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Tuesday, December 9, 2014

The End of the Gutbuster

By Pat Leonard, July 5, 2012


July 4, 1862, was hardly a day of celebration for the soldiers of the Union’s Army of the Potomac. Having been routed during the recent Seven Days battles by their new lead adversary, Robert E. Lee, the demoralized men in blue were left clinging to a scrap of the Virginia Peninsula, their earlier cries of “On to Richmond!” now just a bitter memory.

The soldiers could not have known then, and would not know until years later, the immense impact on their lives that would be wielded by the single unassuming officer who entered their camps that day. Thousands of these men (and their eventual replacements) would perish in future battles, but thousands more would survive those battles, thanks to that solitary officer: Dr. Jonathan Letterman, who was reporting for duty as the Army of the Potomac’s new medical director.

If ever a man was the right person for a job, at the moment when his skills were most desperately needed, it was Letterman at the conclusion of George McClellan’s ill-fated Peninsula Campaign. An Army medical officer since 1849, Letterman was selected for the medical director position by his longtime friend and colleague, the surgeon general William Hammond. Letterman had previously served with both McClellan and Hammond in western Virginia, and the latter two men had conferred and agreed upon his appointment. For his part, Letterman later wrote: “It was a position I did not seek; it was one I could not decline.”

As good friends often are, Hammond and Letterman were complete opposites. Hammond was loud, impulsive and self-aggrandizing, while Letterman was soft-spoken, modest and methodical. Yet what both men held in common – an unflagging desire to reduce the sufferings and preserve the health of Union soldiers – made them an effective team during the Civil War’s most turbulent period.

Arriving on the peninsula, Letterman found an army not only in disarray but also in extremely poor health. Exhausted by ceaseless campaigning, ill-nourished and living in filthy conditions, some 25 percent of the men were suffering from a host of diseases like malaria, typhoid fever and scurvy. Letterman immediately set about improving their situation, requisitioning fruits and vegetables for their diet, implementing sanitary measures in their camps and evacuating men who were too sick or disabled to fight.

Letterman then turned his attention to the organizational deficiencies that had plagued the Army’s medical services since the Battle of Bull Run. He developed an independent ambulance corps, made up of men taken from the ranks to preserve unit cohesion, who would be trained in life-saving measures. He perfected and put into practice a triage system, similar to one developed by Napoleon’s armies, to bring about the best possible outcomes for the greatest number of wounded men. And he reformed field hospital operations, which had been divided by regiments and had often resulted in some stations being overwhelmed during battle while others stood idle.

McClellan gave Letterman a free hand to implement many of these reforms, issuing general orders that Letterman had actually composed, while others were instituted out of sheer necessity. For example, when Gen. John Pope’s Army of Virginia – which had not adopted the “Letterman system” – was crushed at the Second Battle of Bull Run in late August 1862, wounded Union men laid on the field for days, needlessly suffering and dying from thirst, exposure and starvation. Hammond was so outraged that he wrote a scathing letter to his superiors, Secretary of War Edwin Stanton and General-in-Chief Henry Halleck, demanding that Letterman’s reforms be embraced throughout the Army. Stanton, who did not like Hammond, and Halleck, who did not like change, refused, but the arrival of thousands of near-dead men on Washington’s doorstep, and the firestorm that ensued (fanned by the writings and speeches of an influential Boston physician, Henry Bowditch), eventually caused the upper echelons to relent.

Letterman modified his system as the war intensified. He soon discontinued the use of two-wheeled ambulances, which were highly maneuverable but so harsh-riding and prone to overturning that the men who were transported in them took to calling them “avalanches” and “gutbusters.”

Letterman’s system received its first real test at the Battle of Antietam in September 1862. Knowing roughly where and when the battle would take place, he and his staff rode hard to survey the countryside and established hospitals in barns, churches and other structures that could accommodate dozens, and in some cases hundreds, of wounded men.

The ambulance corps performed well at that battle, removing 8,350 wounded Union soldiers and more than 2,000 wounded Confederates from the field in less than two days. Medical supplies ran short, however, thanks to the enemy’s destruction of railroad bridges in the Army’s rear. This disruption caused Letterman to make yet another reform in his system to improve the distribution of supplies and reduce waste.

Writing after the war, Letterman commented on two additional practices developed in the wake of the Antietam bloodbath. One was his insistence that severely wounded soldiers not be released to well-meaning relatives who came to the field to take their loved ones home. Letterman believed that soldiers recuperated better at field hospitals along with their comrades and that unnecessary transport to faraway homes would more likely kill than heal them.

Moreover, in explaining his rationale for providing equal care to Confederate wounded, he made a statement of compassion with which he has ever since been identified. “Humanity teaches us that a wounded and prostrate foe is no longer our enemy,” he wrote in his memoir, “Medical Recollections of the Army of the Potomac.”

At the time, however, Letterman was not quite so charitable to those who criticized the surgeons under his command. Following the engagements at South Mountain and Antietam he wrote:

The surgery of these battle-fields has been pronounced butchery. Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon. These sweeping denunciations against a class of men who will favorably compare with the military surgeons of any country, because of the incompetency and short-comings of a few, are wrong, and do injustice to a body of men who have labored faithfully and well.

