Surgeon In Blue

by Scott McGaugh

  Since his family had moved out of town four years earlier, Letterman may have lived in one of several dormitories available in Canonsburg, including one on campus, or in one of several private boarding houses within a few blocks of campus. The most desirable, only a block from campus, was named for Mrs. Armstrong, who ran it, and nicknamed “Fort Hunt.” Like many students, Jonathan may have kept a horse at his grandparents’ stable a few blocks away in order to visit his parents, whose house was about two-and-a-half miles outside of Canonsburg.19

  College tuition totaled $30 a year. Student housing costs ranged from $1.25 to $2.50 per week. Some landlords charged extra for coal to heat tenants’ rooms, typically about three cents per bushel. Overall, parents anticipated their child’s annual college expenses to be less than $100.20

  Letterman and others typically arose at 5:30 a.m. Breakfast was served at 6:00 a.m. and classes ran from 8:30 a.m. to noon. In his first year at Jefferson, Letterman took classes in Roman and Grecian Antiquities, Cicero’s Orations, Algebra, and Latin Composition.

  As a freshman, Letterman cofounded Jefferson College’s chapter of the Beta Theta Pi fraternity. It soon became known as an elitist fraternity, and the founders readily acknowledged that they emphasized membership quality over quantity. Beta Theta Pi initiated about five students per year. Members tended to regard themselves the best of the student body. Once their organization became known, other students referred to them as Betas, but membership remained a tightly held secret.21

  Many of Letterman’s fraternity brothers built successful careers after graduating from Jefferson. Joseph Calvin, Alonzo Linn, and Enos Barnett all became college professors. James Beaver was elected governor of Pennsylvania and became a justice on its supreme court. Milton Latham was elected governor of California, while Ulysses Mercur served in Congress for twenty years. William West became attorney general in Ohio before serving on its state supreme court as well.22

  Literary societies also were a major source of extracurricular activity. Letterman joined the Philomathean Society. The stated goal of the “Philos” was to educate future leaders by emphasizing rhetoric, oratory, and writing skills. Letterman and others wrote essays, debated different points of view, and competed for the annual honor of making a speech on graduation day. The keynote speeches reflected the lofty goals of Philos. “For the sake of our country, blessed with wise political institutions, we stand in need of all the light that can be shed over it by education. Your relative duties of this Republic, of which you are favored citizens, are of the highest importance. You, whom I address, are the future freeman, or rather the sovereigns of your country; and knowledge will be as necessary to enable you to perform those high duties, as it is to the monarch on the throne,” opined one Philo.23

  The curriculum in Letterman’s second year included Geometry, Odes and Satires of Horace, Geography, Surveying and Navigation, and Elements of Rhetoric.24 In his final two years, his education shifted away from the classics and toward a more contemporary curriculum. His classes in 1844 included Natural Philosophy (as the study of the natural world was known), Nautical Astronomy, Analytic Geometry, Chemistry, and Physiology.25 The four-year curriculum’s courses began in October and concluded in March.

  By that point in his college career, Letterman either had decided to become a physician or, at the very least, his father intended that his son attend medical school. The elder Letterman had written to Jefferson Medical College in Philadelphia in the spring of 1844, asking that his son be admitted following his graduation from Jefferson College in 1845. Leatherman may have written the letter in advance of his son’s graduation because he knew he was ill. Shortly after he wrote it, the elder Jonathan Leatherman died, on April 11, 1844. He was fifty-eight years old.

  At nineteen years of age, Jonathan became the senior male of the family. His mother, Anna, had three sons to care for, the youngest being William, who was eleven.26 An opportunity to train with his father while finishing his undergraduate work had been lost. If Letterman decided to pursue a medical education, he would have to leave his widowed mother and his family to attend a medical school in Philadelphia or elsewhere. He had reached the first major fork in his life’s path: stay in Canonsburg or leave to become a physician? He would have to decide in less than a year when he completed his undergraduate studies.

