On April 13, 1777, John Adams described the spread of disease in Philadelphia and the fate of the sick soldiers in that city in a letter to his wife, Abigail Smith. In his letter, he mentioned a local institution, called the Philadelphia Bettering House. He told her that
“I have spent an Hour, this Morning, in the Congregation of the dead. I took a Walk into the Potters Field, a burying Ground between the new stone Prison, and the Hospital, and I never in my whole Life was affected with so much Melancholly. The Graves of the soldiers, who have been buryed, in this Ground, from the Hospital and bettering House, during the Course of the last Summer, Fall, and Winter, dead of the small Pox, and Camp Diseases, are enough to make the Heart of stone to melt away. The Sexton told me, that upwards of two Thousand soldiers had been buried there…To what Causes this Plague is to be attributed I dont know….Disease has destroyed Ten Men for Us, where the Sword of the Enemy has killed one.” 
The Bettering House, built in 1766 or 1767, sitting on south Spruce street, was an important part of the city’s landscape. At the time, it was an almshouse, where fever-stricken patients were cared for by nuns and fed warm meals.  The house offered monetary and spiritual “relief” to the poor.  In the main building, the first floor consisted of offices, the second floor was where a steward, governor, and doctors stayed, the third floor housed the sick, the fourth housed people deemed “insane,” and the fifth floor was for other sick individuals. The “paupers” were divided by gender, with men in one side and women on the others, staying in the building’s left and right wings.
By late 1776, the Bettering House had been commandeered by the Continental Army. Months earlier, in September 1776, managers and attendants of the house opposed Continental militia, sick with dysentery, sent there to recover because their presence would endanger the health of those others staying in house.  It was only one of the many places in the city where sick and wounded soldiers were housed in the winter of 1776-1777. An estimated 500 soldiers with a variety of aliments were sheltered in Philadelphia, including at least thirty Marylanders in the Bettering House.  Some of these soldiers slept on hard floors in stores and private homes that had been quickly turned into hospitals. Due to the amount of men housed in the city and poor conditions, some of those in the Maryland Flying Camp were even sent out of the city and back to a Baltimore hospital in order to receive the best care for the soldiers. 
Members of the Maryland 400, Michael Nowland, John Booth, and John Price were some of the invalids housed in the city’s Bettering House, then run by a military surgeon of the Continental Army, Bodo Otto. During this period, a college-educated doctor, John White, and surgeon’s mate at a local hospital, likely tended sick and wounded soldiers, and was almost killed by fever himself.  Nowland was described as “convalescent,” meaning that he was recovering from his sickness. As for Booth, he was “walking about, but weak” while Price had “slow fever & deafness,” with slow fever referring to typhoid and deafness perhaps coming from gunfire during the battle. 
Of the 98 soldiers housed in the Bettering House, half were convalescent, weak and recovering, or “fit for duty.” Of the other soldiers, they suffered from wounds received on the battlefield, swelling, fever and related illnesses, the digestive disease of jaundice, rheumatic diseases that affect muscles and joints, and other pains in the body.  There were also three listed without conditions, one of whom pleaded for a discharge from the house.
From 1777 to 1778, after the British victories at Brandywine and Germantown in the fall of 1777, the British occupied Philadelphia, and took over the Bettering House, using it to care for their own soldiers.  By that time, the Continentals were still suffering from diseases, illnesses, and war wounds, but they were sent elsewhere or cared for in camps in Morristown, New Jersey, and Wilmington, Delaware, used by the Marylanders in subsequent winters.
– Burkely Hermann, Maryland Society of the Sons of American Revolution Research Fellow, 2016.
 John L. Cotter, Daniel G. Roberts, and Michael Parrington, The Buried Past: An Archaeological History of Philadelphia (Philadelphia: University of Pennsylvania Press, 1994, reprint), 206; Letter from John Adams to Abigail Adams, 13 April 1777 [electronic edition]. Adams Family Papers: An Electronic Archive. Massachusetts Historical Society.
