Surgeon In Blue

by Scott McGaugh

  On October 13, the Sanitary Commission intensified its anti-Finley campaign. Several commissioners had become impressed with William Hammond’s scientific credentials, military experience, and robust leadership. They recommended that Hammond, previously thought to be a worthy Tripler replacement as medical director of the Army of the Potomac, in fact should replace the surgeon general. Additional concerns over the shortage of supplies and medicines faced by Union army surgeons prompted the commission to construct large supply depots in Wheeling, Cincinnati, Philadelphia, New York City, and Washington. The commission also distributed a circular addressed to “the Loyal Women of America,” calling on them to form relief societies and go door to door “in sacred service to their country” to collect donations for their men in uniform.16 Dozens of relief societies across the North collected donations, ranging from bandages to pillows to food that were amassed by the Sanitary Commission for delivery to the battlefield by rail and wagon.

  The Sanitary Commission climbed far onto a political limb when it also recommended that the surgeon general be required to respond to the Sanitary Commission in writing when he declined its recommendations. The commission campaign to oust Finley and Tripler, as well as to establish a more professional field army medical corps, initially failed in both respects. However, it heightened public awareness of the medical shortcomings on the battlefield that would lead to a number of changes the following year.

  The political intrigue escalated in December 1861 after the Army of the Potomac had settled into its quarters for the winter. Although no significant fighting would take place until March, reports of still rampant disease, inadequate hospital quality and capacity, and appalling military camp living conditions persisted. Nearly one in four soldiers remained ill in December. McClellan apparently had lost faith in his medical director, prompting the general to appoint a board of inquiry to investigate the cause of fevers that plagued his troops. Meanwhile, his soldiers faced a daily routine of mud, rain, snow, and boredom. They griped about their food, soaked their hardtack in coffee for days at a time to render it edible, and bought fruit from sutlers for curing in jars of whiskey.

  That month, the Sanitary Commission began lobbying Congress to establish a corps of medical inspectors. When Finley overruled one of his medical officers who planned to establish a military hospital in Union-held territory in South Carolina, because Finley believed the state’s mild climate made a hospital unnecessary, a vociferous public outcry resulted. Public pressure for fundamental change in military medicine mounted.

  On December 10, Senator Henry Wilson introduced a medical department reform bill. The legislation called for promotion of medical officers based on merit rather than seniority, a younger and more vigorous surgeon general, a hospital inspector corps, construction of military hospitals based on more advanced European hospitals, responsibility for medical transportation transferred from the quartermaster corps to the medical department, and the establishment of medical supply depots. Reform dominated the headlines in New York City’s The World and The Times newspapers as some called for Finley’s removal while others criticized the meddling of the Sanitary Commission. At about the same time, the Sanitary Commission met with General McClellan and presented a long list of complaints. McClellan appeared sympathetic, and indicated he would push for Hammond as Finley’s replacement if Congress passed the reform bill and it became law.

  Correspondents’ reports, editorials, and published soldiers’ letters filled newspapers with frustration, resentment, and anger in the latter half of 1861. Bull Run had demonstrated that America faced a long, bloody war beyond the scope of anyone’s imagination or preparation. McClellan commanded a sickly army largely comprised of undisciplined volunteer regiments unfamiliar with the demands of military life. He had been locked in a feud with the army’s general in chief, Winfield Scott, before Scott retired and McClellan became general in chief on November 1 as well as commander of the Army of the Potomac. But by the end of 1861, President Lincoln had grown weary of McClellan’s demands for an ever-increasing troop level in the absence of an announced battle plan. McClellan’s egotistic attitude had further soured his relationship with the president on November 13, when Lincoln waited half an hour for a meeting with his general before being told that McClellan had retired for the night and would not be awakened for the president.

