Dr. Jonathan Letterman’s Report on the Union Army Medical Corps at Gettysburg

By Mark, 7-7-13

Dr. Jonathan Letterman was the Medical Director of the Army of the Potomac at the time of the Battle of Gettysburg.  At the time, Letterman had only been in his position for a year but had instituted sweeping changes in the way the Army took care of the wounded.  Letterman established the Army’s ambulance service, established field hospitals, aid stations, and an efficient medical supply system  He also designed the first triage procedures used by the Army to evaluate the wounded.  Medical care and survival rates improved dramatically under his leadership, and many of his procedures and concepts are still used today in battlefield medicine.

Letterman’s procedures were put to the test at the Battle of Gettysburg and its aftermath.  There were over 14,500 Union wounded when the fighting was over, and some of the over 18,000 Confederate wounded had fallen into Union hands.  Those numbers would overwhelm any system, but under Letterman’s procedures, the care of the wounded was much more organized and effective than it had been a year earlier, resulting in more lives saved.

In his official report on the Army of the Potomac’s  medical department’s performance at the Battle of Gettysburg and its aftermath, Letterman criticized some decisions by army commanders that he believed inhibited his department’s effectiveness, praised the actions and efforts of the army’s medical personnel, and dismissed civilian doctors who volunteered to help as virtually worthless.  Here’s Dr. Jonathan Letterman’s refreshingly blunt and honest assessment of the army medical department at Gettysburg.

HEADQUARTERS ARMY OF THE POTOMAC,
MEDICAL DIRECTOR’S OFFICE,
Camp near Culpeper Court-House, Va., October 3, 1863.

GENERAL: I have the honor to submit the following report on the operations of the medical department of this army at the battle of Gettysburg, July 1, 2, and 3:

As the subject of transportation has an important bearing upon the manner in which the wounded are attended to after a battle, it is necessary to make some allusion to the manner in which this department was supplied. It is scarcely necessary to say that if-the transportation is not sufficient to enable the officers of the department to conduct it properly, the effect must fall upon the wounded.

In the autumn of 1862, I investigated the subject very carefully, with the view to the adoption of some system instead of the irregular method and want of system which prior to that time was in vogue, to limit the amount necessary, and to have that amount always available. The transportation was one wagon to each regiment and one to each brigade. This gave all that was required, and it was not too much; and, it may be remarked, was a reduction of nearly one-half of that which had been in use prior to that time. This system worked well. At the battle of Chancellorsville, the department had upon the left bank of the Rappahannock means sufficient, had it been allowed to use them, for taking care of many more wounded than there came under its control.

On June 19, while the army was on the march, as it were, from before Fredericksburg to some unknown point north of the Potomac River, the headquarters being near Fairfax Court-House, Va., the transportation of the department was cut down by Major-General Hooker on an average of two wagons in a brigade, in opposition to my opinion, expressed verbally and in writing. This reduction necessitated the turning in of a large portion of the supplies, tents, &c., which were necessary for the proper care of the wounded in the event of a battle. Three wagons were assigned to a brigade of 1,500 men, doing away with regimental wagons. This method in its practical working is no system at all, as it is liable to constant changes, and proved to be, what I supposed at the time it would be, a failure to give the department the means necessary to conduct its operations.

The headquarters left Fairfax Court-House on June 26 ultimo, for some point as yet unknown in Maryland or Pennsylvania.

On the 25th of that month, I directed Assistant Surgeon [Jeremiah B.] Brinton, U.S. Army, to proceed to Washington, and obtain the supplies I had ordered the medical purveyor to have put up, and there await orders.

On the 26th, he was ordered to proceed with them to Frederick. This step was taken to obviate the want of supplies consequent upon the reduction of transportation. At this date it was not known that the army would be near Frederick; still, the risk had to be run, and the event justified the order, Dr. Brinton arriving at Frederick on June 28, the day after the arrival of headquarters there, with twenty-five army wagon loads of such supplies as would be most required in case of a battle. The train with these supplies followed that of headquarters until we reached Taneytown.

On July 1, the trains were not permitted to go farther, and, on the 2d, were ordered farther to the rear, near Westminster.

On the 1st, it was ordered that “corps commanders and the commander of the Artillery Reserve will at once send to the rear all their trains (excepting ammunition wagons and ambulances), parking them between Union Mills and Westminster.”

On the 2d, these trains were ordered still farther to the rear, and parked near Westminster, nearly 25 miles distant from the battlefield. The effect of this order was to deprive the department almost wholly of the means for taking care of the wounded until the result of the engagement of the 2d and 3d was fully known. I do not instance the effect of this order, excepting to show the influence of it upon the department. The expediency of the order I, of course, do not pretend to question, but its effect was to deprive this department of the appliances necessary for the proper care of the wounded, without which it is as impossible to have them properly attended to as it is to fight a battle without ammunition. In most of the corps the wagons exclusively used for medicines moved with the ambulances, so that the medical officers had a sufficient supply of dressings, chloroform, and such articles until the supplies came up, but the tents and other appliances, which are as necessary, were not available until July 5.

The supply of Dr. Brinton reached the field on the evening of July 4. This supply, together with the supplies ordered by me on July 5 and 6, gave more than was required. The reports of Dr. Brinton and Dr. [John H.] Taylor show that I ordered more supplies than were used up to the 18th of July, when the hospitals were taken from under my control. Surgeon Taylor, medical inspector of this army, who was ordered on July 29 to Gettysburg, to examine into the state of affairs there, reports to me that he made “the question of supplies a subject of special inquiry among the medical officers who had remained with the wounded during and for a month subsequent to the battle. The testimony in every instance was conclusive that at no time had there been any deficiency, but, on the contrary, that the supply furnished by the medical purveyor had been and still continued to be abundant.” This is, perhaps, sufficient to show that not only were supplies ordered in advance, but that they were on hand when required, notwithstanding the difficulty in consequence of the inability of the railroad to meet the requirements made upon it, until after General Haupt took charge of it on July 9. I have not deemed it necessary to present any tables showing the amounts ordered and issued, considering what I have just given as ample enough to show the action of this department. The chief want was tents and other appliances for the better care of the wounded. I had an interview with the commanding general on the evening of July 3, after the battle was over, to obtain permission to order up the wagons containing the tents, &c. This request he did not think expedient to grant but in part, allowing one-half the wagons to come to the front; the remainder were brought up as soon as it was considered by him proper to permit it. To show the result of the system adopted upon my recommendation regarding transportation, and the effect of the system of field hospitals, I may here instance the hospital of the Twelfth Corps, in which the transportation was not reduced nor the wagons sent to the rear at Gettysburg.

