Surgeon In Blue

by Scott McGaugh

  In 1839, the 8,950-man army of the United States reported 22,248 cases of disease. On average, a soldier reported sick every five months.

  While Letterman attended medical school classes in early 1846, negotiations were taking place between the United States and Mexico over America’s expansionist intent to annex the Southwest, from Texas to California. That summer less than seventyfive medical officers supported General Zachary Taylor’s 8,000 soldiers when they marched into Mexico-controlled South Texas. As it had been at the outset of the War of 1812, the military medical corps was unprepared and understaffed. Scurvy, measles, mumps, and malaria overwhelmed the medical staff. Volunteer soldiers from rural areas who had not been exposed to childhood diseases proved particularly vulnerable.49

  As the war extended into Mexico and America’s army grew twelvefold, Congress authorized a medical staff increase to only 115 medical officers and 135 medical staff volunteers.50 Staff shortages plagued the medical department. The absence of an ambulance corps forced medical officers to sometimes beg quartermasters for wagons to transport the wounded and sick. The army’s regimental hospitals amounted to little more than a collection of tents that lacked nurses and stewards.51 Wounds quickly became infected and infested with maggots as hospital gangrene swept through rows of patients.

  Mortality rates became appalling. In 1847, the overall yellow fever mortality rate totaled 28 percent, and spiked to 66 percent in August of that year.52 The supply of quinine to treat malaria was insufficient. Some of the troops had not been inoculated against smallpox, although General George Washington had proved the vaccine’s effectiveness when he became the first general to have his army inoculated seventy years earlier.

  By the time the Treaty of Guadalupe Hidalgo was signed on February 2, 1848, more than 100,000 troops had been sent to Mexico. Enemy fire killed 1,500 while more than 10,000 died from disease. Statistically, it became America’s most deadly war with one in ten men dying of disease. The disease rate was ten times that of the civilian population, not counting the thousands of soldiers who returned home permanently debilitated by chronic dysentery.53 An undermanned and unprepared military medical corps had stood nearly powerless in its war against disease and the enemy.

  Jonathan Letterman graduated from Jefferson Medical College in March 1849. He had completed two sets of lectures, studied as a physician’s apprentice for three years, and wrote a medical paper that he submitted to the school’s dean. His final-year thesis was entitled “Influence of Sects in Medicine on the Science.”54 After passing an oral examination by the entire medical school faculty, Letterman became part of a graduating class of 188 new doctors.

  Letterman could have returned to Canonsburg and established a medical practice. His mother’s side of the family remained well connected, and his father had built a respected family medical reputation prior to his death. It presumably would not have been too difficult to become a successful leading citizen in his hometown, where there were few physicians, and to help his mother raise his two younger brothers. But perhaps life’s horizon beckoned to the young man who had been away from home for the first time in his life. A strong work ethic and powerful drive for achievement had propelled him to an elevated status in the student body. Perhaps that had spawned a desire for a career greater than small-town medicine. The army needed physicians and offered medical school graduates immediate responsibility for hundreds of men. Remote outposts in California, Kansas, New Mexico, Florida, Minnesota, Arizona, and elsewhere carried the scent of adventure.

  Jonathan Letterman traveled to New York City to face a military examination board. As one of fifty-two U.S. Army physician applicants, he had to demonstrate “knowledge of Latin, of physics or natural philosophy, of a given amount of practical anatomy in the form of dissection and a certain amount of clinic instruction.” Eighteen withdrew during the review, seven failed the physical examination, and one was not a U.S. citizen. The U.S. Army accepted Letterman and twenty-five others. One of those accepted, medical school graduate William Hammond, later would form a far-reaching alliance with Letterman. On June 29, 1849, Hammond and Jonathan Letterman joined the U.S. Army as assistant surgeons.55

  America had grown to encompass thirty states. A vast territory from Colorado’s Rockies to California’s Sierra Nevada had been added to the country. Gold had been discovered in California. Waves of immigrants reached both coasts. A railroad network had begun to connect the major cities of the East. Westward expansion into remote and barely explored territories took place in wagons and on foot. Territories from Florida to Minnesota required security that only an undermanned U.S. Army and its skeletal medical department could provide. The need for hundreds of army outposts, most of them staffed by a single medical officer, provided unique opportunities for medical school graduates eager to practice their craft, including Jonathan Letterman. Upon passing his exam by the army medical board of examiners in New York City in 1849, he received orders to report to a remote outpost in Florida where he would be responsible for the health of up to two hundred men.56 He was twenty-four years old.

