Joseph Lovell,MD (1788–1836): First US army surgeon general

Introduction

The Treaty of Ghent, signed on Christmas Eve 1814, returned Britain and America to the status quo antebellum and, the Battle of New Orleans notwithstanding, brought the War of 1812 to a close. In its aftermath, American political and military leaders attempted to return national governance to its pre-war status as well. But as a confident and remarkably unified America began to expand across the Alleghenies and into the trans-Mississippi west, it became apparent that this growth and development demanded a broad, comprehensive, and flexible approach to all aspects of government. Security along the Atlantic coast and on the expanded western frontier that stretched from a fuzzy Canadian–American border to New Orleans suggested to some national leaders a requirement for a larger standing army than that of 1811 and one that would be organisationally efficient and operationally effective. In April 1818, a new Secretary of War, John C Calhoun (1782–1850), reorganised the United States Army to meet those standards. He also placed a permanent Surgeon General on the army staff in Washington, DC and, with President James Madison’s (1751–1836) concurrence, hand-picked Joseph Lovell ¹ to lead the Army Medical Department. Lovell, still some months from his 29th birthday, accepted the challenge. Over the next 18 years he not only directed the Medical Department but also created its organisational structure, defined its function, and specified the requirements and roles of its medical officers.

A well-educated Boston family

Joseph, the first child of James Smith (1762–1825) and Deborah (Gorham) Lovell (1769–1793), was born in Boston on 22 December 1788 into an old and prominent family of that city. ² Great-grandfather John Lovell (1710–1778) graduated from Harvard in 1728 and became master of the Latin School in 1734. ³ Grandfather James Lovell (1737–1814) received his primary education at the Latin School and graduated at Harvard in 1756. ⁴ Arrested as a rebel spy in the spring of 1775, James was sent on a prison ship to Halifax, Nova Scotia, at the same time that his father took up residence in that city as a loyalist refugee. ⁵ James was exchanged in the Fall of 1776 and returned to Boston to become a delegate to the Continental Congress. ⁶ After the Revolutionary War, James was appointed Receiver of Continental Taxes in Boston and he established the first Custom House on State Street. ⁷

Lovell’s father, James Smith Lovell, graduated from Harvard in 1787, ⁸ worked as an Officer of Police and, from 1803 to 1818, as a Custom House Officer. ⁹ He and Deborah had three more children: Helen Ann (1790), John Livingston (1791) and James (1793–1826) but Deborah died, possibly in childbirth, in February 1793. Other than the fact that Joseph’s father remarried twice and added seven more children to the family, little is known of Joseph’s early life. ¹⁰ He probably received his primary education at the Latin School, and he received his AB (Bachelor of Arts) from Harvard in 1807. ¹¹

Harvard’s first class to receive an MD

Lovell began his medical apprenticeship in Boston under William Ingalls, MD (1769–1851). ¹² Ingalls pronounced Lovell a qualified doctor in 1810. Joseph established his first practice, approved by the Massachusetts Medical Society, in his father’s home on Pleasant Street, Boston. ¹³ Over the next few months, he became an active and successful member of Boston’s medical community, but in the Fall of 1810, Lovell returned to the classroom at Harvard Medical School.

