Despite the medical department’s blinkered, provincial attitude, on June 13 President Lincoln approved Secretary of War Cameron’s recommendation to create the United States Sanitary Commission. Its charge was to advise military medical officers on the health inspections of recruit, military camp sanitation, preventive health care, military diet, and medical supplies and logistics. It could provide donated medical supplies, clothing, and other personal items for soldiers. Although limited in its influence, the commission took an active interest in the leadership of the army’s medical department when Surgeon General Lawson died on May 15, at the age of seventy-two.
The commission lobbied for any of several much younger and highly qualified surgeons to replace Lawson. One was William Hammond, the intellectual surgeon-scientist who had entered the military with Letterman and later attracted national military medicine attention with the diet studies he conducted early in his career. President Lincoln instead appointed another elderly surgeon, Clement Alexander Finley, as surgeon general. His decision infuriated the commission. “It is criminal weakness to intrust such responsibilities of the surgeon-general to a selfsatisfied, supercilious, bigoted blockhead, merely because he is the oldest of the old mess-room doctors of the frontier-guard of the country. . . . He knows nothing, and does nothing, and is capable of knowing nothing and doing nothing but quibble about matters of form and precedent,” wrote the commission’s executive secretary, Frederick Law Olmstead.2
Clement Alexander Finley, age of sixty-four, had served as a medical officer since 1818 in a string of routine garrison assignments. His single substantial opportunity to develop combat medical experience was during the Mexican-American War, but twice his service had been cut short by illness and transfer back to the United States. At the time of his appointment, much of his duties had been to examine military surgeon candidates. To many, it appeared he was appointed by President Lincoln over the acting Surgeon General Wood because Wood was the brother-in-law of the Confederate president, Jefferson Davis.
Finley was an unremarkable military surgeon who became surgeon general at a time when most line officers held the medical department in low regard. That lack of respect placed a premium on resolute and collaborative leadership by the new medical commander. Finley failed on both counts. Shortly after Finley took office, Major General Benjamin Butler’s troops suffered a number of casualties while attacking a Confederate battery near Fort Monroe. Rather than rely on his medical director, John Cuyler, and Cuyler’s staff as it coped with a measles outbreak, Butler commandeered a local hotel as his command hospital for fifty-three wounded. To treat them, he asked his family’s physician, Gilman Kimball, to leave an army hospital in Annapolis where he was a contract surgeon. Although Kimball violated Finley’s direct orders not to abandon Annapolis, the surgeon general did nothing about that act of insubordination and later Kimball became a brigade surgeon.3 Cuyler wasn’t the only medical director whom the surgeon general failed to strongly support.
While Letterman and other veteran medical officers continued to serve in isolated military outposts thousands of miles from the war, the build-up of a massive army filled with incompetent civilian doctors and unqualified soldiers tested the leadership deficit in the medical department even further. In the months preceding Bull Run in 1861, newly formed state volunteer regiments poured into the nation’s capital, some of them arriving in cattle cars. Many of the troops were sick, some were dehydrated, and few had the requisite equipment a soldier needed to wage war or take care of himself.
The recruits supposedly had been screened prior to arrival. But lax army regulations led to haphazard inspections based mostly on a cursory visual inspection. “In passing a recruit, the medical officer is to examine him stripped; to see that he has free use of all his limbs; that his chest is ample; that his hearing, vision and speech are perfect; that he has no tumors, or ulcerated or cicatrized legs; no rupture or chronic cutaneous affection; that he has not received any contusion, or wound of the head, that may impair his faculties; that he is not subject to convulsions; and has no infectious disorder that may unfit him for military service.”4
As undemanding as the screening standards were, many of those responsible for the screenings were unqualified to conduct them. In Indiana, the governor suggested a medical staff appointee who had been a hospital steward and had read materials in a doctor’s office. While Ohio, Vermont, and Massachusetts regiments had rigorous examinations by qualified medical personnel, in Wisconsin regiment colonels “examined” medical staff volunteers5—a medical degree was not required at the time.