Surgeon [John] McNulty, medical director of that corps, reports that “it is with extreme satisfaction that I can assure you that it enabled me to remove the wounded from the field, shelter, feed them, and dress their wounds within six hours after the battle ended, and to have every capital operation performed within twenty-four hours after the injury was received. I can, I think, safely say that such would have been the result in other corps had the same facilities been allowed–a result not to have been surpassed, if equaled, in any battle of magnitude that has ever taken place.

A great difficulty always exists in having food for the wounded. By the exertions of Colonel [Henry F.] Clarke, chief commissary, 30,000 rations were brought up on July 4 and distributed to the hospitals. Some of the hospitals were supplied by the commissaries of the corps to which they belonged. Arrangements were made by him to have supplies in abundance brought to Gettysburg for the wounded; he ordered them, and if the railroad could have transported them they would have been on hand.

Over 650 medical officers are reported as present for duty at that battle. These officers were engaged assiduously, day and night, with little rest, until the 6th, and in the Second Corps until July 7, in attendance upon the wounded. The labor performed by these officers was immense. Some of them fainted from exhaustion, induced by over-exertion, and others became ill from the same cause. The skill and devotion shown by the medical officers of this army were worthy of all commendation; they could not be surpassed. Their conduct as officers and as professional men was admirable. Thirteen of them were wounded, one of whom (Asst. Surg. W. S. Moore, Sixty-first Ohio Volunteers, Eleventh Corps) died on July 6 from the effects of his wounds, received on the 3d. The idea, very prevalent, that medical officers are not exposed to fire, is thus shown to be wholly erroneous. The greater portion of the surgical labor was performed before the army left. The time for primary operations had passed, and what remained to be done was to attend to making the men comfortable, dress their wounds, and perform such secondary operations as from time to time might be necessary. One hundred and six medical officers were left behind when the army left; no more could be left, as it was expected that another battle would within three or four days take place, and in all probability as many wounded thrown upon our hands as at the battle of the 2d and 3d, which had just occurred. No reliance can be placed on surgeons from civil life during or after a battle. They cannot or will not submit to the privations and discomforts which are necessary, an-d the great majority think more of their own personal comfort than they do of the wounded. Little more can be said of those officers who have for a long period been in hospitals. I regret to make such a statement, but it is a fact and often a practical one. Dr. [Henry] Janes, who was left in charge of the hospitals at Gettysburg, reports that quite a number of surgeons came and volunteered their services, but “they were of little use.” This fact is so well known in this army that medical officers prefer to do the work rather than have them present, and the wounded men, too, are much better satisfied to be attended by their own surgeons. I, however, asked the Surgeon-General, July 7, to send 20 medical officers to report to Dr. Janes, hoping they might prove of some benefit, under the direction of the medical officers of this army who had been left behind. I cannot learn that they were ever sent.

Dr. Janes was left in general charge of the hospitals, and, to provide against contingencies, was directed, if he could not communicate with me, to do so directly with the Surgeon-General, so that he had full power to call directly upon the Surgeon-General to supply any want that might arise.

The ambulance corps throughout the army acted in the most commendable manner during those days of severe labor. Notwithstanding the great number of wounded, amounting to 14,193, I have it from the most reliable authority and from my own observation that not one wounded man of all that number was left on the field within our lines early on the morning of July 4. A few were found after daylight beyond our farthest pickets, and these were brought in, although the ambulance men were fired upon when engaged in this duty by the enemy, who were within easy range. In addition to this duty, the line of battle was of such a character, resembling somewhat that of a horseshoe, that it became necessary to remove most of the hospitals farther to the rear as the enemy’s fire drew nearer.

This corps did not escape unhurt; 1 officer and 4 privates were killed and 17 wounded while in the discharge of their duties. A number of horses were killed and wounded, and some ambulances injured. These facts will show the commendable and efficient manner in which the duties devolving upon this corps were performed, and great credit is deservedly due to the officers and men for their praiseworthy conduct. I know of no battle-field from which wounded men have been so speedily and so carefully removed, and I have every reason to feel satisfied that their duties could not have been performed better or more fearlessly.

Before the army left Gettysburg, and knowing that the wounded had been brought in from the field, six ambulances and four wagons were ordered to be left from each corps, to convey the wounded from their hospitals to the railroad depot, for transportation to the other hospitals. From the Cavalry Corps but four ambulances were ordered, as this corps had a number captured by the enemy at or near Hanover a few days previous. I was informed by General Ingalls that the railroad to Gettysburg would be in operation on the 6th, and upon this based my action. Had such been the case, this number would have been sufficient. As it proved that this was not in good running order for some time after that date, it would have been better to have left more ambulances. I acted on the best information that could be obtained.

The number of our wounded, from the most reliable information at my command, amounted to 14,193. The number of Confederate wounded who fell into our hands was 6,802, making the total number of wounded thrown by that battle upon this department 20,995. The wounded of July 1 fell into the hands of the enemy, and came under our control on the 4th of that month. Instruments and medical supplies belonging to the First and Eleventh Corps were in some m-stances taken from the medical officers of those corps by the enemy.

Previous to leaving Gettysburg, I, on July 5 and 6, ordered supplies to be sent to Frederick from Washington and Philadelphia, to meet the wants of the department in the event of another battle, which there was every reason to suppose would occur shortly after the army left Gettysburg. While at the latter place, I asked the Surgeon-General to have 50 medical officers ready to meet me at such a point as I should thereafter indicate.

On July 7, I desired them to be sent to Frederick. Late in the night of July 9, 47 reported. These officers were designed to make up, as far as possible, the deficiency of medical officers existing in consequence of the large detail from this army left at Gettysburg.

