order that is ignored is a bad order . Let's talk about the battlefield itself . So let's say 1777 , 1778 , there's a battle going on , soldiers are getting shot or or bayoneted . Uh , talk us through . Um , how they would receive medical care , how would they be evacuated from the battlefield , and , um , would , would they go to uh a triage center and then a hospital or just , just walk us through that and , and if you could , um , you know , what was the recovery rate like for an injured continental soldier ? There was no medic at the time . There was not really a litter or a stretcher , so Some of your buddies would help you back to wherever it was that the regimental surgeon had set up to do his job , not really what we think of as an aid post now . The surgeon would open up his medical kit , a wooden box with surgical instruments inside . Uh , and maybe he , he's probably at some sort of landmark where they can , the troops can say , oh , take the wounded guys back to there , a farm building or a clump of trees that was a navigation point . Ah . The wounded guy might be carried by the corner of his corners of his coat , so those big turn backs that they had that could be useful . uh , it might be a wheelbarrow , uh , uh , and then from that regimental point , uh , uh . Uh , 8 station back further to the rear , probably by wagon , uh , you know , no springs on it , bumpy dirt road , so they've just been a delight . But the surgery , there are no diagnostic tools other than using your eyes , poking a finger into a hole , and they did have metal probes so that they could , you know , put two in and sort of You know , the , the children's game operation and try , you know , flesh open to get down to the musket ball . Uh , they would try and get the musket ball out , get out , um , chunks of fabric , uh , dirt , uh , broken bone . They would tie off , obviously bleeding , um , arteries , uh , they . paid off with Suture uh or uh cauterize it , you know , heated iron to to uh scar it over . Uh , if they know that that infection is pretty much guaranteed , they don't know why it's guaranteed , but they know it's guaranteed . So if blood flow is in our terms compromised . Um , they would probably go ahead and amputate below that point . But if you get an abdominal or chest wound or something up in the head , you're likely to die because there's nothing they can do because it's not that the surgery is particularly bad surgery , uh , it's that the infection will get you later . Oh wow . Um , I Don't have , we don't have pretty , we don't have good or really much in the way of uh . Patient data , but I would bet that um extrem extremity wounds that bad enough to require an amputation . 25% mortality if it's just a flesh wound , much less if it's , you know , a trunk wound uh . probably close to 100% mortality , not from Bleeding out , although that would have been a real risk . Uh , but the the subsequent infection , they , they don't also you mentioned triage and they don't do it the way we would think of it . They say surgery is so . The results are , are really unpredictable in their eyes . It's often first in , first out , and priority might be given to an officer because . Uh , in some ways , that's their social status and to a degree , their utility to the unit . Uh , But it we don't really have many accounts of how they made those decisions . Warfare was rough uh back then , but it's just didn't want to get hurt on the battlefield . Yeah , partly because they don't have any anesthesia . They have postoperatively , they might , or I guess they could give you opium . For pain the head they would use opium for pain afterwards , but they don't , it's just an unpleasant thing . You know , we , we , we talk about the establishment of , of the medical department on 27 July 1775 , but it was also the establishment of the medical corps . So I'm a little confused by that . So can you explain the difference between the medical corps and the medical department ? Thank you . This is something that is easily confused . Um , the medical corps is a uh term the army uses for the , the group of doctors that are with the army , um . So there's a medical corps , there's a dental corps , you can guess who those people are a nurse corps , veterinary corps now , and these are all post-revolutionary War . So , so the medical corps is the Army's doctors . In the Revolutionary War , they were , I'd say with the army because they don't have ranks . Their their job titles are things like surgeon and assistant surgeon , hospital surgeon . Medical director , uh , not lieutenant or major . And they're not even authorized to get uniforms and pensions until pretty late in the war . Oh wow . So there's , so they're not even considered soldiers at that point then ? They're just doctors assigned to the army or ? Well , they , they volunteered to join uh . And but I think there is a cultural difference at the time between the combat , the combat arms , which are , which are