  Tripler, meanwhile, had demonstrated a certain organizational ability after four months on the job, but mounting frustration over a fragmented command structure, the quality of army recruits, inadequate equipment, and what he saw as interference from non-military organizations had produced a paralysis that had cost him the confidence of McClellan, the Sanitary Commission, and others.17 Public pressure weighed on both Tripler and McClellan. The Army of the Potomac had grown into a massive force of more than 170,000 men, but with a leadership that was sharply and publicly questioned. When spring arrived in 1862, the first full year of Civil War campaigns would begin, and the Union army would be supported by a military medical structure that lacked foresight, innovation, and the ability to adapt. Generals leading those armies endured immense public pressure to produce victories, but that would require a healthier fighting force and far better care of the wounded.

  In January 1862, two devoted career military surgeons arrived at the same command on the western edge of the Civil War. After thirteen years’ military service, the quiet and thoughtful Jonathan Letterman became medical director in the Department of West Virginia, under the command of General William Stark Rosecrans. The same month Hammond, the high-profile, widely traveled, and prolific surgeon who now counted the Sanitary Commission among his most powerful supporters in Washington, became Rosecrans’s medical purveyor.

  The gaunt-thin and reflective Letterman cut a far different figure than the oversized Hammond, who stood six feet two inches, weighed two hundred fifty pounds, and sported a full, bushy beard that surrounded a round, soft face. Yet they shared many qualities. Neither lacked self-confidence. Both enjoyed tackling complex problems and developing carefully analyzed, multifaceted solutions. The army’s early war experience had revealed a number of unprecedented medical department issues and shortcomings that demanded such intelligent medical officers, who intuitively and independently sought solutions to seemingly insurmountable issues. Now, within the limits of a divided military and medical command system, Letterman and Hammond largely controlled an army’s medical personnel, supplies, hospital construction and operations, hygiene-standard inspections, and battlefield care. They were in a position to make meaningful changes with Rosecrans’s support, and in the face of continued political turmoil at the top of the Union army’s leadership they formed a professional alliance.

  As commander in chief, President Lincoln’s dissatisfaction extended beyond his general in chief, McClellan, to his War Department. In January 1862, Lincoln replaced Secretary of War Simon Cameron ten months after appointing him to the post the previous March. Cameron’s administration had been plagued by charges of corruption, indefensible patronage, and incompetence. To many, Cameron appeared more interested in making money than prosecuting the war. Besides this, Cameron’s annual report in 1861 had proposed the emancipation of slaves, which caused a maelstrom for a president not yet ready to make the same pronouncement.

  While the Sanitary Commission and leading members of Congress publicly campaigned for the replacement of what they believed was President Lincoln’s antiquated and overmatched surgeon general, the president sought to restore order at the top of the War Department. His choice, Edwin Stanton, became a surprising appointment.

  Stanton held an unconcealed low opinion of Lincoln, which stemmed from their participation in a legal case in 1857. A Democrat, Stanton had been a reporter for the Ohio Supreme Court, built a successful law practice, and had been appointed attorney general by President James Buchanan in 1860. Opinionated, sometimes belligerent, and extremely intense, the new secretary of war could be as dismissive of those he considered unworthy
as he could be deferential to others when it served his purpose. But Stanton had the backbone and organizational acumen that the president’s War Department desperately needed, and to secure them Lincoln was willing to live with his appointee’s personal disdain.

  Upon his appointment as medical purveyor in the Department of West Virginia, Hammond traveled to New York and Washington to personally procure badly needed supplies, ranging from operating equipment to mattresses and books for Letterman. Hammond then turned his attention to the crude state of midwinter military hospitals in West Virginia and Maryland. He called one hospital “disgusting” and considered it unfit for patients, given the lack of supplies, inexperienced surgeons, bad diet, filthy conditions, and absence of records. Another hospital, he wrote, “defies description. It is simply disgusting. The outhouses are filled with dirty clothes, such as sheets, bed sacks, shirts, etc., which have been soiled by discharges from sick men. The privy is fifty yards from the house, and is filthy and offensive, ad nauseam. It consists of a shed built over two trenches. No seats; simply a pole, passing along each trench for men to sit on. . . . I do not hesitate to say that such condition of affairs does not exist in any other hospital in the civilized world.”18