  In his senior year, Letterman took Differential & Integral Calculus, Mental Philosophy, Political Economy, and Paley’s Natural Theology.27 By that time, he had made an impression upon other students. “[He is] one of the noblest spirits of our class, a diligent student cheerful and hopeful, he was always prepared for class and his friends admired his open-hearted frankness.”28 Upon graduation in the spring of 1845, he moved to Philadelphia to begin studying at one of the nation’s foremost medical schools, an institution whose roots led directly back to Letterman’s college campus in Canonsburg.

  The same year Jonathan Letterman had been born, Jefferson Medical College was established as the medical department of Canonsburg’s Jefferson College. The founder was George McClellan, a bold, twenty-eight-year-old physician who had graduated from medical school five years earlier in 1819. McClellan became one of the four original professors when the school opened on January 1, 1825, in a former cotton warehouse. McClellan took a clinical approach to the medical school’s curriculum, treating poor patients as case studies for medical student observation. That was atypical at the time, as most medical colleges emphasized lectures and reading over clinical involvement.29 McClellan became the medical school’s most noted professor, famous for lecturing without notes and involving his students in his presentations.

  The trustees of Jefferson College bore no responsibility for the financial health of the affiliated medical school in Philadelphia. The college received $15 for each degree issued by the medical school. Medical school professors paid rent to the college and in turn charged fees for their lectures. The more noted the professor, the higher the fee he charged his students. In the early years of Jefferson Medical College, class fees ranged from $14 for Anatomy, Surgery, or Chemistry to $12 for the Practice of Medicine or Midwifery and Diseases of Women and Children.30 By the time Letterman entered medical school, the fees had been standardized at $15 per course, payable in advance, plus $30 for the diploma.31

  By 1838, Jefferson Medical College had become so popular that it needed to expand, but it lacked the resources to finance enhanced facilities to accommodate a growing student body. When the state legislature granted an independent charter to the medical school that year, it acquired the legal authority to acquire property and finance construction. By that time, it was one of twenty-eight medical schools in the country but had lost much of its early luster.32

  The medical faculty had become fractured with camps aligned with and against McClellan and his oversized personality. The school’s board of trustees opted to fire the entire faculty, including McClellan, on June 10, 1839, because “. . . there were too many inharmonious elements, too many conflicting interests, too much friction in the operation of the machinery, too much selfishness on the part of some members.”33 The firing carried a proviso that the professors could apply for reinstatement. Although trustees rehired some professors, they rejected McClellan’s application for reinstatement. The founder of Jefferson Medical College, in effect, had been fired by his school.

  Shortly after Letterman arrived in the fall of 1845, the school underwent a major expansion project, for it had become the largest medical school in the country. A widely recognized architect, Napoleon LeBrun, redesigned the façade of the single, multistory building so that it resembled a Roman temple. Six massive columns across the school’s entrance each sat on a base that rose seven feet above street level.34 The lecture hall on the first floor accommodated six hundred students. The two floors above formed an amphitheater, called “the pit,” complete with a skylight to help hundreds of students look down on the surgeries taking place. A museum at the rear of the second floor held medical specimens
; illustrations and engravings of fractures, dislocations, tumors, and diseased organs; and a diseased bone collection.35

  Although McClellan was no longer a member of the medical staff (he established a competing medical school in Philadelphia after leaving Jefferson), the emphasis on student interaction through lectures over reading textbooks continued. School administrators also hired some of the nation’s foremost physicians as professors. They lectured about six hours a day, four days a week. Students not only observed their professors treating patients but also had the opportunity to provide follow-up care.