At the time Lovell began classes, the school had just moved to Marlborough Street in Boston from its original location in Cambridge. ¹⁴ John Warren (1753–1815), founder of the school in 1782, was Professor of Anatomy and Surgery. A legendary instructor and surgeon, Warren had served at the battle of Long Island, the retreat across Manhattan and New Jersey, and the battles at Trenton and Princeton during the revolution. Later he directed the military hospital in Boston and passed on his skills to younger surgeons. All of these experiences undoubtedly enriched his lectures. ¹⁵ His son, John Collins Warren (1778–1856) who had studied at Guy’s Hospital in London and the Clinique de l’Ecole de Médecine in Paris, assisted as Adjunct Professor in both anatomy and surgery. ¹⁶ Benjamin Waterhouse (1754–1846) taught the Theory and Practice of Physic. A strong advocate of vaccination against smallpox, Dr Waterhouse had successfully tested this technique on adolescent boys in 1802, an experimental study in which John Warren was a senior advisor. ¹⁷ Professor Aaron Dexter (1750–1829) and Adjunct Professor John Gorham (1783–1829) taught chemistry and Materia Medica in 1810. ¹⁸ James Jackson (1777–1867), assumed the new Chair of Clinical Medicine. Jackson, who also had studied at St Thomas’ and Guy’s Hospital, ¹⁹ brought new methods of clinical instruction to the Boston Dispensary, the Marine Hospital in Cambridge, the State Prison in Charlestown and the Almshouse, each of which had opened its doors to the school by the Fall of 1810. ²⁰ The collective medical and surgical knowledge and experience of these men, their appreciation of research and new medical methods, and their use of Boston’s clinical facilities to imitate those of London and Paris, provided Lovell with a remarkably robust medical education. He graduated in March 1811 in the first Harvard Medical School class to receive an MD degree ²¹ and then returned to private practice. ²²

Boston medical politics, which had been controversial since the War of Independence, continued that trend during 1811. Lovell joined his old preceptor, William Ingalls, and James Mann (1759–1832), Benjamin Waterhouse (1754–1846) and others in an effort to create a Massachusetts College of Physicians as an alternative association to the Massachusetts Medical Society. ²³ This attempt to break the Society’s monopoly on medical licensing and, by extension, the monopoly Harvard had over medical education, was vigorously opposed and defeated by John Warren and his colleagues at Harvard. There is no evidence that this soured Lovell’s practice. After the war and perhaps expecting to return to Boston, he became a member of the Society in 1817. ²⁴

The War of 1812

In March 1812, the 9th United States Infantry Regiment was organised and began recruiting in Massachusetts. ²⁵ Lovell joined the unit as regimental surgeon on 15 May ²⁶ and the regiment joined other units at Burlington, Vermont in December. ²⁷ It may be assumed, due to his immediate success as a regimental surgeon, ²⁸ that he spent this extra time preparing for that role. John Warren and James Mann ²⁹ could have provided sound advice on military trauma and associated diseases as well as the administration of military hospitals. Lovell would have found a number of pertinent books to study at the Boston Medical Library: Cuming’s Naval, Military, & Private Practitioners Amanuensis Medicus et Chururgicus, (London, 1806), a comprehensive treatise of one Royal Naval surgeon’s experiences, John Jones’ Practical Remarks on the Treatment of Wounds and Fractures, (New York, 1775) was America’s first surgical text and included disease prevention measures for military surgeons, Woodfield’s Military and Domestic Surgery, and Gerhardt van Swieten’s The Diseases Incident to Armies with the Method of Cure. To which are added; the Nature and Treatment of Gunshot Wounds by John Ranby, and also Preventatives of Scurvy at Sea by William Northcote. Van Swieten’s contribution was translated from the German and printed at Philadelphia in 1776 and, although meant as a handbook for those regimental surgeons without benefit of professional medical education, it provided useful knowledge for any inexperienced military physician. In addition to these, the library offered JFD Jones’ Treatise on Haemorrhage and the use of the Ligature and Seguin Jackson’s Observations, etc., on the Epidemic Disease of Gibraltar which a military surgeon would find of benefit. ³⁰ At the Library of Boston, he quite possibly found the 1810 American edition of John Pringle’s (1707–1782) Observations on the Diseases of the Army with notes by Benjamin Rush (1746–1813), Donald Monro’s (1727–1802) two-volume work, On Preserving the Health of Soldiers (London, 1780), Robert Hamilton’s Duties of the Regimental Surgeon (London, 1784), and Robert Jackson’s (1750–1845) Medical Department of the British Army (London, 1803) and System for the Medical Department of Armies (London, 1805). ³¹