  2

  OUTPOST MEDICINE

  “We had no bandages.”

  Summer swarms of mosquitoes greeted Letterman when he arrived at Fort Meade in the heart of southern Florida’s swamps in late summer 1849. Nearly all of the army’s outposts were located in remote regions of America’s expanding frontier. Here, as in many far-flung outposts, hasty construction in an unsuitable site based on real and perceived threats made duty rigorous and oftentimes debilitating.

  Although the brutal, seven-year war against the Seminoles had ended in 1842, tension between settlers and the Seminoles in southern Florida persisted when Letterman arrived seven years later. Isolated Indian attacks against white settlers in 1848 prompted the army to build a two-hundred-mile, all-weather road from Tampa on the west coast across to Fort Pearce on the east coast, reinforced by military outposts about every ten miles along its route. The line of defense was intended to keep Florida’s Indians penned inside 26,000 square miles of extreme South Florida.1 Lieutenant George Meade surveyed a portion of road’s route in late 1849 and identified the location for a new fort alongside Peace River about fifty miles east of present-day Tampa. Endless swamps surrounded the location. When senior officers approved his plan, they named the outpost Fort Meade.2

  Within a few months, a half-mile square bluff overlooking the river had been converted into a hardscrabble military outpost. A bridge, ferry, barracks, officers’ quarters, and one-room hospital were constructed. During the first summer’s operation in 1850, Letterman faced widespread malaria among the troops. Nearly a third of the detachment of two hundred men fell victim in one ninety-day period.3

  Because of the army’s chronic shortage of medical officers, Letterman also became responsible for the troops at a nearby outpost, Fort Chokonikla. They, too, suffered horribly at the onset of summer. In June, approximately 70 percent of the troops had fallen sick. Letterman’s diagnosis on July 1 concluded that the “prevailing sickness is caused by malarious exhalations, and is chiefly in the form of Intermittent and Remittent fevers, which are in a majority of cases, irregular, and accompanied, frequently with excessive vomiting, owing to an inflammation of the inner coat of the stomach.” In a second letter, Letterman recommended the fort, surrounded by marsh on three sides, be abandoned, noting, “a day but seldom passes without some men, varying from one to four or five, being taken sick, who were, apparently, in perfect health in the morning.”4

  Letterman apparently wasn’t pleased with his first army assignment. In July 1850, he wrote Surgeon General Thomas Lawson, asking if a medical officer had been assigned to a military expedition to map the relatively new border between the United States and Mexico. Lawson had been named the army’s second surgeon general in 1836, a few months after Joseph Lovell died at the age of forty-seven. His eighteen-year tenure as surgeon general had been marked by increased professionalism among the medical corps and widespread support fo
r his policies within the corps. His successor, Lawson, was nearly the polar opposite of the genial Lovell.

  Lawson had begun his military career by enlisting in the navy and then resigning after two years’ service, before joining the army as a garrison’s surgeon’s mate in 1811. Lawson shared his predecessor’s ambition to increase the standing and role of the medical corps. In 1839, his office published a twenty-year compilation of army medical statistics summarizing illness and mortality rates, military outpost weather reports, and medical officer reports on the physical condition of army outposts.

  Yet Lawson’s leadership style contrasted sharply with the Lovell’s. He often clashed with superior officers, was considered relentless to a fault by those who knew him, and unhesitatingly removed subordinate medical officers deemed incompetent. A lifelong bachelor, he lacked Lovell’s charm, a weakness that hampered his efforts in a political position that required tactful advocacy, coalition building, and the cultivation of powerful allies.