  His scathing report recommended replacement hospitals comprised of small buildings of fifty patients each that emphasized proper ventilation and that conformed to the prevailing medical community thought. It led to Hammond’s appointment as hospital inspector in March. Working with Letterman, he was now in a position to apply years of European military medical study to the massive medical challenges presented by the Civil War. He had seen little to praise in American military hospitals. “The permanent military hospitals of the United States are . . . of little importance as models. None of them are built after the plans which have been adopted by hygienists as best coming up to the standard required by sanitary science,” he wrote.19

  Hammond considered adequate ventilation and efficient operation vital to military hospitals. His pavilion-hospital design featured an elevated ridge at the top of the roof lines to vent the interior space. Holes along the sides of the wards under the beds provided intakes of fresh air. He wrote that a hospital ward should be confined to no more than two rows of beds and ideally should be no taller than one story. His precise calculations called for 1,205 cubic feet of space for each patient bed, and he claimed that an oblong patient ward of no more than fifty patients was ideal.

  Letterman used Hammond’s design to build one of the first military pavilion hospitals in the United States in Parkersburg, West Virginia, featuring an administrative building and two detached patient wards. Soon thereafter, Letterman supervised the construction of a similar pavilion-style military hospital in Grafton, West Virginia. Both were completed in the spring, at a time when the Sanitary Commission also employed Hammond’s pavilion philosophy to build several large military hospitals in advance of the coming combat season.

  Letterman and Hammond also collaborated with General Rosecrans, brigade surgeon William Hayes, and assistant surgeon Edward Dunster on a new ambulance design after early war models had proved inadequate or unreliable. They designed a 750-pound wagon that was drawn by two horses and could carry between two and six patients. Compartments held medical supplies, stretchers, and five gallons of water. The interior benches and seats could be removed to accommodate specific patient needs. Their design struck a balance between earlier models that had been too light or too heavy. The “Wheeling Wagon” became the army’s standard ambulance wagon until an improved model was adopted in 1864.

  This first collaboration between Letterman and Hammond was cut short by an act of Congress. On April 18, 1862, the Sanitary Commission’s six-month lobbying campaign resulted in passage of legislation that overhauled the surgeon general’s office and army’s medical department. The commission had specifically campaigned for “a Surgeon General who should have some adequate conception of the real wants to the army, and capacity and energy enough to carry into execution a liberal system of providing those wants . . . a thorough inspection and enforced by official authority.”20 The law not only called for a new surgeon general, it authorized promotion based on merit rather than seniority and the addition of eight medical inspectors.21 On the eve of 1862’s battles, the way had been cleared for bright, young surgeons to take control of the army’s medical department.

  On April 25, at thirty-three years of age, Hammond became the new surgeon general as a brigadier general. He replaced Finley after the latter had been reprimanded for trying to bar the Sanitary Commission from military hospitals, relieved his surgeon general duties, and sent to Boston to await further orders. Finley elected to resign.22 Hammond had leaped over more senior medical officers, including Letterman, but his military experience, nutrition research, medical school teaching experience, hospital expertise, and imposing presence made him the ideal choice. McClellan, too, was an ally. When McClellan spotted Hammond’s name on a list of medical officers he said, “He is our man. He is the only one of a whole corps, who has any just conception of the duties of such a position, and sufficient energy, faithfully to perform them.”23

  Hammond took possession of a hollow office comprised of four rooms and a meager staff responsible for hundreds of thousands of men in the field and more than one hundred military hospitals. The year before Hammond took over, Finley proudly noted the medical department did not spend all of its allocated $2.445 million budget. In his first year in office, Hammond’s budget would total more than $10.1 million and he would exceed that by nearly $1.5 million.24

  Hammond tested hospital stewards applying for jobs on his staff on their verbal, written, and penmanship skills and laid the groundwork for a far more activist department. He also turned to colleagues he knew, respected, and trusted. Jonathan Letterman was one. Hammond recommended to Secretary of War Stanton that Letterman be transferred to Washington and become responsible for that city’s hospitals. Hammond wanted medical inspectors assigned to major cities with large concentrations of military hospitals.25 However, the egos of Stanton and Hammond clashed almost immediately, delaying implementation of some of his recommendations. As the drama between the surgeon general and the secretary of war grew heated, the fighting on the battlefield had already resumed.