With a relatively impotent navy, American strategy focused on Upper and Lower Canada. British supplies moving down the St Lawrence River and across Lakes Ontario and Erie to western military posts had supported Indian attacks on the American northern and northwestern frontiers since the end of the Revolutionary War. Control of these waterways became the primary military and naval strategy throughout the war with the permanent seizure of Canadian territory arguably, as a secondary goal. ³²

From 1812 to 1815

From December 1812 until May 1815 Lovell was continuously in the field, administering a general hospital and on campaign against British forces. ³³ In both settings, he was recognised quite rapidly as a competent and capable military medical officer. James Mann, now Chief Surgeon Medical Services in New York, stated that Lovell was ‘one of the most able and attentive surgeons of the army’. ³⁴ During the 1813 campaign season, according to William E Horner, MD (1793–1853), a military surgeon at Buffalo, New York, Lovell ‘distinguished himself by his skill and zeal in the campaign of 1813, as well as in 1814…,’ ³⁵ and in 1816 Mann commented in his Medical Sketches of the Campaigns of 1812, 13, 14 that Lovell’s ‘frequent reports… bespeak an accurate and discriminating mind. As an operative surgeon, he is inferior to none’. ³⁶ Although Lovell’s perceptive, analytical mind had been developed in Boston, the medical experiences that matured him as a medical surgeon and staff officer are found in the Niagara Campaigns of 1813 and 1814.

On 27 May 1813, Lovell participated in the successful amphibious assault on Fort George and treated many of the 250 American and British casualties. He assisted William Beaumont (1785–1853), Surgeon’s Mate, 6th US Infantry Regiment in trepanning the skull of a gunshot wound victim and Beaumont commented that Lovell performed the operation ‘in a most adroit & masterly manner… ‘ ³⁷ Lovell remained at Fort George throughout the summer and early autumn of 1813 during which time he noted and described the effect of the lake environment – a rainy summer with large day/night temperature fluctuations – when combined with long and fatiguing picket duty in producing typhus, intermittent fevers (malaria), dysentery, and diarrhoea. Lovell also recognised that the incidence of typhus and intermittent fevers was small when compared to dysentery and diarrhoea, what he termed the true army ‘camp diseases’. ³⁸

In October 1813, Lovell deployed from Sackett’s Harbor, New York with Major General James Wilkinson’s (1757–1825) attack on Montreal that was aborted after the embarrassing American defeat at the Battle of Crysler’s Farm. ³⁹ During this operation, severe winter lake weather revealed to Lovell not only the lack of medical-to-line staff coordination in deploying medical equipment and supplies but also a larger deficiency in providing ammunition, rations, blankets, and winter clothing to American soldiers. ⁴⁰ Wilkinson retreated across the St. Lawrence River to French Mills to spend the winter. Of their arrival on 14 November, Lovell commented

the weather became intensely cold, and remained so during the winter… Even the sick had no covering except tents, from the period they embarked at the Mills, until the 1 January… Provisions were scarce, and of a bad quality. Medicine and hospital stores [had] been lost or destroyed during the passage down the St. Lawrence. ⁴¹

The situation did not improve significantly until the 9th Regiment moved to Sackett’s Harbor with Major General Jacob Jennings Brown’s (1775–1828) Division in late February 1814 to prepare for the summer campaign. ⁴²

The Niagara Campaign of 1814

The 1814 Niagara Campaign began with the arrival of elements of Brown’s division, under the command of Brigadier General Winfield Scott (1786–1866) at Buffalo in early April. The entire division had been assembled and a hospital established in Buffalo by June, the month in which Lovell was promoted to Hospital Surgeon. ⁴³ The following month, Lovell accompanied the 9th Infantry as American forces took Fort Erie from the British, defeated Major General Sir Phinias Riall (1775–1850) at the Battle of the Chippewa and fought General Sir Gordon Drummond (1772–1854) to an arguable draw at Lundy’s Lane. ⁴⁴ Also known as the Battle of Bridgewater, this ‘slug fest’ began late in the afternoon of 25 July 1814 and continued until after dark.