  The strength of Letterman’s medical education lay in the quality of the faculty, regarded at the time as one of the finest in the country. Letterman learned from the doctors who wrote many of the textbooks used by other medical schools. Dr. Robley Dunglison was a prolific writer who later came to be known as “the Father of American Physiology.” Dr. Robert Huston taught therapeutics and had served as an assistant surgeon in the War of 1812. Dr. John Mitchell taught the practice of medicine and was an entertaining lecturer, research chemist, and published poet. Dr. Charles Meigs taught obstetrics and childhood diseases and was a devoted translator of French medical literature. Dr. Thomas Mutter taught surgery, relying on diagrams and specimens from the medical school’s growing museum.36

  The school year spanned two four-month semesters with the second term a repeat of the same courses of the first term. Students were not graded throughout their coursework. They passed most courses based on an oral quiz at the end of the semester. The curriculum covered eight principal areas: anatomy, physiology and pathology, pharmacology, therapeutics and pharmacy, chemistry and medical jurisprudence, theory and practice of medicine, principles and practice of surgery, and obstetrics and diseases of women and children.37

  Apart from taking classes, Letterman worked as a physician’s apprentice in the community. The city was perhaps the most cultured and dynamic metropolitan area in America, with a cosmopolitan population. Nearly four hundred thousand residents in the Philadelphia area reflected the nation’s changing demographics, for famine as well as political and social discontent in Europe had provoked waves of immigration, sparking anti-Catholic, -Irish, -German, and -African protests.38 The poor newcomers settled in overcrowded neighborhoods where malaria, cholera, smallpox, and tuberculosis were common and where the wooden frame houses were vulnerable to devastating fires.

  Letterman studied medicine near the end of an era that some historians have characterized as “the darkest in the history of medicine in the United States.”39 Many medical schools were little more than diploma factories available to those who could afford the tuition. Some states prohibited students from dissecting cadavers, and some schools dawdled in accepting the relatively few medical advances of the period. Harvard reportedly did not offer its medical students a stethoscope until 1868, nearly thirty years after its invention.40 In some respects, military outpost physicians were less qualified than many of the doctors during the Revolutionary War who had been educated in Europe.

  Physicians in the eighteenth and early nineteenth centuries dogmatically believed nearly all diseases could be explained by one or two principles. They often cited decaying vegetable or animal matter as a principal cause of disease.41 Many considered fever to be a disease rather than a symptom. No one knew conclusively what caused cholera, malaria, and tuberculosis, diseases that ravaged overcrowded cities and military camps. Few could distinguish between malaria and yellow fever with their similar symptoms.

  Physicians often diagnosed ailing patients as having what they called an imbalanced system. That led to widespread use of massive amounts of purgatives in the belief that they restored a patient’s physiological balance. Many doctors believed mercury cleansed the cardiovascular and digestive systems. Heavy doses of calomel mercury to treat pneumonia, dysentery, typhus, tuberculosis, and yellow fever led to patient poisoning. Bloodletting to drain “impure” blood to restore a patient’s balance was declining in popularity but still practiced.

  Physicians also were nearly powerless against infection. In the late 1840s, surgeries on wounds, abscesses, tumors, and fractures nearly always led to infected wounds that oozed pus. Physicians considered pus a positive sign of healing. It would be nearly twenty years before Joseph Lister discovered that bacteria were the source of infection and that using bandages soaked with antibacterial carbolic acid reduced the incidence of infection.

  Medicine had not yet become a learned profession. The proliferation of profit-making medical schools in the early 1800s led to modest admission and graduation standards. American medical education trailed that of leading institutions in Europe, most notably the Paris Medical School. State licensing of physicians did not exist. As a result, public distrust of physicians grew while interest in homeopathic medicine increased. Medical charlatans thrived, and the army began requiring examinations of physician candidates to confirm their qualifications.