 Louise Stockton, The Bettering House and Other Charities, A Sylvan City: Or, Quaint Corners in Philadelphia Illustrated (Philadelphia: Our Continent Publishing Co., 1883), 398, 404, 408-410, 418, 422-423, 426; Priscilla Ferguson Clement, Welfare and the Poor in the Nineteenth-century City: Philadelphia, 1800-1854 (Rutherford: Fairleigh Dickinson University Press, 1985), 40, 81, 83-85. It was not the same as the Blockley Almshouse.
 Gary Nash, “Poverty and Politics in Early American History,” Down and Out in Early America (ed. Billy G. Smith, University Park, PA: Philadelphia, 2004), 16-17; Simon Newman, “Dead Bodies: Poverty and Death in Early National Philadelphia, Down and Out in Early America (ed. Billy G. Smith, University Park, PA: Philadelphia, 2004), 55; Karin Wolf, “Gender and the Political Economy of Poor Relief in Colonial Philadelphia,” Down and Out in Early America (ed. Billy G. Smith, University Park, PA: Philadelphia, 2004), 163, 166, 174, 177, 179, 181-182, 184; Michael Meranze, Laboratories of Virtue: Punishment, Revolution, and Authority in Philadelphia, 1760-1835 (Chapel Hill: Institute of Early American History and Culture, 1996), 152-153; Steven Rosswurm, Arms, Country, and Class: The Philadelphia Militia and the “Lower Sort” During the American Revolution (New Brunswick: Rutgers University Press, 1989, reprint), 27-28.
 Philadelphia Hospital Reports Vol. 1: 1890 (ed. Charles K. Mills, Philadelphia: Detre and Blackburn, 1891), 4-5.
 Richard L. Blanco. “American Army Hospitals in Pennsylvania during the Revolutionary War.” Pennsylvania History vol. 48, no. 4 (1981), 347, 349, 352, 354; Mary C. Gillett, The Army Medical Department 1775-1818 (Washington D.C.: Center of Military History, 1981), 70. The influx of sick soldiers led Philadelphia to have a vital role to the Continental army as a smallpox inoculation center, while it was a medical center of the United States at this period. This ameliorated George Washington’s concern about the “threat of contagion” and complimented his attempt to establish hospitals in locations that did not lead to further spread of illness. Philadelphia. As for Maryland soldiers, Thomas Hamilton may have stayed in the Bettering House, but due to conflicting names this cannot be confirmed.
 After the battles of Brooklyn and White Plains, many of the soldiers of the Maryland 400 were transferred to hospitals. Some were sent to North Castle, New York, like William Marr, due to their wounds on the battlefield, while others, such as John Riley, Valentine Smith, and possibly James Garner, were sent to a military hospital in Annapolis. Later in the war, Walter Muse, then captain of the Second Maryland Regiment, later supervised a hospital as part of his duties. Another man, George McNamara, who enlisted in the Fourth Independent Company, deserted before the Battle of Brooklyn, and was left in a hospital by his new company. Later, James Hindman, his captain, asked that McNamara receive a discharge due to his swollen leg.
 Colonial And Revolutionary Families Of Pennsylvania, Vol. 1 (ed. John W. Jordan Baltimore: Genealogical Publishing Co., 2004, reprint), 326, 872-873; Richard A. Harrison, Princetonians, 1776-1783: A Biographical Dictionary (Princeton, New Jersey: Princeton University Press, 1981), 210; Gillett, 44, 70.
 “List of Sick Soldiers in Philadelphia, December 1776.” Pennsylvania Archives Second Series Vol I. (ed. John B. Linn and Wm. H. Egle M.D., Harrisburg: Benjamin Singerly State Printer, 1874), 528, 531-532.
 “List of Sick Soldiers in Philadelphia, December 1776,” 528-532.
 Philadelphia Hospital Reports Vol. 1: 1890 (ed. Charles K. Mills, Philadelphia: Detre and Blackburn, 1891), 5-7; Gillett, 109. After the Continentals re-occupied Philadelphia, the Bettering House was again used to house sick soldiers.