Tents were ordered by my request, and the corps supplied as far as their transportation would permit, and the remainder kept in reserve. It is not necessary to enter into a detailed list of the articles ordered and on hand ready for the anticipated battle. I have the orders in my office, and it is with pleasure I can state for the information of the commanding general that, notwithstanding the short time in which I had to make the necessary preparations, this department was, when near Boonsborough, fully prepared to take care of the wounded of another battle of as great magnitude as that which this army heat just passed through at Gettysburg.

It is unnecessary to do more than make an allusion to the difficulties which surrounded this department at the engagement at Gettysburg. The inadequate amount of transportation; the impossibility of having that allowed brought to the front; the cutting off our communication with Baltimore, first by way of Frederick and then by way of Westminster; the uncertainty, even as late as the morning of July 1, as to a battle taking place at all, and, if it did, at what point it would occur; the total inadequacy of the railroad to Gettysburg to meet the demands made upon it after the battle was over; the excessive rains which fell at that time– all conspired to render the management of the department one of exceeding difficulty, and yet abundance of medical supplies were on hand at all times; rations were provided, shelter obtained, as soon as the wagons were allowed to come to the front, although not as abundant as necessary on account of the reduced transportation. Medical officers, attendants, ambulances, and wagons left when the army started for Maryland, and the wounded were well taken care of, and especially so when we consider the circumstances under which the battle was fought and the length and severity of the engagement.

The conduct of the medical officers was admirable. Their labors not only began with the beginning of the battle, but lasted long after the battle had ended. When other officers had time to rest, they were busily at work–and not merely at work, but working earnestly and devotedly.

I have not considered it necessary to give in this report other than a very general outline of the operations of this department at that time. To enter into a detailed account of them would, I presume, be more than the commanding general would desire.

I am, general, very respectfully, your obedient servant,

JON A. LETTERMAN,
Medical Director.

Brig. Gen. S. WILLIAMS,
A. A. G., Army of the Potomac.

Official Records of the War of the Rebellion, Series I, Volume XXVII, Part 1.

From: ironbrigader.com

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Dr. Jonathan Letterman and CW Medicine

From: featherfoster.wordpress.com

Evacuating the wounded from the battlefield could take days at the start of the American Civil War.

Dr. Jonathan Letterman is usually considered the Father of Battlefield Medicine.

Dr. Jonathan Letterman (1824-72) was an army surgeon who came from a distinguished medical family. During the 1850s, he was deployed at various locations “out west,” and learned firsthand the needs as well as the limitations of his profession. It also gave him ample time and opportunity to rethink a good many military medical procedures that had been entrenched since the Napoleonic Wars a half-century earlier.

At the beginning of the American Civil War, Dr. Letterman was appointed by the Surgeon General as the Medical Director of the Army of the Potomac. He was given the rank of Major. It was a fortuitous appointment. Jonathan Letterman was now in a position to put several of his unconventional (for the times) ideas into practice.

The Ambulance Corps Is Created

General George McClellan was an early and ardent advocate of Dr. Letterman ‘s approach to evacuation of casualties.

In 1861, the start of the Civil War, the system of retrieving wounded soldiers from the battlefield was inefficient at best. The army surgeons were in charge of the ambulances. The drivers and stretcher bearers were a motley assortment of non-combatants, i.e. buglers, drummers, cooks, etc. They were untrained, and in many cases, little more than children who would and did cave in under pressure and run from the field. It did not take very long before the army surgeons realized that they were overwhelmed with casualties and had neither the time nor facility to train their support underlings.

Special ambulance wagons were refitted with supplies and equipment to transport the wounded from the battlefield.

After the battle of Second Manassas (Bull Run) in midsummer, 1862, it took a week to remove the wounded from the battlefield. Many soldiers died unnecessarily whose lives could have been saved with nothing more than prompt treatment. Recognizing this gross ineffectiveness, General George B. McClellan, an ardent supporter of methods and training procedures, gave Dr. Letterman a free hand to employ whatever means he thought necessary to improve such poor medical service. Dr. Letterman had been thinking and rethinking such matters for a decade, and had many systems and changes in mind.

He immediately began organizing a well-trained and equipped Ambulance Corps, as an entity of its own. He designed special insignias for its members, which provided quick on-field recognition. It also gave the corps a sense of camaraderie amongst themselves and amongst the troops.

The Ambulance Corps was composed of non-medical personnel, but they would be trained and supervised by the army doctors. A chain of command was set in place to insure order rather than chaos. Each corps had a captain; each division a first lieutenant; each brigade a second lieutenant; and each regiment a sergeant. They would oversee all aspects of recovery from the field – including the care and maintenance of the ambulance wagons themselves.

The newly-created Ambulance Corp proved its value within months after it was established. Quick response likely saved hundreds of lives.

New ambulance wagons were properly equipped for the immediate care and transport of the wounded. It was a modified wagon well supplied with stretchers, kettles, lanterns, beef stock, bed sacks, and emergency medical supplies. The ambulance staff was recruited among rank and file soldiers.

Under Dr. Letterman’s system, ambulance personnel were specifically trained to lift and carry the wounded, and provide certain immediate treatment, such as applying tourniquets. They were also charged with cleaning, refitting and resupplying the ambulance wagons after a battle.

With proper training, a sense of its huge value and importance to the war effort, and most of all, lives saved by the timely removal of the wounded from the battlefield, the Ambulance Corps was able to provide quantifiable results in short order.

The Results of the Letterman System

When the Civil War began in 1861, no one was prepared for the horrendous number of casualties, both North and South. The original slap-dash measures of finding and evacuating casualties proved to be inefficient and humiliating to the army in general. Immediately after the Second Battle of Bull Run in the summer of 1862, (which took a week to remove the casualties) Dr. Jonathan Letterman was put in charge and in addition to organizing his Ambulance Corps, he also instituted a system for providing actual statistics regarding the evacuation of casualties.

The Battle of Antietam, September 17, 1862: 9500 casualties evacuated in twenty-four hours.

The Battle of Fredericksburg, December 13, 1862: 9000 casualties evacuated in twelve hours.

The Battle of Gettysburg, July 1-3, 1863: 14,000 casualties removed from the field by the morning of July 4.