Many marginally qualified doctors in the volunteer regiments thus became responsible for the health and hygiene of thousands of vulnerable young men away from home for the first time. Many volunteers had not developed immunity to childhood diseases and had been used to mothers or servants washing their clothes, cleaning their quarters, and cooking their food. The military camp hygiene of these men was deplorable. Meanwhile, civilian doctors had to learn the army’s way of ordering food and medical supplies, securing transportation from the quartermaster, obtaining horses and forage, erecting and maintaining hospital tents, and protecting medicines in the field.6
Although the regular army too had a critical need to replace the surgeons who had resigned to join the Confederacy, the dearth of qualified candidates crippled its efforts to recruit them. On the day in May when Finley took over as surgeon general, the medical department accepted 62 of 116 candidates. The shortage forced the army to hire civilian doctors, many of whom were more interested in field duty so they could develop operating experience than in the routine, daily health care of soldiers.
Army quartermasters, many of whom were equally new to the army, failed to adequately prepare for the proliferating needs of the newly arrived combat units. Soldiers stood in midsummer lines for hours, waiting to be issued rations and shelter assignments where, noted one observer, “At last, utterly worn out and disgusted . . . they reached their camps, where they received rations as unwholesome as distasteful to them, and endeavored to recruit their wasted energies while lying upon rotten straw, wrapped in a shoddy blanket.”7
The quartermaster corps was similarly ill-prepared to provide the horses and wagons needed by the medical department. The competing priorities of carrying out officers’ orders, filling troop needs in supplies and ammunition, and outfitting the medical department compounded the problem of a shortage of horses, feed, supplies, and wagons.
In July 1861 came the first significant change that would lead to Jonathan Letterman joining the Civil War. The day after the Bull Run disaster, President Lincoln decided that General McDowell had to be relieved of his command. The same day a charming and magnetic general in Ohio received a telegram. George B. McClellan, the son of the man who founded the medical school that Letterman had attended, was summoned east.
After enrolling at West Point at the age of fifteen, he had graduated second in his class of fifty-nine cadets, where aristocratic Southerners were his closest friends. After graduation, McClellan had proven to be a charismatic leader. He traveled to Europe in 1855, as part of the Delafield Commission to study the military lessons of the Crimean War. At a time when the American army had no established ambulance system, minimal hospital capacity, and moribund medical leadership, McClellan had seen firsthand how a poorly managed and inadequately equipped medical department could ravage an army.
Part of the Delafield Commission’s report read, “The requisites for an ambulance should be such to adapt it to the battlefield, among the dead, wounded and dying; in the plowed fields, on hill-tops, mountain slopes, in siege batteries and trenches, and in a variety of places inaccessible to wheel carriages, of which woods, thick brush, and rocky ground are frequently the localities most obstinately defended, and where most soldiers are left for the care of surgeons.”8
McClellan had resigned his commission in 1857 to become a railroad engineer. He rejoined the army on May 3, 1861. Among several states t
hat sought him to command their regiments, McClellan became the commanding officer of Ohio’s militia. Short, handsome, and broad-shouldered, “Little Mac” valued the pomp and circumstance of the military. His subordinates praised his organizational ability, work ethic, and general affability. McClellan had little use for civilian involvement in military matters and generally held his tongue in the presence of politicians. He did not support immediate abolition of slavery, instead favoring gradual emancipation, but confessed “to a prejudice in favor of my own race & can’t learn to like the odor of either Billy goats or niggers.”9
For all his charisma, the diminutive McClellan also had a darker side. An enormous ego led to his belief that most men were his intellectual inferior and a conviction that he was the man to save the Union on the battlefield. Others held him in high regard as well. Eleven days after reentering the service, he was promoted to major general in the Union army. At the age of thirty-four, he became the second most senior officer in the army. McClellan’s presence and intellect led to his appointment in July as the commanding officer of the Military Division of the Potomac. It was one of the more prestigious and pressurefilled commands within the Union army. His primary mission was to defend the nation’s capital and take the fight to the Confederates’ capital, Richmond. He wasted no time in calming the chaos and organizing the post–Bull Run remnants of the highest-profile army in the Union.