  Lawson was sympathetic to Letterman’s plight. In 1839, he had written: “The service in Florida to most of the medical officers employed there, has been, indeed, not only irksome but exceedingly laborious and hazardous, many of them having from the very dispersed state of the troops to give their attention to two, three, or more posts and stands; frequently passing from one station to another without an escort, and occasionally under fire of the enemy.”5 Nevertheless, Lawson denied Letterman’s request. Four months later, Letterman sought reassignment to Oregon. That, too, was rejected. Letterman remained at Fort Meade, treating the sickly garrison.

  In December 1851, the soldiers dismantled the outpost and reconstructed it at a new site on a ridge one mile west of the river.6 It remained in an extremely remote area of Florida. The nearest civilian settlers lived more than ten miles from Fort Meade.7 The move came during one of southern Florida’s coldest winters on record. “Officers and men suffered much from the cold . . . the quarters being entirely inadequate for their protection. The buildings are very inferior; those of the men are no more than sheds, which afford but little protection from the rain or cold. Being placed upon posts several feet high, and situated upon the highest ground in the vicinity, and no trees of any size near, they are necessarily much exposed to the winds, which frequently, during the winter, blow strong and cold,” wrote Letterman.8

  As the threat of Indian attacks faded following Fort Meade’s relocation, the garrison’s troop level shrank to less than seventy-five. On at least one occasion Letterman and the outpost’s commanding officer were the sole officers present.9

  When Congress approved an increase in the army’s size during wars and conflicts, as they had done during the Mexican-American War of 1846–48, the medical department often lagged behind in the authorization of additional medical officers. In 1848, the army listed ninety-four surgeons and assistant surgeons. After accounting for illness or incapacity, certainly fewer than that were available at any given time, which left some of the army’s eighty-nine outposts without a medical officer and none nearby in the event of an emergency. The shortage was not new. In 1842, the army had only seventy doctors for its seventy-five outposts.10

  The shortage forced Surgeon General Lawson to restrict leaves of absence and to rely on contract surgeons. A civilian doctor with a private practice could make as much as $50 a month from the army by treating its soldiers. He received additional pay if he provided his own medicine, and his compensation could reach as much as $100 monthly if he had to leave his private practice behind when accompanying troops on an expedition. Some army doctors desiring personal leave reportedly had to pay for their own replacement contract surgeons if the army refused to provide funding.11

  Army and contract doctors often faced major outbreaks of disease at isolated military outposts like Fort Meade. Yellow fever periodically raged in military ports along the Eastern seaboard and in remote outposts plagued by hordes of mosquitoes. Doctors did not understand the cause and treatment of many diseases, and some debated when and under what conditions it was necessary to place sick and dying patients in quarantine. Meanwhile, soldiers dreaded the progression of yellow fever. “In its progress, the eyes and skin became gradually yellow, until the whole body was of an intensely yellow hue; black vomit came on; tongue became black, and there was hemorrhage from the mouth and nostrils; hiccough; delirium, or coma; and death closed the scene,” wrote surgeon J. B. Porter in 1841.12

  Malaria was a near constant companion in some forts, including Fort Meade. On occasion doctors had difficulty diagnosing malaria. A soldier’s jaundice could stem from spleen or liver problems. His diet could be deficient. A flushed face, rash, red eyes, and headaches resembled typhoid. Cholera produced similar diarrhea, vomiting, and stomach pain symptoms.13

  Although doctors knew the benefits of quinine, Letterman and others sought additional treatments to ease the agony of the ill. Letterman believed ten to thirty drops of chloroform mixed with water helped soothe the stomachs of soldiers stricken with malaria. However, Letterman also briefly mentioned that such a treatment wasn’t advisable for patients with inflamed stomachs.14

  At times, Letterman dealt with inflamed egos as well as raging bowels. On December 18, 1850, William French reported to Fort Meade as the commanding officer. The same day Thomas J. Jackson reported as the quartermaster officer. Both held brevet major rank and had served together in the Mexican War. Within a few months, their friendship disintegrated, beginning with a dispute over who had responsibility for outpost construction, the commanding officer or the quartermaster.