So exceptional were the results of the Letterman System, that Congress mandated the system by law in 1864. Dr. Jonathan Letterman has rightly earned the title of “The Father of Battlefield Medicine.”

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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.

Sources:

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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Jonathan Letterman, Doctor (1824–1872)

From: biography.com

QUICK FACTS

NAME: Jonathan Letterman
OCCUPATION: Doctor
BIRTH DATE: December 11, 1824
DEATH DATE: March 15, 1872
EDUCATION: Jefferson Medical College
PLACE OF BIRTH: Canonsburg, Pennsylvania
PLACE OF DEATH: San Francisco, California
NICKNAME: "Father of Battlefield Medicine"

Though not as well known as Ulysses S. Grant, Jonathan Letterman played an important role in winning the Civil War for the Union and is known today as the "Father of Battlefield Medicine."

Synopsis
Born in Canonsburg, Pennsylvania, Jonathan Letterman followed his father’s profession and became a doctor. During the American Civil War, he instituted several crucial medical procedures to efficiently remove battlefield casualties, immediately assess their condition and provide short- and long-term care, saving thousands of lives in the process. After the war, Letterman moved to San Francisco, California, where he practiced medicine and served as coroner. He died on March 15, 1872.

Early Life and Military Service
Jonathan Letterman was born in Canonsburg, Pennsylvania, on December 11, 1824. The son of a surgeon, Letterman followed in his father’s footsteps. He graduated from Jefferson Medical College in 1849, assuming the rank of assistant surgeon in the Army Medical Department that same year. From 1849 to 1861, he served in several military campaigns against Native American tribes in Florida, Minnesota, New Mexico and California.

Field Doctor in the Civil War
At the outbreak of the Civil War, Jonathan Letterman was assigned to the Army of the Potomac and was soon named medical director of the entire army, rising to the rank of major. Upon his first assignment, Letterman recognized that the typical field soldier was suffering from a number of health conditions, scurvy being one of them. He successfully addressed this problem by introducing fresh vegetables into their diet. But addressing the problems of battlefield casualties wasn’t going to be so easy.

During Civil War battles, Letterman and his fellow doctors had to deal with casualty levels far greater than expected. As an example, the Second Battle of Bull Run (Second Manassas, August 28–30, 1862) produced nearly as many U.S. casualties as the entire Revolutionary War. This was due, in part, to the combination of improved weaponry and outdated battle tactics. Another problem was the appalling inefficiency in dealing with casualties. Wounded men were left to fend for themselves unless carried off by a fellow soldier. Oftentimes, they would lie for days on the battlefield to suffer from exposure and thirst. It took more than a week to remove the wounded from the Second Bull Run battlefield.

Major Improvements in Medical Procedures
Jonathan Letterman made several changes to reduce the number of deaths after a battle. First, he established an ambulance corps with trained stretcher bearers to pick up the wounded and bring them to hospital clinics. He also instituted a triage system with prioritized treatment based on the degree of a soldier’s injury and likelihood of survival. Letterman developed a three-stage process for treating soldiers after evacuation with a field-dressing station next to the battlefield to quickly dress wounds and stop bleeding; a field hospital close by, usually in homes or barns, where emergency surgery could be performed; and a large hospital located away from the battlefield that would provide long-term treatment.

Proof of the effectiveness of these methods was made evident just two weeks after their implementation. The Battle of Antietam (Sharpsburg, September 17, 1862) is considered the bloodiest single-day battle in American history. There were more than 23,000 casualties, 12,000 of them Union soldiers. Under Letterman’s command, medical personnel were able to remove all wounded Union troops from the field within 24 hours, probably saving thousands of lives.

Later Life
During the remainder of the war, Jonathan Letterman served for a brief period as Inspector of Hospitals for the U.S. Army and then resigned in December 1864. He moved to San Francisco, where he continued to practice medicine and was elected coroner from 1867 to 1872. Upon the death of his wife, Letterman became severely depressed and died of intestinal disease on May 15, 1872, at age 47. He was buried at Arlington National Cemetery. In 1911, the Army hospital at the Presidio in San Francisco was named in his honor.

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Major Jonathan Letterman (December 11, 1824 - March 15, 1872)

From: civilwar.org

Dr. Jonathan Letterman may not be as well known as General Ulysses S. Grant, but he played just as important a role in winning the Civil War for the Union. Known as the “Father of Modern Battlefield Medicine,” Letterman’s work saved thousands of soldiers from dying horrible deaths on the battlefield.

Letterman was born in Canonsburg, Pennsylvania on December 11, 1824. His father was a surgeon, and Letterman followed in his footsteps, graduating from Jefferson Medical College in 1849 and assuming the rank of assistant surgeon in the Army Medical Department that same year. From 1849 until 1861, Letterman served on various military campaigns against Native American tribes in Florida, Minnesota, New Mexico, and California.

With the beginning of the Civil War in 1861, Letterman was assigned to the Army of the Potomac and was eventually named medical director of the entire army in June 1862, with the rank of major. After it took over a week to remove the wounded from the battlefield at Second Manassas, Letterman was given free range by General George McClellan to do whatever was needed to revamp the poor medical services that the men received in the field.

Before Letterman’s innovations, wounded men were often left to fend for themselves. Unless carried off the field by a comrade, or one of the regimental musicians doubling as a stretcher bearer, a wounded soldier could lie for days suffering from exposure and thirst. Letterman started the very first Ambulance Corps, training men to act as stretcher bearers and operate wagons to pick up the wounded and bring them to field dressing stations. He also instituted the concept of triage for treatment of the casualties.

Letterman developed an evacuation system that consisted of three stations:

1) A Field Dressing Station - located on or next to the battlefield where medical personnel would apply the initial dressings and tourniquets to wounds.

2) A Field Hospital – located close to the battlefield, usually in homes or barns, where emergency surgery could be performed and additional treatment given.

3) A Large Hospital – Located away from the battlefield and providing facilities for the long term treatment of patients.

In addition to these improvements, Letterman arranged for an efficient distribution system for medical supplies.

