Tuesday, January 10, 2017

Civil War Medicine: Dr. Letterman’s System Evolves

By Feather Schwartz Foster, 3-9-15

Dr. Jonathan Letterman had devised, implemented and had gained success with a well-trained ambulance corps.  Then he turned his attention to medical practices itself.

Civil War Doctors and their Equipment

By 1860s, medical practice in America had barely evolved since colonial times. In Europe, however, both Louis Pasteur and Joseph Lister were poised to revolutionize medicine with their concepts of bacteria, germs and antisepsis. Nevertheless it would be decades before those theories were accepted as science in the United States.

Dr. Jonathan Letterman, the Father of Battlefield Medicine, pioneered the Civil War Ambulance System and then turned his attention to arranging medical instrument kits and field hospitals.

During the Civil War, medical doctors with varying degrees of training and competency enlisted in the both North and South. In the South, which was desperately in need of any amount of medical expertise, all doctors were welcomed. In the North, however, there was a rigorous hierarchy of army surgeons, medical doctors, assistant doctors and even nurses. The animosity and friction it caused was understandable, but it was frustrating.

Dr. Jonathan Letterman, who had a decade of experience as an army surgeon out West, was not about to brave the shoals of in-fighting, especially since doctors were urgently needed. He was, however, prepared to implement two system to improve the mechanics of medical practice, both of which were readily executed and accepted enthusiastically by the Army itself as well as the doctors.

The Civil War Medical Kit

Dr. Letterman pioneered and devised a standardized medical kit of various instruments needed for immediate surgery. The instruments were interchangeable so they could be easily replaced due to loss or damage.

Most army doctors, whether from within the Army Corps itself or as private recruits, brought their own instruments at the start of the Civil War. Some of those instruments were antiquated. Some were in dire need of repair. Unsurprisingly, many were lost or damaged in transport and on the battlefield. A good many were inadequate to treat the types of wounds inflicted by the bone-shattering minie balls.

Most doctors brought their own instruments at the start of the Civil War. Many of them were antiquated, damaged or lost.

Dr. Letterman’s prior experience as an army surgeon had inspired him to develop a list of basic medical tools that he believed were necessary to treating battlefield casualties. He believed wholeheartedly that a standardized kit was essential, along with a fully equipped medical wagon-per-brigade. Then the instruments could easily be transported, and more importantly, replaced if and when needed. Every doctor would then be equipped with all the tools he needed to meet all possible situations.

These medical kits contained various sizes and shapes of knives, scalpels, forceps, bistouries (long, narrow knives for minor incisions), curettes for scraping and cleaning, and lancets for making punctures. In addition, there were tourniquets, bone saws, chain saws, sutures and bandages.

Each medical wagon was outfitted to contain seventy-six different medicines, dressings, medical books, and additional surgical instruments. They were further equipped with bedding, basins, vials, bedpans, basic food staples (hardtack and beef stock), kettles, plates, drinking vessels and spoons. When the extravagance of these supplies was raised, Letterman is said to have responded, “Lost supplies can be replaced, but lives lost are gone forever.”

Letterman’s Final Reform: The Field Hospital System

Shortly after the Second Battle of Bull Run (Manassas), Dr. Letterman introduced and implemented a system to provide a “dressing” station at the front, headed by one assistant surgeon from each regiment. Their purpose was to perform basic “triage”, and tend to immediate first aid and/or minor wounds.

The remainder of the medical staff would be organized into teams, and divisional field hospitals would be set up a few miles behind the lines. While people today are appalled by the lack of sanitation, it was a huge improvement over previous conditions.   With hundreds, and frequently thousands of casualties brought to these makeshift facilities, only the most skilled physicians would be permitted to perform surgery. It would be left to the others to dress wounds, handle the record-keeping, supply maintenance, etc.

Throughout the North, the precursor to today’s VA Hospitals were established for long-term care, which included battlefield illnesses and/or providing prosthetic limbs, etc. These would be solid permanent structures, rather than tents or makeshift facilities at the front.

While some doctors groused and complained that their experience was being slighted, both the Army and the senior medical professionals agreed that it was “a brilliant achievement in hospital management,” despite the lack of sanitation. Countless lives were no doubt saved.

Dr. Letterman’s models for Ambulance Corps, a standardized medical kit and wagon, and field hospital management would be the model for armies throughout the world for the next half century.


Henig, Gerald S. and Niderost, Eric – Civil War Firsts: The Legacies of America’s Bloodies Conflict, Stackpole Books, 2001

About Feather Schwartz Foster
Feather Schwartz Foster is an author-historian who has made more than 500 appearances discussing presidential history. She teaches adult education at the Christopher Wren Association (affiliated with William and; Mary College), and adult Education programs at Christopher Newport University. She has been a guest on the C-SPAN "First Ladies" program. She has written five books.

Image 1: Every Army Ambulance wagon was equipped with an array of medicines, vials and syringes for emergency treatment.

Image 2: To try to make some sense out of overcrowded, confused and often filthy field hospitals, Dr. Letterman organized a system to triage and treat casualties promptly and more efficiently.

From: featherfoster.wordpress.com


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