Throughout the American Revolution, opposing armies fought a common enemy. Primary documents on both sides are full of complaints, descriptions and responses to the attacks of a stubborn adversary; fever.
As the Declaration of Independence was being prepared, Joseph Hewes of North Carolina complained from Philadelphia on May 17, 1776, “An obstinate ague and Fever, or rather an Intermitting Fever, persecutes me continually; I have no way to remove it unless I retire from Congress and from public business; this I am determined not to do till N. Carolina sends a further delegation, provided I am able to crawl to the Congress Chamber.” The next day, Benedict Arnold and his men, who had left Montreal for the border area of St Johns, arrived at that “dirty, stinking place” in a camp which “echoed with execrations upon the musketoes.”
The following week, Nathanael Greene wrote George Washington from Bound Brook, New Jersey, pleading for vinegar for his feverish troops. On May 27, 1776, Richard Hutson, South Carolina delegate to the Continental Congress, optimistically predicted that if the British did not move against Charleston soon, that city could breathe freely at least until November, “for it would be the height of madness and folly for them to come here during the sickly season.”
As far north as Fort Ticonderoga, fever was reported. In August of that year, Pvt. Simeon Walker of Woodbury, Connecticut, arrived with Hinman’s Connecticut troops, remaining “at Ticonderoga until sometime in the fall being taken sick with fever and ague. Was permitted to return home.” Walker was one of the lucky ones. Generally, if a soldier had an “ague fit,” complete with chills and shaking, he had no choice but to persevere and move on. A medical book of the day supported this stoic behavior: “… the patient ought to take as much exercise between the fits as he can bear … Nothing tends more to prolong an intermitting fever than indulging a lazy indolent disposition.”
The pension records of John Almy describe what having fever and ague was like for a boy who at age thirteen or fourteen “in Feby or March 1776” enlisted into a rifle company in the State service:
Was taken with a fever and ague, and from that, a continual fever; and was left in the hospital at Trenton. After getting better in about two or three weeks, he set off for the regiment and travelled to Princeton. There he had a return of the fever and ague; and after remaining about as long as he did at Trenton, went on to Fort Lee, and crossed, as he thinks, to York Island, where he found his regiment encamped near Fort Washington. The same evening there came orders for all the sick that were able to walk, to make the best of their way in the direction that the baggage went. Fort Washington being taken and the army obliged to retreat, declarant kept on with the sick, until he arrived at the White Plains, but could not keep so far ahead, but that they would bring the wounded to dress where he had stopped to shake with the ague … When he arrived at the White Plains, he found a few loads of baggage; no provision, or any kind of convenience for the sick; of consequence, the sick straggled out to the farm houses, and begged. Declarant continued to wander about, but failed in his health, and could hear nothing of his regiment. He then wrote a letter to his father in Tiverton in the State of Rhode Island, with little hope that it would reach him, but he received it, came on, went to the encampment of the sick, there saw one of the company to which declarant belonged, who told him, he did not know where declarant was, or what had become of him. After making diligent search, declarant’s father set off on his return; by accident, took a wrong road, where he found declarant in the road, and with some difficulty conveyed him home. Fever and ague grew worse, continual fever set in; and declarant did not get well in six months’ time, nor does he think that he ever got over it.
Fevers were, at that time, believed to be caused by “effluvia and miasma” and it is difficult to tell from most eighteenth-century documents what kind of fever was being discussed. Fevers were, and are, caused by mosquitos and by ticks, fleas, contaminated food and water, bacteria, and crowded conditions. Not every case of fever and ague was malaria, and mosquitos were not America’s “secret weapon” as some secondary sources blithely report. In the fens and marshlands of England and in British holdings around the globe, malaria had been known for centuries.” Scottish physician William Buchan’s explanation of the causes of these fevers applied to the swampy places and irrigation ditches of the New World as well as to the Old:
Agues are occasioned by effluvia from putrid stagnating water. This is evident from their abounding in rainy seasons, and being most frequent in countries where the soil is marshy, as in Holland, the Fens of Cambridgeshire, the Hundreds of Essex, &c. This disease may also be occasioned by eating too much stone fruit, by a poor watery diet, damp houses, and evening dews, lying upon the damp ground, fatigue, depressing passions, and the like. When the inhabitants of a high country remove to a low one, they are generally seized with intermitting fevers, and to such the disease is most apt to prove fatal. In a word, whatever relaxes the solids, diminishes the perspiration, or obstructs the circulation in the capillary or small vessels, disposes the body to agues.
