Sunday, August 30, 2015

The Army Medical Department at Gettysburg

From:, Summer 2013

An Overview
On 1 July 1863 a meeting engagement west of Gettysburg PA escalated into one of the biggest battles in the US. The Union Army of the Potomac (roughly 92,000 strong) was moving west to block the Confederate Army of Northern Virginia (roughly 75,000 strong) which had invaded Maryland and moved into Pennsylvania. The Army of the Potomac’s Medical Director, Major Jonathan Letterman, would rise to the occasion of dealing with almost 15,000 US wounded and roughly 7,000 wounded Confederate prisoners. Each regiment (nominally 1,000 men strong) had 2 or 3 surgeons, a medical supply wagon, and two ambulances; one surgeon was usually detached to the divisional hospital. There were no medical enlisted men with regiments, and bandsmen were usually assigned as llitterbearers and medical assistants during battle. Each brigade had a small medical staff, a medical supply wagon, and 3 ambulances. Divisions had a single medical advisor, a field hospital with 3 operating teams, and more ambulances. The Corps had a 3-man medical staff and ambulances; the field hospitals were grouped at corps level.

However, the commander of the Army of the Potomac, MG George Meade, authorized only ammunition wagons and ambulances to travel with regiments and brigades, no medical supply or hospital wagons. (XII Corps did not implement the order, and many units kept their medical supply wagons while leaving hospital wagons, mainly carrying tents, behind.) Meade wanted the army more mobile, especially as he was not certain of winning the coming battle. Letterman obtained permission to form a 25-wagon supply train, but it could only follow behind the army.

On 1 July, US forces held Confederate attacks in the morning; casualties were evacuated to local buildings for treatment. However, additional Confederate forces drove the US troops back in the afternoon, overrunning the improvised hospitals. Many medical personnel stayed with their patients. This was before Geneva Protocols, but the two armies had agreed medical personnel were considered neutral.

On 2 July, two of the corps had their hospitals far forward (some were shelled or even received small-arms fire) because the US forces might be attacking or defending and needed their hospitals accessible. In late afternoon the hospitals were relocated further back, which meant moving over 4,500 wounded. The fighting was concentrated both on the Union left and in the afternoon, creating local evacuation problems. Many wounded were left on the battlefield until an unofficial truce during the night allowed ambulances to move freely. (V Corps alone collected 1,300 wounded in 10 hours.)

On 3 July, total casualties were only 2,500, and those were mainly during the bombardment before Pickett’s Charge and during that charge. They never threatened to overwhelm the hospital capabilities.

On 4 July the armies watched each other, but did not engage. Thunderstorms in the afternoon led to local flash floods, and since some hospitals were near streams (for the water supply, and to be out of the way) a few immobile patients drowned.

Lee retreated on the night of 4/5 July and left almost 7,000 Confederate wounded and 1,000 US wounded behind. He left the captured US medical personnel, but no supplies. Letterman’s supply train arrived, and a private organization (the US Sanitary Commission) also provided supplies (nearly $400,000-worth at today’s prices). Letterman also asked The Surgeon General to send 70 extra doctors, not for replacements (only 13 surgeons were wounded at Gettysburg, 1 dying of his wounds on 3 July) but because the Army of the Potomac would be moving after the battle and he would need to leave some doctors with the wounded. Letterman also had to leave a great deal of equipment, which could not be replaced for a month.

On 22 July a hospital camp (called Camp Letterman) opened at Gettysburg for about 16,000 patients, about 150 per doctor. Almost 20% of the Army of the Potomac’s doctors stayed. Although railway evacuation from Gettysburg started on 7 July, the camp stayed open until 20 November as patients gradually become transportable.

Assistant Surgeon (1LT) John S. Billings had already commanded a rear-area hospital in Washington, DC, and was now assigned to the Fifth Corps in the field. He reported: …

"About the middle of June, the 2d Division of the Fifth Corps took up its line of march, which, passing, successively, through Benson's Mills, Catlett's Station, Manassas, Centreville, Gum Spring, Aldie Gap, Leesburg, Edwards's Ferry and Frederick, terminated, so far as I was concerned, at Gettysburg, Pennsylvania on the morning of the 2d of July. On this march, all the ambulances were collected into a train, which followed immediately behind the division, and was super-intended by a medical officer detailed for the purpose. Transportation was allowed in the proportion of one wagon for the medical supplies of two regiments, and this train of wagons followed close behind the ambulances. For the approaching battle, I was detailed as surgeon in charge of the field hospital of the division, and, also, as one of the operators, my assistants being Assistant Surgeons Whittingham and Breneman, U.S.A. At this time, I was attached to the 7th Infantry, and also acted as medical officer for the 10th Infantry during the march. On the 1st of July, about four o'clock P.M., the division reached Hanover, distant about twelve miles from Gettysburg, and went into camp. Just as the tents were fairly pitched, news came of the repulse of the First Corps, and a few minutes later, we were on the road to Gettysburg.