In early August, Drummond attacked Black Rock, New York just north of Buffalo, which caused the Buffalo hospital to be moved a few miles west to Williamsville. A British attack on Fort Erie proved disastrous but in early November the Americans evacuated and destroyed the fort and fell back into New York. ⁴⁵ Lovell finished out the war as the Director of the army hospital at Williamsville, New York. ⁴⁶

Initial post-war assignment

The peacetime army was divided into Northern and Southern Divisions, ⁴⁷ commanded by Major Generals Jacob Brown and Andrew Jackson (1767–1845), respectively. Lovell initially contended seriously with old friends James Mann and Benjamin Waterhouse for the army surgeon’s billet in Boston ⁴⁸ and obtained membership in the Massachusetts Medical Society. ⁴⁹ However, he quickly gave up aspirations to continue a military medical career with Brown’s command. By August 1816, he was designated Chief Surgeon with duty at division headquarters at Brownville, New York. ⁵⁰ A year later, he was given the duties of Inspecting Hospital Surgeon for the division. ⁵¹

He also pursued a relationship with Margaret Eliza Mansfield (1795–1836) of Hudson, New York that culminated in marriage on 16 September 1817. ⁵²

Reorganisation of the US Army and its staff

The war had revealed a disturbing number of command, control, and logistics problems within the War Department and the army. Congress attempted to resolve them in An Act fixing the military peace establishment of the United States passed on 3 March 1815. The act created an army of 10,000 men, composed of infantry and artillery regiments, each with a surgeon and two surgeon’s mates, and a corps of engineers. The Hospital Department was abolished and replaced with ‘such number of hospital surgeons and surgeon’s mates, as the service may require, not exceeding five surgeons and fifteen mates, with one steward and one wardmaster to each hospital’. ⁵³ The Act pleased no one and a board of general officers wrestled with the issue in April. On 17 May, general orders were published which directed the distribution of regiments into the numbered military departments that comprised the divisions. The Hospital Department was reinstated and consisted of an Apothecary General and two assistants, two Garrison Surgeons and 10 Garrison Surgeon’s Mates and five hospital surgeons and 15 surgeon’s mates who would be assigned to the Northern and Southern Divisions. ⁵⁴ However, the department had no chief executive.

Soon after his inauguration in March 1817, President James Monroe (1758–1831) began casting about for a Secretary of War who could bring efficiency and stability to the department. In October, John C Calhoun (1782–1850) accepted the challenge and officially joined Monroe’s cabinet on 8 December 1817. ⁵⁵ Calhoun’s assumption of office came at a critical juncture for the army’s medical services.

In October, James Mann had written from Boston to Brown concerning an improved system of health police for the army. Mann’s concepts were logical and well meant, but they described essentially a tactical organisation for medical services only, the object of which was as a manual for line officers. ⁵⁶ Lovell had provided Brown the Sick Report for the Northern Division for 1817 in which he noted not only on the deficiencies of the medical department and his frustrations with it since 1812 but also his confidence that, with the appropriate corrective actions contained therein, the department would be prepared for any future contingency. ⁵⁷ Essentially, Lovell outlined a medical service that was operationally relevant and functional: it maintained the health of troops in garrison and the field and also provided the commander with timely, supportive medical information.

In early January 1818, Brown sent both reports to Calhoun and stated

With the present organisation of the Medical Department of the Army I am not satisfied. We have not the connected chain – that complete and perfect responsibility and accountability necessary to ensure the faithful discharge of duty. I would not advise any system that should remove the Hospital Surgeons in service, but I would recommend a Medical Director & Inspector of Hospitals for each Division who should not only rigidly examine the conduct of the Gentlemen of the faculty, but keep an eye upon the Apothecary General, and the supplies issued by him and report quarterly to the Chief of Division. ⁵⁸

Brown conferred with Calhoun in February. Calhoun’s vision for a medical department and the physicians in it was broad and suggested an organisational complexity that had never truly been appreciated by commanders or Congress. He wanted to keep militarily-experienced physicians on the rolls, applicants to have a medical college diploma, ⁵⁹ and one central directing authority, a Surgeon General on the army staff. ⁶⁰ What they discussed concerning the reorganisation of military medical services has not survived but undoubtedly it included who that central authority should be.