As the Philadelphia Campaign began to take shape, army hospital personnel at Ephrata, Lititz, and Bethlehem, Reading, Trenton, Princeton and areas beyond began complaining. In December of 1777, Dr. Benjamin Rush wrote a long letter to General Washington insisting on a reorganization of the Medical Department, noting: “Too many sick are crouded together in One house. I have seen 20 sick men in One room ill with fevers & fluxes, large eno’ to contain only 6 or 8 well men without danger to their health. Six of our Surgeons have died since the 1st of last may, from Attending the sick under these circumstances, and almost every Surgeon in the department has been ill in a greater or lesser degree with fevers caught in our hospitals.”
Robert Jackson, surgeon’s mate with the 71st Regiment of Foot in the British army, similarly lamented, “It is unfortunate that the mode, too frequently pursued, of collecting sick soldiers into general hospitals, so multiplies the causes of disease, as defeats the purpose.” “It is proved in innumerable instances, that sick men recover health sooner and better, in sheds, in huts, and barns, exposed occasionally to wind, and sometimes to rain, than in the most superb hospitals in Europe. Pure air, in this respect, is alone superior to all forms of care, and to all other remedies, without such aid. Where a number and variety of human beings are accumulated under the same roof, the air cannot long remain pure. It may not be positively impregnated with contagion; but it is not salutary.”
In the spring of 1778, Lt. James Morris of Connecticut was held prisoner by the British in Philadelphia. The situation in the prison was similar to the hospitals but worse: “At this time seven hundred prisoners of war were in the jail. The soldiers were soon seized with a jail fever and in the course of three months it swept off four hundred men, who were all buried in one continuous grave, without coffins. Such a scene of mortality I never witnessed before. Death was so frequent that it ceased to terrify; it ceased to warn; it ceased to alarm survivors.”
As the war effort moved south, reports of fever and ague increased. Rice irrigation ditches and pools of stagnant shallow water were the home of the anopheles mosquito. Mosquitos biting those who already suffered from the malaria parasite spread the disease to rich and poor alike. An eighteenth century saying, variously attributed to a German soldier, to Eliza Lucas Pinckney and to the ever-popular “anon,” summed it up: “South Carolina is in the spring a paradise, in the summer a hell, and in the autumn a hospital.”
According to surgeon’s mate Robert Jackson, the most common illnesses the army suffered in 1780 were “intermittents,” probably vivax malaria. It was reported that a Hessian regiment had lost “many men and some officers, and at present has not really above sixty men fit for duty,” and, on July 17, 1780, Cornwallis received a letter from Lt. Col. Nisbet Balfour, commandant of Charleston: “We are turning sickly fast and our surgeon very ill.” On July 29, 1780, Cornwallis received a similar letter from Major James Wemyss writing from Georgetown, South Carolina, reporting that his men were “falling down very fast” with intermittent fevers. A few days later, he reported that six men had died of putrid fevers and thirty other men were ill. Cornwallis ordered Wemyss to move inland along the Black River, cautioning him not to stay long in any place along the river “which is a very sickly country” and to move by “short and easy marches” to encamp in the High Hills of Santee, an area reputedly much healthier.
On the American side, things were no better. General Horatio Gates wrote to the Director of Hospitals, Southern Department from Hillsborough on 19th July, 1780, “I find an Hospital under the Direction of a Regimental Surgeon — without medicines or Stores of any kind — I also learn from the Army that with it there’s no Hospital Establishment whatever, and that the Sick are but illy accommodated — I have now to request that you will repair to my Head Quarters immediately — with such other Gentlemen as fall within your Arrangement, and may be absent. Should any Accident prevent your complying with this order, you will give me as Early Notice of it as possible.”
The next day, he wrote to the President of the Board of War, Philadelphia, “As I have no answer to any Letter I have wrote you, since I recd the Orders of Congress to take command this way, I know not what is doing to supply the medical Department … I yesterday wrote to Doctor Rickman, who lives near Williamsburgh, and ordered him to come and reside here, when the First General Hospital must be fixed. The Board will do well to enforce this Order, or see that some otherwise properly provided with a Director to the General Hospital of the Southern Army.”
On August 23rd, British General Cornwallis wrote to Sir Henry Clinton: “I am at present so hurried with business, with everybody belonging to me sick. Our sickness is great and truly alarming. The officers are particularly affected; Doctor Hayes (John M. Hayes) and almost all the hospital surgeons are laid up. Every person of my family (official) and every Publick officer of the Army is now incapable of doing duty.”
At almost the same time, an American was writing a comparable letter to his commander:
The great numbers of men that are down with the Ague, & fever prevents my even giving a Guess when it will be in my power to comply with yr. orders. I am truly unhappy for the unfortunate Event of the G. Army On the 16th Instant, and sorry that the Want of Horse should in so great a measure be the Cause of it.