The success of the Ambulance Corps was proven at the battle of Antietam on September 17, 1862. While there were over 23,000 casualties, medical personnel were able to remove all of the wounded from the field in just 24 hours. The battle of Fredericksburg, where the Union suffered an additional 12,000 casualties, and the battle of Gettysburg, with 14,000 Union wounded, both tested Letterman’s system to the extreme, but again, it proved a great success, saving thousands of soldiers’ lives. In March of 1864, the system was officially adopted for the U.S. Army by an Act of Congress.

With Letterman’s work with the Army Medical Corps completed, and after serving a brief period as Inspector of Hospitals, Letterman resigned from the army in December 1864. He moved to San Francisco where he served as coroner from 1867 to 1872, and published his memoirs, Medical Recollections of the Army of the Potomac.

In 1872, after the death of his wife, Letterman became severely depressed. Several illnesses followed and on March 15, he passed away. He was buried in Arlington National Cemetery where his gravestone honors the man “who brought order and efficiency in to the Medical Service and who was the originator of modern methods of medical organization in armies.”

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Jonathan Letterman, (1824-1872)

"Medical Recollections of the Army of the Potomac". New York: D. Appleton & Co., 1866

On November 13, 1911, a new government hospital located near San Francisco, California was named the Letterman General Hospital in honor of the man who was responsible for reorganizing the army medical department during the Civil War and creating an effective ambulance system still used today, relatively unchanged, by modern armies. As stated by biographer Dr. G. E. Dammann, who wrote the biographical introduction to the 1994 reprint of Letterman’s Medical Recollections…, “Jonathan Letterman is the person who could be named father of medical evacuation”.

A native of Canonsburg, Pennsylvania, Letterman received an M.D. from the Jefferson Medical College in 1849 and went almost immediately into army medical service. He worked as an army surgeon in several U.S. frontiers before reporting to duty with the Army of the Potomac in 1861. In 1862, Letterman’s friend, Surgeon General Hammond, named him medical director for the Potomac division, a post he held under the command of Major-General McClellan.

Prior to Letterman’s reorganization, the U. S. Army had only a few facilities in Washington, D. C. that operated as general hospitals. Regimental hospitals that followed their units were the primary medical caregivers. There was no ambulance corps, but only litter bearers who carried the wounded from the field. These were often regimental musicians with no medical training. And ambulances were “engaged in carrying everything but wounded soldiers”. Noticing the disorganization and inefficiency of the medical corps, Letterman set out to restructure the system. He established an ambulance corps under the command of the medical director instead of regimental officers, and he made the transportation of the wounded their sole responsibility (Dammann iii). The new ambulances more than adequately proved their effectiveness, and Congress institutionalized them for all Union divisions in 1864.

As a part of Letterman’s reorganization, he also standardized medical supply wagons for each regiment and bulk supply wagons for the brigades. In addition, he consolidated the hospitals into a three-tiered system, consisting of field hospitals for immediate care of units, post hospitals for the sick and wounded of each garrison, and general hospitals that received patients from throughout the army. All these measures allowed the medical department to efficiently face the many difficult battles still ahead, and they became the basis for military medical administration for the rest of the Civil War.

In January of 1864, Letterman left the army (around the same time Hammond was replaced as Surgeon General). Shortly thereafter, he moved to San Francisco, where he served two terms as coroner and remained in that position until his death in 1872. Letterman’s memoirs as medical director during the war were published in 1866 as Medical recollections of the Army of the Potomac. Some of the original army orders and reports quoted within this book concern Letterman’s change of command order, the placement of ambulances under the medical department, and other medical reorganization and standardization orders. The Reynolds-Finley Historical Library has a first edition copy of this work.

Image: Jonathan Letterman and his staff. Letterman is seated on the left.

From: uab.edu

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A Mystery in Manuscripts

By James Labosier, 9-25-14

Among the History of Medicine’s manuscript collections rests a small group of letters and diaries from Army Surgeon Jonathan Letterman. However, these papers, donated to the Library in 1924 by Dr. Joseph T. Smith, Jr., a Baltimore physician and Letterman’s nephew, include two diaries which Letterman did not write. There is some tantalizing evidence in the historical record which places Letterman in the proximity of the activities documented in the diaries and he almost certainly personally knew some of the persons who traveled with the diaries’ author. How they made their way into this set of documents and who actually did write them is a mystery.

Both diaries, written by the same person, detail the daily adventures, sights, and people encountered during month-long trips along the Santa Fe trail between Fort Leavenworth, Kansas and Fort Union, New Mexico in May and September of 1860. But it is clear that that person could not be Dr. Letterman—official Army records prove he was stationed elsewhere during the periods the trips took place.  It is true that by December, 1859, Jonathan Letterman was assigned to Fort Union, New Mexico as assistant surgeon. But for more than a year, he had been on detached service with General John Garland’s expedition on the Great Plains. And in January 1860, he was transferred from Fort Union to Fort Tejon, California, where he arrived on February 29, 1860.

The earlier of the two diaries begins as a group—including recruits for New Mexico regiments and 160 horses for the mounted service—depart from Fort Leavenworth on May 30, 1860. During the 37-day trek over the north fork of the Santa Fe Trail the diary’s author carefully notes the distances traveled each day and the availability of fresh water and grass for forage at each place they camped. He seems interested in the physical composition of the land, noting limestone and sandstone formations. The journey ends at Fort Union on July 5. Throughout the entire journal the author has given no overt clue to his own identity.
Official army post returns (monthly summaries of activities submitted by Army outposts to the War Department) verify that Dr. Letterman was on detached service from Fort Tejon on the Mojave river during May and June and had been since early April.

The diary’s author notes of the expedition: “Lt Pegram in command Capt. M Ferran A.Q.M.” This is likely Captain John C. McFerran, an officer from Jefferson Barracks, Missouri, who had been transferred to New Mexico. Captain McFerran was formally assigned to Fort Union and reported on July 18, thirteen days after the expedition arrived. McFerran may have been acquainted with Dr. Letterman since he had previously been assigned to Fort Union at the same time and had in fact been transferred out of Fort Union on January 5, 1860, the same day that Letterman had been transferred.  Could McFerran be the author?

