Thursday, February 6, 2014

Dr. Jonathan Letterman

By John Tooker, MD, MBA, FACP
Excerpted from: "Antietam: Aspects of Medicine, Nursing and the Civil War"

Jonathan Letterman was a native Pennsylvanian, graduating from Jefferson Medical College in Philadelphia in 1849, soon followed by military service as a U.S. Army Medical Department Assistant Surgeon in the Seminole Indian Wars with Stonewall Jackson. Assigned to the Army of the Potomac in June 1862, Major General McClellan promoted Letterman to the post of Medical Director of the Army of the Potomac.

By September, Letterman had devised an efficient and, for the times, modern system of mass casualty management, beginning with first aid adjacent to the battlefield, removal of the wounded by an organized ambulance system to field hospitals for urgent and stabilizing treatment, such as wound closure and amputation, and then referral to general hospitals for longer term definitive management. This three-stage approach to casualty management, strengthened by effective and efficient transport, earned Letterman the title of “The Father of Battlefield Medicine”. While simple in design, the orderly and organized execution of a casualty management plan in the confusion of war, with very large numbers of casualties, was a massive undertaking.

Each battle required advance planning and marshalling of vital resources, such as skilled and trained first aid attendants near the battlefield, ambulance attendants and drivers, wagons, mules, nurses, surgeons, medical supplies, clean water, food and firewood. Communications among the cooperating parties were difficult, and, of course, the rate at which casualties were received could not be controlled. Letterman's official battle report outlines in detail the logistical challenges of providing medical support to the army.

The management of casualties was organized at the unit level—first aid at the regimental level with triage to the mobile field hospitals at the division and corps level. The ambulance corps was established by U.S. Army Special Order 147 in August of 1862, following the Seven Days Battle that ended the Peninsular Campaign in July of 1862. Letterman's model of casualty management became the standard for the Union Army by an act of Congress in March 1864. At First Manassas in 1861, with about 5,000 combined dead and injured soldiers, it took a week to get the casualties off the field. At Antietam, with about 23,000 dead and wounded, all the casualties were removed from the battlefield in 24 hours.

The mass casualty management system that Letterman devised was extensively utilized after Antietam, perhaps no better than at Gettysburg. There were more than 50,000 casualties, dead and wounded during the three day battle in early July, 1863. At the close of the battle, 22,000 wounded Union and Confederate soldiers were treated according to the Letterman model. A large general hospital, Camp Letterman General Hospital, was constructed at Gettysburg to provide care to the wounded long after the armies had moved on. Once the general hospital closed, those needing continuing hospitalization were shipped to larger hospitals in Philadelphia, Baltimore, Washington and Richmond.

Dr. Jonathan B. Letterman resigned his commission in December, 1864, completing his service to the Union Army and moved to San Francisco where he practiced medicine and served as a coroner. His memoir, Medical Recollections of the Army of the Potomac, was published in 1866. Letterman died at the young age of 48 on March 15, 1872 and was later interred in Arlington National Cemetery. The Army Hospital at the Presidio was named Letterman General Hospital in 1911, honoring the military physician who pioneered the care of battle casualties.



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