1781 was a busy year for battles; Cowpens, Guilford Courthouse, Hobkirk’s Hill, the Siege of Ninety-Six, all took place before the “fever season” really began. By the late spring and summer of 1781, there were many cases of fever reported in Virginia and the Carolinas. Some soldiers, like John Ware, were not hospitalized. His pension papers state, “In the Summer of 1781, in the month of July, this … this deponent was taken sick with what was in those days called the Dumb ague or Slow fever and was left on the road … and owing to this circumstance he failed to get a fight as he expected.” Among those imprisoned at Charleston, a putrid fever caused by “the human miasma” was highly contagious. The sick brought into the general hospital from the prison ships generally died in the course of two or three days, with all the marks of a highly septic state.
In early August, 1781 some of General Wayne’s men were sent to a general hospital located in a private home at Hanover, Virginia. In September, as preparations for the siege of Yorktown increased, the physician at the Hanover hospital died and the responsibility for the care of his fellows fell entirely upon one of the patients.
Following the Battle of Eutaw Springs, South Carolina on September 8, 1781, reports of fever increased. Although most reports simply noted that a soldier suffered from “fever and ague,” some pension records tell a story.
One soldier explained that “owing to sickness and fatigue, very near perishing before he reached the camp, when Adjutant Weathers … carrying him to a shade, gave him brandy and cheese, etc. and he was there sick about a month.” 
British reports were no less dramatic. On the retreat from Eutaw Springs to Charleston, Maj. John Marjoribanks fell ill and was left at Wantoot Plantation where, racked by fever, he died in the hut of one of Daniel Ravenel’s slaves. On September 20, 1780, Banastre Tarleton became violently ill and Maj. George Hanger filled in as commander of the British Legion. Hanger also became ill and was sent to Camden, South Carolina to recover. When Tarleton was well enough to resume command, Cornwallis came down with a fever, remaining severely ill until late October.
General Nathanael Greene moved his Continental army to the Upper Coastal Plain’s High Hills of Santee to gain relief from the heat, humidity, and diseases associated with the adjacent Middle Coastal Plain swamps. On September 27, Robert Kirkwood noted in his journal that he had gone to Headquarters “for Docts. Medecine for my men and returned the 30th, Inst. 40 miles.”
The siege of Yorktown, Virginia began on September 28. During course of the battle, Army surgeon James Thatcher of the 16th Massachusetts Regiment, wrote, “Our New England troops have now become very sickly; the prevalent diseases are intermittent and remittent fevers, which are very prevalent in this climate during the autumnal months.” On the 19th of October, Cornwallis surrendered 7,087 officers and men, 900 seamen, 144 cannons, 15 galleys, a frigate and 30 transport ships. Pleading illness, he did not attend the surrender ceremony. Cornwallis later estimated that only 3,800 of his 7,700 men were fit to fight.
In the minds of many people, the surrender at Yorktown in the fall of 1781 brought the Revolutionary War to an end, but it was not over. Delaware’s Kirkwood simply noted in his Journal from South Carolina, “Received Intelligence of the Surrender of Lord Cornwallaces whole Army to his Excelency Genl. George Washington in York Town Virginia.” On November, 1781, “This day was ordered to march by the way of Howell’s Ferry to Col Thompson’s and there to join the Army. The troops moved, but I went to Capt Howells having the ague & Fever where I stayed untill the 27th Inst.”
The letter Lt. Andrew Armstrong wrote to Gov. Thos. Burke from Camden, South Carolina on July 10th, 1782, summed up the feeling of many by the end of the war:
I have a d—d fever and ague, but I do not believe that writing to a Doctor will cure me.
I am Sir, with my compliments to Mrs. Burke.
There were other hospitals, other diseases, other soldiers and other documents pertaining to fever and ague in the Revolutionary era. This is only a glimpse of what transpired, told as much as possible by the voices of the past. Today’s soldiers still suffer from malaria, yellow fever, typhus and typhoid.  No matter the ideology, nationality or cause, fever remains a leveling force.
 Mary Gillette, “The Army Medical Department 1775-1818,” in Office of Medical History in Army History Series, edited by Maurice Matloff, 60, www.history.amedd.army.mil/booksdocs/rev/gillett1/ch3.html.
 Gillette, “The Army Medical Department,” 60. See also Richard Hutson; Hutson Letterbook, 1765-1777, South Carolina Historical Society.