Another curious fact is that an assistant surgeon, Joseph C. Bailey, had been transferred from Fort Crittenden, Utah to Fort Union in May. His whereabouts are unaccounted for during the month of June, but he reports for his assignment at Fort Union a few days after Captain McFerran.  It is not unlikely that Dr. Letterman and Dr. Bailey, both medical men, would be acquainted. Could Bailey be the author?

The second diary begins as a group numbering over 100 leaves Fort Union on September 27, 1860. Documentation from army post returns verifies that Jonathan Letterman was present at Fort Tejon during September and October. Captain McFerran again travels with the group. He had been relieved of his position at Fort Union on September 18 and reassigned to Albuquerque. Joseph C. Bailey, however, could not have been on this trip. In August he had been detached to a Comanche expedition. He returned to Fort Union on October 15, when the military party being documented was en route along the Santa Fe Trail to Fort Leavenworth.

During this trip the author implies that he is a military surgeon when he mentions visiting some of his patients. But when this dusty group reaches the walls of Fort Leavenworth 52 days later on October 29, the diary’s reader still has no clue as to the name of its author. Monthly reports from army posts in California, New Mexico, Utah, and Kansas prove that he could not have been Jonathan Letterman. We are left with the hope that an inquisitive researcher may be able to identify the author of these diaries and perhaps also tell us how they came into the possession of Dr. Letterman’s heirs. If that researcher is you, or someone you know, we invite you to share what you know about the diarist by commenting below.

Image 1: Fort Union National Monument. A wide landscape with low mountains in the background and the ruins of a large fort.

Image 2: Group of Soldiers Near the Arsenal, Fort Union.

James Labosier is Associate Curator for the Archives & Modern Manuscript in the History of Medicine Division at the National Library of Medicine.

From: circulatingnow.nlm.nih.gov

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Gettysburg, July 7 (Tuesday), 1863

[By] Letterman, Jonathan, Surg., Med. Dir. Army of the Potomac, Gettysburg, Pa.

The ambulance corps . . . acted in the most commendable manner during those days of severe labor. Notwithstanding the great number of wounded, . . . I know, . . . that not one wounded man of all that number was left on the field within our lines early on the morning of the 4th of July. A few were found after daylight beyond our farthest pickets, and these were brought in, although the ambulances were fired upon, when engaged in this duty, by the enemy, who were within easy range . .  A number of horses were killed and wounded, and some ambulances injured . . . I know of no battlefield from which wounded men have been so speedily and so carefully removed, and I have every reason to feel satisfied that their duties could not have been performed better or more fearlessly.

The number of our wounded, . . . amounted to fourteen thousand one hundred and ninety-three. The number of Confederate wounded who fell into our hands was six thousand eight hundred and two; making the total number of wounded thrown by that battle upon this department twenty thousand nine hundred and ninety-five. The wounded of the 1st of July fell into the hands of the enemy, and came under our control on the 4th . . . Instruments and medical supplies belong[ing] to the First and Eleventh Corps were in some instances taken from the medical officers of those corps by the enemy .

Sourced from: "Civil War Medicine: Care & Comfort of the Wounded" by Robert E. Denney

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Toward an Ambulance Corps

From: history.amedd.army.mil

Soldiers wounded in July 1861 at First Bull Run had to fend for themselves because there was a "pitiful absence of provision for the wounded." Ambulance drivers were generally either impressed soldiers or wagon and hack drivers pulled from the streets of Washington, and rumors of forthcoming roundups sent drivers fleeing from the city. Surgeons reported drivers who were insubordinate or drunk or who appropriated space inside the ambulances intended for blankets and food. As to the vehicles themselves, the Army had been forced to round up commercial wagons and hacks to serve as ambulances.

Second Bull Run, the following summer, demonstrated that little had improved after a year of combat operations. Army surgeons at Centreville, Virginia, operated on casualties who lay without blankets on the bare earth. Surgeon Thomas A. McParlin, medical director of the Federal Army of Virginia, wrote that Americans should follow the lead of the Europeans. "A well-organized regularly established ambulance corps would have been a blessing." The need was felt in other theaters as well. In Missouri, Surgeon John H. Brinton reported that the lack of adequate evacuation capability had caused abandonment of the wounded. Those who were able crawled to whatever cover they could reach; many were captured.

The absence of personnel dedicated to the evacuation mission required commanders to use combat soldiers to remove the wounded from the battlefield, further reducing the Army's fighting strength. Not surprisingly, the speedy return of soldiers who left the battlefield to assist the wounded was problematic. A Confederate report echoed the universal complaint of line commanders: "If any from the ranks are drawn from the fight to carry off the wounded, they never return until the fight is over, and thus three are lost to the company instead of one wounded."

Confederate Army medical organization mirrored the Union's, as leadership of the Southern medical department was in the hands of former Union medical officers, including Confederate Surgeon General Samuel Preston Moore. While the Confederate medical manual was based on U.S. Army regulations, its field medical doctrine included the European concept of a sanitary corps with officers and soldiers designated for evacuating the wounded. Those soldiers would serve in the front lines, where "not infrequently they lose their lives in accomplishing their benevolent tasks."

A variety of ideas for an ambulance system surfaced in the Union Army. One was for an ambulance company of two lieutenants and sixty-seven soldiers for each corps, with the entire ambulance organization under command of a medical officer. A variation of that idea was an ambulance company for each division. The Sanitary Commission proposed an ambulance regiment for the Army of the Potomac.53 Some medical officers adopted partial remedies. The Army of the Potomac published an order written by Surgeon Charles S. Tripler, the medical director, detailing twenty-five soldiers per regiment as an ambulance corps under the supervision of the brigade surgeon. Tripler required the medical officers to train the medical soldiers on a daily basis and sent his medical inspectors out to check on the instruction. The inspectors also checked the number and kind of ambulances, their condition, and whether the soldiers and vehicles were employed solely in medical evacuation.54 In the West, Surgeon Brinton organized the regimental ambulances into ambulance trains, each under a noncommissioned officer "whose business it was to see that a continuous line of wagons should ply between the scene of conflict and the general hospitals."