On 14 April 1818, Congress approved Calhoun’s reorganisation authorising six departments – Quartermaster, Commissary, Ordnance, Paymaster, a combined Adjutant and Inspector General, and Medical, all located in Washington. Lovell was Calhoun’s first choice for Surgeon General and President Monroe concurred on that decision four days later ⁶¹ with Tobias Watkins (1780–1855) and James C Bronaugh as Assistant Surgeons General serving in the Northern and Southern Division, respectively. ⁶² On 21 April, the War Department issued the following orders:

All reports, returns, and communications connected with the Medical Department will hereafter be made to the Surgeon General’s Office in Washington.

All orders and instructions relative to the duties of the several officers of the medical staff, will be issued through the Surgeon General, who will be obeyed and respected accordingly.

The Assistant Surgeon Generals will forthwith commence the inspections of the Medical Department in their respective divisions; agreeably to the instructions they receive from the Surgeon General. ⁶³

A very pleased Secretary of War wrote privately to Brown a few days later

The staff [reorganisation] bill finally passed in the state [in] which you left it… I am happy… to find that the appointment of Dr Lovell is well received. On a slight acquaintance I am well pleased with the doctor, and I trust he will by his industry and talents fully realise the public expectation. ⁶⁴

The army’s first surgeon general

Lovell assumed the duties of his new office from his New York post. He occupied a unique position in United States Army medical history, being given a tabula rasa upon which he was to create an efficient and effective new model medical department. His only restrictions were the War Department’s post-war debt and annual budget, both of which Secretary Calhoun would control with a tight fist, and the large distances between Washington and the frontier posts. These issues would test not only Lovell’s industry and talents but also his determination and patience.

Undoubtedly, Lovell was eager to implement in full the organisational blueprint that had found such favour with Brown and Calhoun. However, he moved methodically, recognising that his first task was to assess what physical and personnel resources he had available, their distribution and medical competence. Assistant Surgeons General Tobias Watkins and James Bronaugh conducted inspections of post hospitals in the Northern and Southern Divisions, respectively, from May through to October 1818. ⁶⁵

During this time, Lovell wrote new regulations for the Medical Department, replacing those of December 1814. In general, these reflected a more robust organisation, a technical chain-of-command, and a sense of departmental mission. They provided a more thoughtful, lucid and, in some instances, detailed description of the clinical and administrative duties and responsibilities of surgeons, assistant surgeons, post and regimental surgeons. A new section titled ‘Of Reports, Returns, Requisitions, &c’ reiterated the importance and necessity of regular written communication with the Surgeon General, Division Medical Directors and Line Commanders. The ‘Miscellaneous’ section that included directives such as ‘no army physician will engage in private practice’ and all of them would have a ‘medical college diploma’ was expanded to establish the specific role of medical officers in accepting recruits, the disposition of soldiers incapacitated by sickness or injury, and describe the conditions for employing civilian physicians in the army. These regulations were accepted by President Monroe in September 1818 and distribution to all surgeons was made in October. ⁶⁶

Lovell appears to have recognised that he was asking his physicians, accustomed to older ways and means of military medical practice and police, to conform to a new set of rules and accept a broader range of responsibilities than previously. Even so, he wanted immediate compliance and results. On 14 October, Lovell wrote to Dr Joseph Wallace

Your returns and report of sick were received this morning and from the latter it appears your garrison has been by far more unhealthy than any from which reports have been received. You will be pleased therefore to make a special report, stating what appears to you the causes of this…