"About six A.M., July 2d, the division marched into position, and formed line of battle on the right of the somewhat horse-shoe shaped line in which our army was drawn up. … About half past three o'clock P.M., the division was brought into action, marching down a little road to the right of the large conical hill called Round Top, which was on the extreme left of the long arm of our horseshoe like line of battle. I accompanied my regiment until they were under fire, and was then ordered to repair to a large stone house and barn, near the base of Round Top, and there establish a field hospital. When I reached the place, our skirmishers were lying behind the stone walls around the house, and as I rode up, a small body of rebels further up the hill, and about seventy-five yards off, saluted me with a volley. They were captured a moment afterwards by a regiment which had passed between them and their own line. On entering the house, I found it unoccupied, and bearing evident traces of the hasty desertion of its inmates. A good fire was blazing in the kitchen stove, a large quantity of dough was mixed up, the bake-pans were greased; in short, everything was ready for use. I immediately set my attendants at work baking bread and heating large boilers of water. In five minutes, I was joined by the other medical officers detailed for the hospital. The ambulance trains reported to me fifteen minutes later, having with it three Autenrieth [supply] wagons, and by the time the operating tables were set up, and materials for dressing arranged, the wounded began to pour in. I performed a large number of operations of various kinds, received and fed seven hundred and fifty wounded, and worked all that night without cessation. An agent of the Sanitary Commission visited me in the evening, and furnished me with a barrel of crackers, a few lemons, etc. Of stimulants, chloroform, morphine and materials for dressing, the Autenrieth wagons furnished an ample supply.

"On July 3d, at seven o'clock A.M., I was ordered by Surgeon Milban, medical director of the corps, to remove the hospital to a point about one mile to the rear. This was done as rapidly as possible. A few shells began to drop in as the first train of ambulances moved off, and by eleven o'clock A.M., the fire on that point was quite brisk. Little or no damage was done, however, and by four o'clock P.M., all the wounded were safely removed. The new site was a grove of large trees, entirely free from underbrush, on the banks of a little creek, about half a mile from the Baltimore turnpike. By means of shelter-tents, india-rubber blankets, etc., shelter was arranged for all the worst cases, and two thousand dry rations, with three oxen, were sent to the hospital by Doctor Milban in the course of the afternoon. All of this day, I was employed in operating and in dressing the more urgent cases. The following morning, it began to rain, and continued to do so for five days and nights with very little cessation. On the morning of the 5th, the regimental medical supply wagons came up, and from them I removed all the hospital tents and tent flies, with two hospital mess chests. On this day, the division moved. I was left behind in charge of the hospital, which then contained about eight hundred wounded. Twenty men were detailed from the division to act as assistants about the hospital. I was also given two ambulances and two six-mule wagons. The ambulance train, which had up to this time been engaged in collecting the wounded of the division from the various corps hospitals to which some of them had been carried, and in hauling straw for bedding, accompanied the division, as did also the Autenrieth wagons. By this time, Assistant Surgeon Brinton had reached White church with a special medical supply train, and from him I procured such supplies as were most needed. The greatest want which I experienced was that of tools. I had not a shovel or pick with which to bury the dead or construct sinks, and no axes. I was compelled to send out a foraging party to the farm houses, who, after a day's labor, succeeded in procuring two shovels and an axe. Seventeen hospital tents were pitched, and in these were placed all the most severe cases, about seventy-five in number. Under the tent flies, I placed one hundred more patients, and the remainder were all under shelter-tents, and were arranged by regiments. By means of the wagons, I procured abundance of clean fresh straw from about five miles distance, and commissary stores and fresh beef were furnished ad libitum. Assistant Surgeons Ramsay, Whittingham, Bacon and Breneman, U.S.A., and two surgeons of volunteer regiments, whose names I cannot at this moment recall, remained with me, and through their energy and zeal the labor of organizing the hospital was quickly completed. Especial praise is due to Doctors Ramsay and Whittingham, whose labors were unceasing, and from whom I received many valuable suggestions. Very few shell wounds came under my notice at this battle, and none from round balls or buckshot. Most of the wounds were from the conoidal ball, and a large proportion were in the lower extremities. Of three exsections of the shoulder joint, all were successful in so far as that the patients recovered. In one case, I removed four and a half inches of the shaft. No cases of tetanus occurred in this hospital. Of secondary hemorrhage there were thirteen cases up to the 22d of July, at which time I left the hospital. Three of these cases occurred after amputation of the thigh; in two the hemorrhage was arrested by pressure, and, in the third, it was found necessary to open the flaps and secure the bleeding vessel. Three cases of hemorrhage from the anterior tibial artery occurred; two were arrested by pressure, and, in the third, amputation was performed with a good result. In one case, the internal maxillary was the bleeding vessel. The hemorrhage in this case was readily controlled by pressure and persulphate of iron. Assistant Surgeon Howard, U.S.A., left in the hospital six cases of gunshot wounds of the thorax, all of which he had treated by hermetically sealing the orifice with collodion. Four of these men died. What became of the other two, I do not know. In one of these cases, I made a post mortem examination, and found an abscess of the lung, communicating with the pleural cavity, which last was filled with a sanio purulent fluid. Four cases of a similar nature were treated with moist charpie. One of these died, and one was dying when I left; the other two were, in my opinion, in a fair way to recover. Five cases of gunshot fracture of the cranium came under my notice. Four of these involved the occipital bone, and all were fatal. A low muttering form of delirium, with occasional paroxysms of furious mania, was present in all from the commencement. Two cases occurred of gunshot fracture of the femur in the upper third. Both were treated by Smith's anterior splint, and one died. In no case of fracture of the long bones did I attempt any formal resection, but confined myself to removing splinters and foreign bodies, and cutting off very sharp projecting points with the bone forceps. From my experience in Cliffburne hospital, I am convinced that regular resections in such cases are worse than doing nothing at all. In no case of fracture of the long bones did I attempt any formal resection, but confined myself to removing splinters and foreign bodies, and cutting off very sharp projecting points with the bone forceps. From my experience in Cliffburne hospital, I am convinced that regular resections in such cases are worse than doing nothing at all."

Image: Lt. Colonel John Shaw Billings


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