Brig. Gen. William A. Hammond, a 34-year-old officer, replaced General Finley as surgeon general in April 1862. Hammond, at six feet, two inches in height, 250 pounds, possessing a booming voice and an aggressive and abrasive personality, was by no means a shrinking violet. Backed by the Sanitary Commission, he had been appointed by President Lincoln over Secretary of War Stanton's objections and immediately incurred the wrath of that powerful man. But at first inertia rather than hostility was Hammond's chief problem. Hammond quickly focused on the need for a coordinated evacuation and treatment capability and recommended establishment of an ambulance corps. However, Maj. Gen. Henry W. Halleck, the Army's general-in-chief, rejected the proposal, declaring that ambulances would add to the problem of large combat trains, the ever-present "tooth-to-tail" argument. Halleck also feared that the presence of medical personnel on the battlefield would spread panic among soldiers who might view them as harbingers of suffering and death. Hammond tried again in September, pleading: "I only ask that some system may be adopted." He lamented that 600 wounded soldiers still lay unattended on the battlefield of Second Bull Run, dying of starvation and neglect. His pleas were again rejected.

The surgeon general persisted, making the establishment of a permanent hospital and ambulance corps the highest priority in his annual report for 1862. He argued that it would enable the Medical Department to enlist soldiers specifically for hospital nursing duties and for the operation of field ambulances, rather than having to depend on the unreliable practice of detailing soldiers from other branches. However, he was unable to get War Department support for his proposal that year.

The Letterman Plan

That same year, however, Hammond selected Maj. Jonathan Letterman as medical director for the Army of the Potomac. What the surgeon general was blocked from doing for the Army, the 38-year-old Major Letterman was able to do for the Army's largest combat formation by putting together an ambulance corps as part of a unitary medical support system. Letterman, a veteran officer with thirteen years in the Army and field medical experience in the campaigns against the Seminole, Navajo, Apache, and Ute Nations, reported on 1 July 1862 to Maj. Gen. George McClellan in Virginia at Harrison's Landing on the James River. Here the Seven Days Battle was in progress and casualties were mounting. Letterman inherited what McClellan described as a collapsed situation: "Supplies had been almost exhausted or necessarily abandoned or destroyed, and the medical officers [were] deficient in numbers or broken down by fatigue."

Letterman, a man of "remarkable energy and ability," moved quickly to establish an integrated medical capability based on three principal elements: a coordinated system of casualty evacuation from the point of wounding back through the division rear; organization of medical logistics, including supply tables and transportation; and establishment of division field hospitals as part of the evacuation chain. Supported by his commander, he set forth his plan in Army of the Potomac General Orders 147, 2 August 1862, which placed all ambulances under the control of the medical director. Captains commanded the corps-level ambulance organization, first lieutenants commanded at the division level, second lieutenants led at the brigade level, and sergeants at the regimental level. Those ambulance officers were progenitors of present-day Medical Service Corps ground and air ambulance officers.

Letterman's use of nonphysician officers to command ambulance units represented a significant shift in Army Medical Department policy. He intended to relieve the physicians from duties that distracted them from their primary mission of patient care, especially in combat. Letterman knew that at such times the needs of the wounded "prevented any supervision [of ambulances], when supervision was, more than at any other time, required."

Another important feature of Letterman's plan was the assignment of vehicles to the direct control of the medical director. Two-patient ambulances, each with two privates and a driver, were allocated on the basis of three for each infantry regiment, two for each cavalry regiment, and one for each artillery battery. Two supply wagons were assigned to each division's ambulance corps. The use of those vehicles was strictly restricted to the Medical Department. Only medical personnel were permitted to accompany the sick and wounded to the rear, and only bona fide patients were allowed to ride in the ambulances. A Union chaplain described Letterman as "virtually a medical dictator."

Letterman implemented his plan later in the year as the Army of the Potomac fought in Virginia and then moved north into Maryland. It was only partially in place for the Battle of Antietam in September 1862, where, during twelve hours of combat, casualties from both sides rose to over 22,700. McClellan's casualties mounted to 25 percent of the soldiers who went into action. On the Union right wing, where Letterman's plan was in place, casualties were rapidly evacuated and all wounded within the Union lines were removed during the night. Casualties on the left, where the new evacuation plan was not in place, were not removed until the following night.

Full implementation of Letterman's plan occurred three months later, at Fredericksburg. There, Letterman reported that the ambulance corps had begun to evacuate the wounded after dark on 13 December and by daylight had removed all the casualties except some twenty soldiers who were within the Confederate lines. Surgeon General Hammond, visiting the Army of the Potomac, was pleased with the results; even more important, commanders began to recognize the advantages of a system that reduced straggling as it saved the wounded.

General McClellan wrote that Letterman's ambulance corps decreased the number of combat soldiers pulled from the battlefield, "one of the great desiderata for our armies." The Army of the Potomac continued to benefit from its unified medical support capability in battles after Antietam. There were 14,193 wounded Union soldiers at Gettysburg, 1-3 July 1863, yet there were no wounded left on the battlefield within Union lines by early morning the day after the battle. Letterman reported: "I know of no battlefield from which wounded men have been so speedily and so carefully removed." By the summer of 1864 the Army of the Potomac's ambulance corps numbered 800 ambulances with 66 officers and 2,600 enlisted soldiers. The medical director's central control provided the flexibility necessary to tailor the medical system to meet changing requirements. Capt. J. G. Pelton, chief of II Corps ambulances, said he could easily shift vehicles and medical soldiers throughout his corps area of operations so as to place the evacuation capability where it was most needed.

Union Army units that failed to adopt Letterman's innovations continued to experience difficulty in battlefield evacuation. Surgeon Glover Perin, upon becoming medical director of the Army of the Cumberland in February 1863, found an inefficient ambulance service. He attributed this to the absence of commissioned ambulance corps officers, the lack of attendants, and the control of ambulances by the Quartermaster Department. He adopted a modified Letterman plan, but even with that in place the Army of the Cumberland left behind an estimated twenty-five hundred of its wounded at Chickamauga in September 1863. Surgeon Thomas A. McParlin, then medical director of the Army of Virginia, received a copy of Letterman's plan and submitted it to his commander, Brig. Gen. John Pope, but there was not enough time to implement it before Second Manassas. McParlin believed that Pope's army would greatly benefit from an ambulance corps. "The lessons of experience should not be disregarded, especially in matters of such transcendant importance. At such a time, a well organized, regularly established ambulance corps would have been a blessing."