The Surgeon General perceived his department as an operationally integral and mission-essential part of the army and his surgeons as essential advisors to their commanders. Likewise, he was the Chief Medical Advisor to the Army Commanding General and the Secretary of War. Without timely and accurate reports from his surgeons, Lovell could not accomplish his own duties and responsibilities. His first quarterly report to the Secretary of War was submitted on 1 November 1818, although it was not as comprehensive as Lovell desired. In describing the lack of compliance of Southern Division surgeons in forwarding quarterly reports to Calhoun he commented, ‘I have therefore to request that orders be sent them through their commanding officers requiring explanation for their neglect of duty’. ⁶⁸

As Lovell reshaped medical department regulations, he was also attempting to recast the military physician’s sense of professional self by aligning those physician’s obligations more closely with their officer associates and the soldiers they cared for. Concerning three unexplained deaths at Oglethorpe Barracks, Georgia, Lovell commented to the surgeon there

The simple fact that a certain number of men have died during a quarter can at any time be ascertained at the Adjutant General’s Office, but something more than this is expected from a Medical Officer who is required to account as far as practicable for the loss of those who may be under his care and direction. ⁶⁹

These early endeavours at creating a Medical Staff Officer were augmented by a requirement that all candidates for positions in the Medical Department have a diploma from a reputable medical college, a few years of practice experience, and that they pass a rigorous examination. ⁷⁰ Important, too, Lovell broadened the military physician’s role in the service beyond routine preventive and acute health care to active participation in advising on their general welfare, which included the recruiting and disciplining of soldiers, uniform design, the construction of quarters and hospitals, and so on.

At Secretary of War Calhoun’s request, Lovell reviewed the component parts of the army ration and offered advice on how they could be improved. These included greater flexibility in exchanging various components, better methods of food preservation, encouraging garrison troops to grow their own vegetables, and deleting whisky from the ration altogether. ⁷¹

Public resources

Lovell also perceived his role as Surgeon General, the role of his surgeons in military medical practice, and their collective role in the army as not only one of public service but also one of protecting public resources. In one of his earliest reports, Lovell told Calhoun that many of the cases of chronic disease found among recruits were due to surgeon neglect while attending recruiting parties

which together with the willingness of many officers to enlist every man that offers, is continually loading the Army with invalids… The management of the recruiting service is and has always been defective because the importance of the duty had not been duly appreciated by officers of any grade… the most active and intelligent officers should be employed and the most experienced and faithful Surgeons stationed at every important recruiting rendezvous. ⁷²

The cause of many inflammatory complaints among soldiers was due simply to exposure from want of proper clothing. ‘In fact, Lovell reported, ‘there is probably no service in which officers appear to pay so little respect to the character of the soldier as in ours, or in which so little attention is given to their comfort, convenience, and health’. ⁷³

Poor officership was also clearly evident in the disciplining of troops. ‘In conversing with Dr [Hanson] Catlett’, Lovell wrote Calhoun in late November 1818

… upon the impropriety of punishing soldiers by protracted confinement in dungeons, by which their health is often materially affected, he mentions several cases at Pittsburgh… as I considered it a subject appertaining to the duties of a medical officer; he was directed to present the facts… ⁷⁴

and in May 1819 he commented acidly that

company officers, dictated by caprice without sanction of a court, habitually inflict corporeal punishment on their men with stripes to such a degree of severity, as frequently requires medical attendance, and often deprives the government for a time of their services. ⁷⁵

Quarterly reports arriving in the Surgeon General’s office were studied with care. Critical issues were identified and addressed expeditiously. Smallpox vaccination of all recruits was a perennial objective ⁷⁶ as was the surgeon’s synthesis and analysis of local disease occurrence with meteorological activity and medical topography of the post. ⁷⁷ American medicine at this time was guided predominantly by the epidemic disease theories of Benjamin Rush and the epidemiological ideas of Noah Webster (1758–1843). These were based upon the relative potencies of contagion, miasmas generated from the decomposition of organic matter, and the epidemic constitution of the atmosphere. Lovell used the science of his day to identify and follow disease outbreaks as well as advise the army command. Early in 1825, he notified Calhoun that Nyctalopia, night blindness with concomitant ophthalmia, was growing to epidemic proportions and suggested the brim of the uniform cap ‘should be much deeper, especially at the sides or ends’. ⁷⁸ Lead poisoning, from using white lead to clean belts and gloves, was identified from a similar review of discharged crippled soldiers. ⁷⁹ OPEN IN VIEWER