 Simeon Walker, Revolutionary War Pension Application, 12 Jul 1832, Court of Probate for the District of Caledonia, in National Archives; “State of Vermont SS District and County of Caledonia.1832. Simeon Walker’s compatriot, Aaron Barlow noted that he and his men were, “lodging among the fleas” during his brief stay at Ticonderoga. https://archive.org/stream/waroftherevolution00recorich/waroftherevolution00recorich_djvu.txt.
 William Buchan, “Of Intermitting Fevers, Or Agues: Symptoms.” Domestic Medecine, Chapter IV. London, 1769. http://www.Americanrevolution.Org/Medicine/Med14.Php,
 This was in November, 1776.
 John Almy, Revolutionary War Pension Application in State of Rhode Island, Ss. County of Newport, Town of Little Compton, Sc Southern Campaign American Revolution Pension Statements & Rosters. Pension Application of John Almy W1531 Transcribed and annotated by C. Leon Harris. www.revwarapps.org/w1531.pdf.
 Mary Dobson, “The History of Malaria in England,” excerpted from Contours of Death and Disease in Early Modern England (Cambridge University Press, 1997), www.malaria.wellcome.ac.uk/doc_WTD023991.html accessed September 25, 2015.
 William Buchan, “Of Intermitting Fevers, Or Agues: Symptoms,” Domestic Medecine (London, 1785), http://www.Americanrevolution.Org/Medicine/Med14.Php.
 Benjamin Rush to George Washington, December 26, 1777, Princetown, N.J., National Archives, Founders Online, http://founders.archives.gov/documents/Washington/03-13-02-0006.
 Tabitha Marshall, “Surgeons Reconsidered: Military Medical Men,” 339-40, http://www.cbmh.ca/index.php/cbmh/article/viewFile/1363/1332.
 Rev. James Morris, US Army, www.history.amedd.army.mil/booksdocs/rev/MedMen/MedMenCh08.html.
 Alured Clarke to Cornwallis, July 10, 1780. PRO 30/11/2/258–61, Clarke to Cornwallis, August 30, 1780, PRO 30/11/63/83–84; Clarke to Cornwallis, October 5, 1780, PRO 30/11/3/86–87, British National Archives.
 Nisbet Balfour to Cornwallis, in Peter McCandless, “Revolutionary Fever, Diseases and War in the Lower South 1776-1783,” Transactions of the Clinical and Climatological Association, 2007, 118:225-249, http://europepmc.org/articles/PMC1863584 .
 Cornwallis to Wemyss, July 30, 1780, (PRO) 30/11/78/61-64, British National Archives.
 Horatio Gates to the Director of Hospitals in the Southern Department, Hillsborough, July 19, 1780, Letter #8, Southern Campaign Revolutionary War Pension Statements & Rosters, http://www.battleofcamden.org/documents.htm .
 Gates to the Director of Hospitals in the Southern Department. Hillsborough, July 19, 1780, Letter #12, Southern Campaign Revolutionary War Pension Statements & Rosters, http://www.battleofcamden.org/documents.htm.
 Cornwallis to Sir Henry Clinton, August 29, 1780. Office of Medical History. Chapter XII, 313, http://history.amedd.army.mil/booksdocs/rev/MedMen/MedMenCh12.html, 15:276-278. Cornwallis to Clinton. Received September 23, No. 3. in Sir Henry Clinton’s, No. 107. Camden, August 29, 1780, http://docsouth.unc.edu/csr/index.html/document/csr15-0196.
 Anthony White to Gates, Halifax, North Carolina, August 31, 1780, in The Colonial and State Records of North Carolina, 583. http://docsouth.unc.edu/csr/index.html/document/csr15-0193.
 John Ware, Revolutionary War Pension Application, Caswell County Historical Association, September 20, 2010, http://ncccha.blogspot.com/2010/09/john-ware-revolutionary-war-pension.html.
 Robert Kirkwood, Journal and Order Book of Captain Robert Kirkwood of the Delaware Regiment of the Continental Line, Joseph Brown Turner, Ed. (Wilmington, DE: Historical Society of Delaware, 1910), 25.
 James Thatcher, Military Journal: The American Revolutionary War from 1776 to 1783; Describing the Events and Transactions of This Period with Numerous Historical Facts and Anecdotes (Hartford, CT: Hurlbut, Williams & Co., 1862), 286.
 Kirkwood, Journal, 26.
 Kirkwood, Journal, 20- 26.
 Andrew Armstrong to Thomas Burke, July 10, 1782, The Colonial and State Records of North Carolina, 583. Documenting the American South, 16:629-630. sr/index.html/document/csr15-0193.