Letterman had to repeatedly make this point to the American public because, as another writer observed, “sick and wounded soldiers and their families tended to thank God when things went well, but blamed the physicians when things went badly.”

At the Army of the Potomac’s next major battle – Fredericksburg, in December 1862 – the Letterman system worked so admirably that, in spite of a resounding defeat, all of the Union wounded were removed from the battlefield and taken to field hospitals in less than 12 hours. Learning of this feat, Gen. Ulysses S. Grant shortly thereafter ordered the implementation of Letterman’s system for all the western armies, which gradually led to its official adoption through an act of Congress.

Yet Letterman still had more life-saving contributions to make. At the Battle of Chancellorsville, in May 1863, it was his ceaseless entreaties to his superiors, as well as his negotiations with his Confederate counterparts, that brought about the construction of a pontoon bridge over the Rappahannock River when the fighting had ended — a step that allowed medical supplies and personnel to reach the field, and to evacuate thousands of wounded who would have otherwise been abandoned.

Less than two months later, from July 1 to 3, the Army of the Potomac fought its most horrific battle, at Gettysburg. Because its location had not been planned by either side, when the battle commenced the ambulance train and medical supplies were still many miles away. Nevertheless, the ambulance corps marched as rigorously as the fighting men to reach the field (stretcher-bearers and hospital stewards not being allowed to ride in the ambulances), and then labored through the next three days, with little or no rest, to retrieve the wounded.

It is difficult to grasp the extent of the carnage that Letterman’s corps had to deal with at Gettysburg, but one way to envision it is through a modern example: the number of men treated for battle wounds – nearly 21,000 Union soldiers and Confederate prisoners – would fill up every bed in the 14 largest hospitals in America today. And that figure does not include thousands more Confederate wounded who were evacuated with Lee’s retreating army.

In spite of the staggering number of casualties, the Medical Corps performed magnificently: every single wounded soldier was removed from the battlefield to one of 160 field hospitals by the following day (July 4, 1863), while a massive 80-acre tent hospital – named Camp Letterman by the men – was set up on a farm field a mile and a half to the east. The tents were erected in six rows of roughly 24 tents each, with each tent capable of holding 12 or 14 cots. When they were well enough to travel, more than 3,000 men were cycled from Camp Letterman to hospitals in Philadelphia, Baltimore and Washington. Camp Letterman remained open until Nov. 20, 1863, the day after Lincoln delivered the Gettysburg Address.

Illustrating the effectiveness of the corps’ prompt and expert action was the low mortality rate among the wounded. While an estimated 25 percent of soldiers died of their wounds during the first two years of the war, at Gettysburg less than 10 percent perished.

Gettysburg was the last battle at which Jonathan Letterman served as the Army of the Potomac’s medical director. He was granted a leave during October 1863, during which he married Miss Mary Digges Lee of Maryland. At his own request, he was relieved of his position at the end of 1863, and served for less than a year as inspector of hospitals with the Department of the Susquehanna. He resigned from the Army in December 1864 and moved to San Francisco. Despondent after his wife died in 1867, Letterman himself succumbed to intestinal ailments on March 13, 1872. He was just 47. In his honor, the Army hospital at the Presidio in San Francisco was renamed Letterman Hospital in 1911.

Today Letterman is recognized worldwide as the father of modern battlefield medicine. His coordinated system was adopted by European armies (where it was known as the “American system”) and remained the pattern of organization for battlefield medicine until it was replaced, almost a century later, by helicopter evacuation. His system of triage, with some modifications, remains the standard for E.M.S. units today.

After the Civil War, many of Letterman’s colleagues praised him and his many reforms in their memoirs. Yet it wasn’t until 80 years after his death that he was paid perhaps the greatest tribute when Maj. Gen. Paul Hawley, chief surgeon of the European Theater of Operations during World War II, wrote to a friend: “I often wondered whether, had I been confronted with the primitive system which Letterman fell heir to at the beginning of the Civil War, I could have developed as good an organization as he did. I doubt it. There was not a day during World War II that I did not thank God for Jonathan Letterman.”

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Image: Dr. Jonathan Letterman (seated, left) and his staff.Library of Congress

From: opinionator.blogspot.nytimes.com

Sources: Jonathan Letterman, “Medical Recollections of the Army of the Potomac”; Alfred Jay Bollet, “Civil War Medicine: Challenges & Triumphs”; Gordon E. Dammann, “Jonathan A. Letterman, Surgeon for the Soldiers”; Bennett A. Clements, “Memoir of Jonathan Letterman”; Robert E. Denney, “Civil War Medicine: Care and Comfort of the Wounded”; Frank R. Freemon, “Gangrene and Glory”; Glenna R. Schroeder-Lein, “Encyclopedia of Civil War Medicine.”

Pat Leonard is the editor and publisher of The Gold Cross, a magazine for volunteer E.M.T.s in New Jersey. He has written two novels, “Proceed With Caution” and “Damned If You Do.” His great-greatgreat uncle, Sgt. Jerome Leonard, 55th Pennsylvania Infantry, was wounded at the Battle of Cold Harbor and later died at Bermuda Hundred hospital after his leg was amputated.


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