  Although army doctor examinations were instituted beginning in 1832, for nearly sixty years the military had considered medical care almost as an afterthought. In 1775, Congress authorized the army hospital department, drawing on a modest civilian medical profession that numbered approximately 3,500 doctors throughout the colonies. Only about 10 percent of those doctors had attended medical school.42

  As had been the case in every war to that time, disease proved to be more deadly than enemy fire. Only 2 percent of the wounded soldiers died on the Revolutionary War’s battlefields, but the mortality rate in military field hospitals was nearly 25 percent. Soldiers carried straw and empty sacks so they could make their own hospital beds.43 Although smallpox inoculation became a significant medical innovation of the Revolutionary War and would carry far-reaching ramifications, the overall mortality rate of disease was ten times greater than the death rate from enemy fire.44

  There were no major advances in the relatively primitive practice of medicine in the early 1800s. Lay healers competed with unlicensed physicians who may have studied in Europe or served for a brief time as an apprentice to another unlicensed doctor, or who had no training at all. Most medicines were herbal and unregulated.

  Battlefield medicine, like medicine for the general population, had remained stagnant since the end of the Revolutionary War. America had disbanded its army and in 1802 had only two military surgeons and twenty-five assistants. In the War of 1812 between America and Britain, organized battlefield care did not exist. In the absence of an ambulance service, wagons patrolled the battlefield after the guns fell silent, searching for the wounded. There were no organized military hospitals, so physicians placed the wounded in temporary shelters, often called “Indian houses,” constructed after each battle.45

  Throughout most of the early 1800s, many military doctors practiced outpost medicine. Some were responsible for more than one outpost, making rounds with their meager supplies that amounted to little more than a first-aid kit, with a limited number of pharmacological concoctions and almost no equipment in a medical era that predated syringes and thermometers. Most practiced a holistic style of medicine that favored herbal remedies.

  It wasn’t until 1818, in the aftermath of the war, that Congress authorized the establishment of a surgeon general for the army. The first was Joseph Lovell, an uncommonly well-educated physician. He had graduated from Harvard College in 1807 and was a member of Harvard’s first medical school graduation class in 1811. Curly hair, narrow eyes, and a small, thin lip gave him an academic look. A year after graduation he demonstrated his leadership skills as a hospital administrator in the War of 1812.

  He assumed his post as surgeon general on April 18, 1818, at the age of twenty-nine, and moved quickly to consolidate authority, although his was a small department. In 1821, it numbered only eight surgeons and forty-five assistant surgeons. Lovell established an esprit de corps and took great personal pride in establishing the rudiments of a professional medical corps. One of his pioneering standards of professional conduct required qua
rterly reports from his outpost surgeons that included not only disease statistics but standardized weather observations.

  He led the abolition of the daily whiskey ration that had long caused problems in the army. He also was instrumental in establishing procedures that enabled boards of officers to remove incompetents among the surgeons. Both subordinates and superior officers held Lovell in high esteem. He reigned over an embryonic military medical corps in an era of unlicensed and unregulated civilian doctors.

  Between 1812 and 1839, the number of military outposts from New Hampshire to Florida ranged between forty and seventyfive. Military doctors remained in chronically short supply. In 1821, there were only forty-four doctors available for the army’s fifty-four posts and stations.46 The shortage produced horrific working conditions. In 1829, Surgeon General Lovell wrote his medical corps was “barely sufficient to supply the several posts, they are seldom permitted to leave their stations, as no one else can perform their duties; and they are thus sometimes compelled in urgent cases to hire a substitute at their own expense, while at most of the interior posts even this is impracticable, and hence some have been on daily duty for ten years; whereas an officer of the line can be at once relieved by the next in command, or his place be supplied by one of the same grade.”47

  Six years later, Lovell issued a similarly dire report to Secretary of War Lewis Cass, focusing the lack of facilities for the sick: “Many of the military posts are entirely destitute of suitable accommodations for the sick. A large portion of the buildings appropriated to that purpose have been erected a long time and were built with perishable materials in a hasty manner to meet the exigencies of the occasion, while at most of the works recently completed, no provision is made for the sick, who are necessarily placed in damp casements, or in temporary buildings entirely unfit to protect them from the inclemencies of the weather, or to preserve the property under the charge of the medical officers.”48