  In March, the Army of the Potomac finally began its long-awaited campaign aimed at the Confederate capital of Richmond. General McClellan had envisioned a grand strategy. First, assemble the largest army in the history of the United States. Next, flank the Confederate troops threatening Washington by making an unprecedented amphibious landing at Fort Monroe on the southeastern tip of the Virginia peninsula, followed by a fifty-mile overland campaign across the peninsula west to capture Richmond. To the sound of blaring bugles and bands, ships departed from Washington filled with men, destined for a large meadow at Fort Monroe. Hundreds of barges were moored there along the shore as tons of ordnance, supplies, and matériel were unloaded and stacked in massive piles. Temporary shelters were carved out of the forest. In approximately one month, an estimated 100,000 Union soldiers filled the temporary military camp.

  Disease inevitably followed. Tripler discovered rampant scurvy among some units whose soldiers refused to eat the nearly inedible desiccated vegetables. Hygiene in a temporary camp built in swampy spring mud was deplorable. As McClellan’s army assembled in Virginia, Tripler thought it inevitable that he would be faced with 50,000 cases of diarrhea.26 He also desperately sought 250 four-wheeled ambulances prior to the start of battle, but received only 177.27 It took nearly a month before McClellan had marshaled his troops and supplies and felt ready to march toward Yorktown, about twenty miles away. The Confederates waited.

  They established three lines of defense, stretching north to south from the York River on the north down to the James River, which formed the southern edge of the peninsula. As McClellan’s army moved west, it encountered the Confederates’ first line of defense at Yorktown, where artful tactics by the Confederates confounded McC
lellan and stalled his poorly disciplined troops. Badly outnumbered, the Confederates had painted logs to look like cannon and made show as though their military force was far greater than it was. McClellan’s attack on Yorktown turned into a siege that lasted nearly a month before the Confederates withdrew to the west.

  Spring rains soaked the Union soldiers, who had carried too much gear on the march and slept in the open. Roads became quagmires that bogged down the army’s renewed advance. Soon “Chickahominy Fever” took hold. So many soldiers fell sick that Tripler decided to evacuate them to Washington, Annapolis, and Baltimore. When malingerers swamped patient boats headed north, Tripler reversed course and kept thousands of sick patients on the peninsula, despite a critical shortage of medical tents.

  Meanwhile, Hammond and Stanton settled their differences enough that Letterman was transferred to his new inspector’s post in Washington. Upon his arrival, he discovered his hospitals had no room for the Peninsula Campaign’s flow of casualties. Letterman made arrangements for patient transfers to Philadelphia, Annapolis, Alexandria, New York City, and Baltimore while instructing an Alexandria surgeon to “put the men in churches and make the best disposition possible. It is not possible to take them here.”28

  As McClellan’s army slogged westward across the Virginia peninsula in May, Surgeon General Hammond had already become testy with Tripler’s pleas for more supplies. On April 14, during the Yorktown siege, Tripler had complained to Hammond’s predecessor that his medical supplies were nearly exhausted. He renewed his complaint to Hammond on May 18, as he grew impatient with delayed medical supply deliveries. In telegrams he pleaded his case for supplies again on May 20 and May 29, begging for more quinine after receiving 100 ounces instead of the 2,000 he had requested.29 Hammond told Tripler to stop complaining and take command of the local situation, as Tripler had the authority to do so. Two days after Tripler’s latest plea, the Confederates attacked McClellan’s forces at Seven Pines in hopes of avoiding a siege of Richmond.