  Letterman became the unlikeliest and probably least qualified go-between in the dispute. The outpost’s medical officer had little use for interpersonal politics. He related to people more on an intellectual than an emotional level. Yet involvement in the rapidly escalating feud between the commanding officer and quartermaster proved unavoidable for the medical school graduate, who had been in the military less than eighteen months.

  The disagreement became so personal that, on February 13, French placed Jackson under arrest briefly for conduct unbecoming an officer. For his part, Jackson refused to speak to French except when his duties required it. Jackson received a reprimand from the commanding officer of the troops in Florida for his behavior but remained openly defiant. On April 12, he began interviewing soldiers about a rumor of improper conduct between French and a nurse who cared for his bedridden, sick wife.

  Letterman had developed a moderately close relationship with French and tried to talk Jackson out of pursuing what had become a personal vendetta. He also didn’t want French’s wife, Caroline, to learn of the rumors.15 Jackson pressed ahead by reporting his findings to Winfield Scott, the commanding general of the U.S. Army, but received another reprimand for insubordination. On May 21, he left Fort Meade for a philosophy and artillery tactics teaching post at Virginia Military Institute. French, however, was not mollified.

  On July 22, French pressed charges of improper conduct against Letterman and another officer, apparently for their role in attempting to mediate the feud with Jackson. Senior command saw no merit in the charges and did not convene a court-martial hearing. Again, on August 22 and September 29, French wrote letters to Adjutant General Roger Jones criticizing Letterman. Again, senior officers declined to hold a court-martial hearing. Finally, in October 1851, the army transferred French out of Fort Meade, leaving Letterman to focus on troop health.16 Thomas J. Jackson later became famous in the Civil War as Stonewall Jackson.

  Three years in the swamps of Florida took its toll on Letterman. On July 4, 1852, he applied for a leave of absence due to “very disagreeable and unhealthy stations . . . harmful effects of the climate . . . (and) matters of a private character of much importance to me.” However, he remained in Florida, and the following March he renewed his campaign for reassignment, requesting orders to join a survey party planning to chart a new railroad route to the Pacific Ocean.17 This marked his third request for transfer, and this too was denied. In
stead, Letterman received four months’ leave. He visited his mother and family in Canonsburg before reporting for a new assignment at Fort Ripley, Minnesota, in August 1853.

  Fort Ripley had been established in 1848 by General George M. Brooke. The Winnebago Indians had been relocated from Iowa to an approximately ninety-square-mile reservation near the Crow Wing and Mississippi Rivers in Minnesota. The troops at Fort Ripley, about 150 miles northwest of St. Paul, monitored the Winnebago as well as the Chippewa and Dakota tribes, who were at odds.18

  Brooke had selected a location on the western bank of the Mississippi, even though the sole road leading to St. Cloud ran on the opposite side of the 180-yard-wide river. The outpost sat on a one-square-mile plateau overlooking the Mississippi. It comprised a collection of one-and-a-half story, woodframe buildings that formed three sides of a square. The north side consisted in housing for officers, a chapel, and Letterman’s hospital. The south row of buildings contained additional officers’ quarters, chaplain’s quarters, and a sutler’s store, while the west side held the enlisted men’s barracks. On the east, the fort opened to the Mississippi.19 As with many remote forts, river marshes lay nearby. Hills covered with dense stands of birch, pine, maple, and elms rose up near the swampy ground that extended from the river’s bank.20

  Letterman had traded the suffocating summers and one uncommonly cold winter in Florida for the biting winters of Minnesota. On January 23, 1854, some mercury was taken from a thermometer at Fort Ripley and placed in a charcoal cup. It froze in fifteen minutes. The next day the mercury congealed in the thermometer bulb. Temperatures recorded elsewhere in the region that morning consistently read more than thirty degrees below zero, making it the coldest stretch of weather in fourteen years.21 Besides severely impacting the health of the troops in Letterman’s charge, the harsh living conditions produced a different kind of hazard: the risk of losing control of the fires that were kept burning in poorly constructed wood barracks in order to stay warm.