McClellan demonstrated his respect for the medical department in August 1861, when he appointed Charles Tripler to replace King as medical director. Amiable but sometimes grumpy, Tripler was a highly regarded surgeon. Not only had he gained combat experience in the Mexican War at Cerro Gordo, Contrera, Churubusco, Mexico City, and Chapultepec, he had published the widely adopted Manual of the Medical Officer of the Army of the United States in 1858. Three years later, he published Handbook of the Military Surgeon with a colleague, and he had been among the candidates recommended for the post of surgeon general by the Sanitary Commission. He was lecturing on military surgery at Cincinnati Medical College at the time of his appointment.
Tripler inherited a medical department whose infrastructure had broken down. Hotels, seminaries, and other Washington buildings had been converted to makeshift hospitals, he discovered. Regimental surgeons had transferred patients to the capital without knowing if hospitals there had open beds. Hundreds of wounded and diseased soldiers were confined to their cots waiting for care in overcrowded spaces with inadequate staffing. “My friend, Lieut. M. is extremely weak and nervous, and the wild ravings of J.C. (another patient) disturb him exceedingly. I requested Surg. P. to have him removed to a more quiet ward, and received the reply, ‘This is the most quiet ward in the whole building.’ There are five hundred patients here who require constant attention, and not half enough nurses to take care of them. . . . While I write there are three being carried past the window to the dead room,” wrote nurse Emma Edmonds.10
The lieutenant wasn’t alone in his suffering. Disease rates among the various Union armies in August 1861 averaged about 30 percent, as thousands suffered from diarrhea, severe dysentery, and malaria. Army medical directors complained of a lack of tents, as most had been allotted for soldier quarters and storage. A shortage of canvas that summer made matters worse, forcing medical directors to build patient shelters from materials they scrounged in the immediate vicinity.
Yet steps were being taken after the Bull Run debacle that would later prove important for Letterman when he implemented his battlefield care reforms. On August 20, McClellan’s determination to convert Union armies from a bureaucraticstyle organization led to the merger of the Departments of West Virginia, Northeastern Virginia, and Shenandoah into the Army of the Potomac. McClellan now had a massive army firmly under his control and told President Lincoln that Virginia would be the primary battlefield of the war. He sought to nearly triple the size of his army to more than 250,000 men, largely based on what proved to be inaccurate reports of enemy strength developed by his intelligence officer, the detective Allan Pinkerton, who used the alias E. J. Allen.11
By this time, the War Department had endorsed more rigorous examination of military doctors and an investigation into complaints of poor medical care. For the first time, the army began screening military doctors when they joined the army, promoted them on merit, and held each of them accountable for his conduct. While McClellan lobbied for a larger army, his medical director now had clear authority to hold his surgeons to account for the quality of their care. But everywhere Tripler turned he saw poor organization and substandard hygiene.
Tripler took action in several areas. He became critical of the physical condition of many recruits. Faced with a disease rate of 33 percent among some regiments, he ordered the relocation of camps away from vermin- and insect-infested marshes. He also thought the long wait between reveille and breakfast contributed to malarial fevers and secured an order ensuring soldiers had coffee available shortly after sunrise reveille. He ordered vaccinations for Confederate prisoners and allowed them exercise.
Within two months, Finley grew jealous of Tripler’s early success in organizing the Army of the Potomac’s medical department. When Tripler met with the surgeon general in the fall of 1861, a violent argument erupted. Finley berated Tripler. Although Finley had command of all hospitals in the Washington area that served the Army of the Potomac, Tripler had opened new hospitals in the area to relieve overcrowding without informing him. The surgeon general grew so irate at what he considered insubordination that he ordered Tripler out of the room. Tripler, in turn, was so offended by Finley’s conduct that he filed charges of conduct unbecoming an officer against his superior. The two settled their differences before the court martial hearing that had been scheduled for early December 1861.