Other armies agreed. The South was never able to field an evacuation and treatment system as sophisticated as the North's, but in Europe, French Army surgeons applauded the American innovation of placing the treatment and evacuation systems under complete medical control. As knowledge of Letterman's innovation spread, European armies proceeded to adopt his system.

A by-product of these innovations was the emergence of a small cadre of junior officers who understood the problems of medical evacuation. Those ambulance corps officers were often recognized for their achievements and valor. Letterman cited Capt. J. M. Garland for outstanding service in equipping the II Corps ambulance organization and for the care and diligence with which his soldiers removed the wounded at Antietam. Surgeon Henry S. Hewitt recognized Capt. S. Windecker, 103d Ohio Volunteers, for managing the Army of the Ohio evacuation system "in the most systematic and praiseworthy manner." Windecker's leadership had enabled Hewitt to keep just one physician with each regiment, while moving the others to the field hospitals where their medical talents could be pooled.

Lt. Henry Knight was cited for his courage under fire during the Union Army's disastrous assault at Fredericksburg in 1862. Capts. W. F. Drum, B. W. Baldwin, and J. G. Pelton of the Army of the Potomac won commendations for ambulance operations that were "well and gallantly performed." Lt. Joseph C. Ayer, chief of the 1st Division ambulances, estimated that his unit evacuated nearly six hundred soldiers during Fredericksburg, and in 1863 he reported that his ambulances evacuated 1,157 casualties in the Battle of Gettysburg. Letterman commended the ambulance corps for performing in a "commendable and efficient manner" at Gettysburg, on a day in which one ambulance corps officer and four privates were killed.

On 11 March 1864, Hammond's efforts and the success of Letterman's plan, backed by petitions and lobbying efforts, resulted in congressional action that established a permanent ambulance corps. The law authorized corps commanders to detail officers and enlisted soldiers to form their ambulance organizations and provided for the examination of candidates by boards of medical officers. As one citizens' committee put it, the Army should carefully screen the officer candidates because of the special trust it placed in them, and they should "at least equal the best of the fighting-men in gallantry." The War Department implemented the law in General Orders No. 106, 16 March 1864, a directive that also gave commanders the authority to create a distinctive uniform for members of the Ambulance Corps.

Despite his success, Letterman had grown tired. In December 1863 he asked for relief from "18 months of arduous and eventful duty." He was reassigned as Medical Inspector of Hospitals, Department of the Susquehanna. General Hammond, while successful in obtaining the Ambulance Corps legislation, had become further alienated from Secretary of War Stanton. In May 1864 he was dismissed from the service by a court-martial on charges trumped up by Stanton. Letterman resigned from the service at the end of the same year. The achievements of both lived on after them.

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Civil War Surgeon Set The Standard For Battlefield Medicine

NPR Staff, July 7, 2013

July 1 marked 150 years since the beginning of the Battle of Gettysburg, a crucial victory for the Union and a turning point in the Civil War. But it came at an enormous cost to both sides — thousands of soldiers were killed and tens of thousands more were wounded.

However, it might have been even worse had it not been for a surgeon named Jonathan Letterman, who served as the chief medical officer of the Union's Army of the Potomac. He presided over some of the bloodiest battles in U.S. history and, over the course of a single year, revolutionized military medicine.

Scott McGaugh has just released his biography of Letterman, called "Surgeon in Blue". He joins NPR's Rachel Martin to discuss the father of battlefield medicine, what conditions were like before he came along and the legacy he left behind.

Interview Highlights

On the state of medicine in the United States at the start of the Civil War:

"In a word, horrific. Military doctors were poorly qualified from a medical standpoint. They didn't know what caused infections, bacteria, anything of that sort. There was no ambulance system, so the early battles, such as Bull Run, left thousands of men wounded on the battlefield for days, some of them dying of dehydration and thirst. They were weakened to begin the battle because [the] Army diet was horrible, in the sense of salt pork, weevil-filled biscuits and alcohol as the daily ration. And their odds of survival, if they were wounded, were not very good in the early battles."

"They had very little place to go. They were dependent upon a few slackers, derelicts and Army band members who were typically assigned as ambulance crews. The ambulances were not nearly enough in number. No one expected to see the kinds of casualty numbers of Bull Run, which obviously became a harbinger of battles to come. If you were lucky enough to be ambulatory, you might have walked or hitched a ride back to Washington, and then walked the streets for several days looking for a hospital bed because there weren't nearly enough hospitals or hospital capacity in the early days of the Civil War."

On how Letterman improved Civil War medicine:

"He stood in a remarkably fortuitous position in time. The commanding general, George McClellan, was something of a reformer; the surgeon general was a very deep-thinking reformer by the name of William Hammond, a young man. And that gave Letterman the opportunity to apply a very keen, analytical, holistic mind to health care, not just on the battlefield but before ever reaching the battlefield. And he was able to very quickly issue new regulations, make them mandatory with real authority, that defined and codified new standards in nutrition, camp hygiene, how and when latrines were dug and when they were covered, the disposal of lice-ridden uniforms. Because at the time when he took over, he was faced with a disease rate of nearly 40 percent."

On what it was like before Letterman developed the modern ambulance corps:

"Prior to that, military officers routinely commandeered wagons intended as ambulances for their personal use and for their baggage with no repercussions. ... Luggage, personal belongings, even their servants in some cases. So one of the very first things Letterman did was acquire the authority from Gen. McClellan to hold military officers and medical officers accountable. [He] developed a corps of trained ambulance drivers and stretcher bearers, so he added a level, or created a level, of professionalism that had not been in existence."

On how keeping soldiers healthy wasn't just about compassion:

"He believed that a healthier Army — wounded men who were kept with their units and treated in hospitals near the Army — were much more likely to return to battle [and] gave Gen. McClellan a stronger, more viable fighting force. And if that made him more effective, that might lead to a faster end to the war and the ability for everyone to go home."

Scott McGaugh writes nonfiction novels about military history, including Battlefield Angels. He is also the marketing director of the USS Midway Museum.

From: npr.org

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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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