sort of , and this is coming out of European nobility , that gentlemen are lead and tradesmen do their thing in the rear , maybe a tradesman handles the wagon . and the supplies , but a gentleman would not do that . And even though the the American colonies had a different social structure , I think there is still some of that around . Nathaniel Green is kind of upset when Washington says , hey , I need you to take over the supply system because Green wants to be a combat arms guy , you know , a subordinate commander . He doesn't want to be in the rear with the gear , but he pulls it together and says , no , no , this is what the boss needs . I will do my best . And I think this is kind of to a higher degree with with medical folks who are necessary and we want them and we need them , and they help . Uh , you know , they , they help soldier morale . Um , both want medical care and they're , they're . A Looking for it , they won't join the army if they're gonna , you know , if the army is going to go and get them sick , the smallpox . Uh , and there , but at the same time , the doctor is just a , a , a guy who's with the army . That's different today . Uh , but this was 250 years ago in a different world . Is there anything else on this topic that we didn't bring up that you you would like to share ? I would spare you some of the the wacky ideas they had to prevent disease . But they , they , because they don't have the science that we do , but they did at the time realize that some diseases . Or some quantity of disease is preventable , uh , and you get guys like doctors are saying , hey , let's keep the latrines away from the kitchens and let's not the , yeah , and , and let's not slaughter the the the the food supply , the beef that we're gonna eat . Let's not slaughter that too close to the tents where the flies will go back and forth , uh . But and that's great . I mean , I'm I'm you know , if the doctor says that and advises the commander , that's one thing . But it's when von Steuben writes it down and as inspector General comes around and choose people out that that it gets enforced . So they have ideas about prevention and they they have some non-scientific , but Uh , clearly observed data that , you know , this is better than that , but it takes the chain of command to enforce that . that you can start seeing results and and again , they don't have the disease understanding that we do . So did it , I'm sure it helps , but you really can't tell from any data . And and hopefully these are good lessons that these soldiers took back to their homes , you know , after they left service or after the war was over and , and , um , and hopefully use the field sanitation concepts uh at home , but . Well , some of it was like wash your hands and face , take a bath twice a week . So yes , I hope so . Well , um , we're gonna need to start wrapping this up , but before we close , it's time for our segment that we call the huzzah trivia . Um , is there some piece of Army trivia that you can share about the Army Medical Corps ? Sure . Uh , I thought that the , the job title that we use today of battalion surgeon or brigade surgeon and division surgeon , that actually goes back to the rev war . It even goes back to those regimental surgeons that , you know , in the militia before the continental Army is formed . Back then , most civilian doctors , which was doctors in the colonies that were all civilians , they are very reluctant to do surgery because pretty much any surgery is going to get infected , um . So most of them don't do surgery , uh , and the military term though , because of the wounds that happened , the military called them all surgeons , and that job title has stuck even though you may have a family practitioner or a cardiologist or somebody who really doesn't do surgery . Their job title is surgeon . Yeah , you know , when you say that and now I'm thinking back on my military career and I would hear that term used , but I knew they weren't surgeons . It's uh just a term really for a doctor , I guess . Yeah , so that goes back to 1775 and even before . Well , cool . Well , thank you so much , Sanders for your insights today about the establishment of the Army Medical Corps and Army Medical department . And if anyone wants to learn more about the Army Medical department . I explore , I encourage you to explore Army history , um , on our website at history.army.mil and if you want to experience army history every day , then you can visit our social media sites on Facebook , X , and on Instagram . So thanks for joining us today on the United States Army History and Heritage podcast for the Center of Military history . I'm Lee Reynolds , and until next time , we're history . The views expressed in this podcast reflect those of the speakers and do not necessarily reflect the views , policies , or opinions of the US Army or Department of Defense . For more information about the Army's proud history and heritage , go to history.army.mil .