By that time, Jonathan Letterman had been transferred from Los Angeles to an assignment in New York City. He had spent more than a decade rotating from one isolated military outpost to another. He had been responsible for the health and welfare of hundreds of men at a time, with no nearby medical support, and had been accountable for their health, disease and wound treatment, diet, and personal hygiene habits. Having unsuccessfully sought transfers, he had endured assignments to a series of remote postings that seemed to coincide with some of the severest regional winters in recent memory.
Letterman’s duty in New York City was as a medical purveyor, whose job was to purchase supplies for the medical department. This assignment became his first experience in considering the health and material needs of thousands of soldiers rather than a few hundred. He also learned the nuances of supplying a medical corps comprised of both professional military doctors intent on spending their careers in military service as well as civilian physicians in volunteer regiments whose primary purpose was to beat the Confederates and return home as soon as possible.
In some cases, the regiments’ surgeons saw the battlefield care problems more clearly than the stodgy surgeon general’s office in late 1861. For example, a surgeon with the 89th New York volunteers, T. H. Squire, published a detailed battlefield evacuation plan in the Boston Medical and Surgical Journal. Other civilian doctors, including J. O. Bronson and Pennsylvania’s surgeon general, H. H. Smith, also developed plans to speed the treatment of the wounded on the battlefield. Finley adopted none of the proposals on the grounds they had not been submitted through the chain of command and that supplies and equipment were not available to implement them.12 At the end of 1861, Tripler and other army medical directors grew increasingly frustrated with a system where an army general commanded the military operation, the Secretary of War controlled medical supplies and logistics, and a surgeon general in a time of war was rigidly territorial rather than flexible and innovative.
While Tripler remained at odds with Finley, the Sanitary Commission became critical of Tripler. The medical director resented what he saw as intrusiveness by the Sanitary Commission and other relief organizations, writing: “I may mention here that a great deal of presumptuo
us intermeddling with the Medical department of this army occurred from time to time. . . . Sensation preachers, village doctors, and strong-minded women, suddenly smitten with a more intimate knowledge and thorough perception of the duties and administration of the medical department of an army that I had been able to acquire in more than thirty years’ experience and study, obtruded their crude suggestions, and marring when they could not make, and paralyzing when they attempted to quicken, succeeded by their uniformed zeal, innocently enough, perhaps, but no less the unfortunately on that account, in defeating measures I had much at heart.”13
About a month before Tripler took medical command of the Army of the Potomac, the commission had issued detailed recommendations of Rules for Preserving the Health of the Soldier that called for short haircuts, ten-to-fifteen-minute breaks every hour during marches in the field, and a “quick time” marching pace of ninety to one hundred paces of twenty-eight inches per minute. This precise standard for the soldiers’ stride and speed enabled the army to maintain a sustainable advance of about two-and-a-half miles per hour.14 The Union army had suffered thousands of casualties in the early months of the war and everyone, it seemed, had an idea about how to keep soldiers healthy and how to improve the care of those who fell on the battlefield.
The Sanitary Commission’s lack of confidence in Tripler in late 1861 matched its dedication to orchestrating the removal of Finley as surgeon general. Tripler and Finley had held their posts less than six months before coming under public fire. The commission also advocated that the commanding officer of each army, instead of the surgeon general, should select his army’s medical director. The commission went further, calling for the establishment of an ambulance regiment, given the “utter want of experience, neglect, and even the positively inhumanity of the soldiers detailed as nurses, as well as in order to secure the services of all enlisted men in the discharge of their ordinary military duties a corps of nurses, men and women also, if deemed expedient, should be engaged for the special care of the sick and wounded.”15
Surgeon In Blue Page 7