Research

A precedent for research in the Army Medical Department was also established during Lovell’s tenure. The remarkable observations and experiments made by Surgeon William Beaumont (1785–1853) on the accidental gastric fistula of French Canadian voyageur, Alexis St Martin (1794–1880), that established the physiology of digestion has been recounted elsewhere. ⁸⁰ From the time of St Martin’s accident in June 1822 until the publication of Beaumont’s book, Experiments and Observations on the Gastric Juice and the Physiology of Digestion in 1833, the Surgeon General supported the work through funding, personal mentoring and introducing Beaumont to the broader American and European scientific communities. ⁸¹

Lovell also began to demand that military physicians and the medical chain-of-command be treated with respect by line officers. Lieutenant Colonel William MacRae, Commander at Norfolk, Virginia, decided that general orders prohibited his surgeon, Dr Robert Archer, from conducting private practice in that city. Lovell told Calhoun that Archer should not be ‘affected by that order’ and requested the surgeon be authorised to continue his private practice. Calhoun directed Adjutant General Daniel Parker (1782–1846) to instruct MacRae as Lovell wished. ⁸² The following month, a surgeon on his way to a new assignment was detained without cause by a line officer in Baltimore. Lovell complained to Calhoun OPEN IN VIEWER

Over 18 years as Surgeon General, Lovell served five Secretaries of War – Calhoun, James Barbour (1775–1842), Peter B Porter (1773–1844), John H Eaton (1790–1856) and Lewis Cass (1782–1866). He received excellent support from all of them with the exception of Eaton who attempted to abolish the position of Surgeon General in 1830 as a cost-saving measure. ⁸⁴

Citizen of a young national capital

Surgeon General Lovell apparently assumed his duties in Washington immediately. He did not move his family from Hudson, New York until late July 1818, a 10- to 12-day trip that filled him with trepidation for their safety. ⁸⁵

The location of the Lovell first home in Washington has been lost, but Lovell purchased a lot at Pennsylvania Avenue just across the street from the Executive Mansion and in the summer of 1824 had a spacious, two-story home built. From this home, the Lovell’s would watch General the Marquis de Lafayette’s procession during his celebratory visit to the United States in October 1824 and President Andrew Jackson’s inaugural procession in 1828. ⁸⁶ In the spacious and elegant parlour and connecting dining room, the Lovell’s entertained a variety of politicians, military and naval officers, bankers, businessmen, artists and socialites of renown in Washington. There the Surgeon General could be the charming host, courtier and politician ensuring the efficacy of his tenure in a pleasant venue.

As the Lovell family grew to fill the 10-room house, Joseph and Margaret became an integral part of the city’s life according to Margaret Bayard Smith, wife of bank president Samuel Harrison Smith and a commentator on early Washington society. ⁸⁷ Lovell was also a member of the National Institute, the Medical Society of the District of Columbia, serving as one of the Board of Examiners in 1822, 1825 and 1834–1835 and as Vice-President in 1826, the Phrenological Society, and a founding member of the Medical Association of the District of Columbia. ⁸⁸

On 5 September 1836 Margaret died, just 12 days after giving birth to her 11th child, a daughter and her namesake. Six weeks later, on 17 October Joseph Lovell succumbed to pneumonia. Both are buried in the Congressional Cemetery in Washington.

Lovell’s 18 year tenure as Army Surgeon General ended abruptly. The organizational and administrative framework he established for the Medical Department did not but rather it became a foundation to build upon and a legacy to cherish. The Lovell home is known today as the Blair House for second owner Montgomery Blair, who purchased the property after Joseph Lovell’s death. It has been the official guest house of the President of the United States since 1942.