The Army Medical Service was in disarray, between the military casualties, extremely high losses due to typhoid, yellow fever and other camp illnesses, political conflicts between Dr. John Morgan and Dr. William Shippen, Jr., and inadequate supplies and guidance from the Medical Committee. Nonetheless, Rush accepted an appointment as surgeon-general of the middle department of the Continental Army. Rush's order "Directions for preserving the health of soldiers" became one of the foundations of preventive military medicine and was repeatedly republished, including as late as 1908. However, Rush's reporting of Dr. Shippen's misappropriation of food and wine supplies intended to comfort hospitalized soldiers, under-reporting of patient deaths, and failure to visit the hospitals under his command, ultimately led to Rush's resignation in 1778.