Surgeon In Blue

by Scott McGaugh

  Feints, counterassaults, and flank attacks by the Confederates stopped the Union advance. After two days’ fighting, Tripler faced nearly 3,600 wounded soldiers. The shorthanded medical department required more than a week to transport all the wounded to nearby ports where hospital ships awaited. The smell of putrid flesh announced the arrival of boxcars filled with wounded at White House on the James River.

  The plight of the wounded four days after the end of fighting shocked Sanitary Commission observers. “Some (wounded) were just as they had been left by the fortune of war; their wounds, as yet, undressed, smeared with filth and blood, and all their wants unsupplied. Others had had their wounds dressed, one, two, or three days before. Others, still, were under the surgeon’s hands, receiving such care as could be given them by men overburdened by the number of their patients, worn out by excessive and long-continued labor,” the observers wrote.30 Many of those patients arrived in Washington on barges and ships that lacked food, water, and sanitation facilities. Some had lain in the early summer sun for days, suffering at the hands of their army that still did not have an organized battlefield care and evacuation system in place.

  Shaken by the damage inflicted by the Confederates, McClellan halted his assault for more than three weeks to draw reinforcements and supplies. The delay gave Confederate General Robert E. Lee valuable time to strengthen Richmond’s defenses and construct a line of defense that stretched thirty miles across McClellan’s path. Fearful of a siege of Richmond by the Army of the Potomac, Lee took the initiative with attacks on June 25, which became the start of the Seven Days Battle. McClellan had lost the initiative and relentless attacks by Lee broke the Union army’s spirit, forcing McClellan to order withdrawal to the James River, about thirty miles southeast of Richmond.

  Six major engagements in seven days produced more than 8,000 wounded men. Although McClellan never overextended his army, railroads remained available, and the Union navy controlled waterways, McClellan’s medical department had been overwhelmed by the flood of the wounded and dying almost from the outset of the Peninsula Campaign. Although Tripler never received the logistical support he believed necessary, public outrage at the plight of the wounded during the Peninsula Campaign destroyed any credibility he had held with Surgeon General Hammond and the Sanitary Commission.

  Tripler had failed to earn the respect of McClellan too. He had not known that some of his army’s patients had been shipped to a Cumberland, Maryland hospital when a public controversy erupted over its filthy condition. He had been unable to overcome the shortage of support staff and hospital inspectors, incompetent volunteer regiment doctors, and the fact that he lacked authority over line officers. He had become so desperate that he had asked for fifty runaway slaves from the quartermaster corps.31 Tripler had taken to pleading for supplies more than taking action. Circumstance and lack of leadership had defeated the medical director just as his army had been beaten back by the Confederates.

  Between the end of the Battle of Seven Pines and the start of the Seven Days Battle, Tripler had already been replaced. On June 19, Tripler conceded professional defeat when he asked for reassignment to Detroit Barracks, Michigan, a post where he had served prior to the war. Hammond approved Tripler’s request and on the same day appointed a man he knew and respected, Jonathan Letterman, as the new medical director of the Army of the Potomac. For Letterman the assignment included a promotion to surgeon and the military rank of major.

  In many ways, Letterman’s experience did not qualify him for the medical responsibility of more than 50,000 men. Outpost medicine bore little resemblance to supervising hundreds of physicians and their assistants; managing the flow of tons of medical supplies; planning tactical medical plans in concert with battle plans for more than fifty regiments; and ensuring thousands of wounded men could be treated promptly and ultimately transported to hospitals more than fifty miles away. At the same time, he had to earn the respect and trust of his commanding general and, to a lesser extent, the commanders of the various corps as well as the quartermasters.

  Who could manage the mountain of logistical considerations without losing sight of the fundamental compassion essential to caring for each wounded soldier? Who could piece together the mosaic of military medicine at the army-command level, knowing that ultimate success rested in the hands of hundreds of anonymous surgeons and stretcher bearers? Who could assimilate, process, reorganize, and act with alacrity when unexpected enemy fire shredded men and anticipated battle plans? It would take a man whose self-confidence left little room for conscious doubt. Someone who was as intuitive as he was analytical. A system builder who instinctively questioned existing procedures and protocols in the face of unprecedented challenges. Surgeon General Hammond believed Letterman was that man.

  Letterman arrived at Harrison’s Landing on July 1, surveyed the carnage, and met with McClellan, who later recorded his first impression of Letterman, writing: “I saw immediately that Letterman was the man for the occasion, and at once gave him my unbounded confidence. In our long and frequent interviews upon the subject of his duties, I was most strongly impressed by his accurate knowledge of his work—the clear and perfectly practical nature of his views and the thorough unselfishness of his character. He had but one thing in view—the best possible organization of his department—and that, not that he might gain credit or promotion by the results of his work, but that he might do all in his power to diminish the inevitable sufferings of the soldiers and increase the efficiency of the Army. . . . I never met with his superior in power of organization and executive ability.”32 From his perspective, McClellan had both a surgeon general and now a medical director worthy of his support.

  The thousands of men who had fallen wounded across eastern Virginia desperately needed both of them.

  4

  TAKING MEDICAL COMMAND

  “I found it in a deplorable condition.”

  Chaos greeted Jonathan Letterman when he transferred to an army that regularly fought in major battles. The Army of the Potomac had been bloodied and defeated and was exhausted after three months’ battle. The long-awaited assault to take Richmond had foundered on the outskirts of the city. The Seven Days Battle, which ended on July 1, had broken McClellan’s army nearly within sight of Richmond, resulting in another humiliating Union army retreat, stinging criticism by the Sanitary Commission, and outrage in leading newspapers of the North. Thousands of wounded men lay unprotected along the James River, waiting for treatment and evacuation.

  America had been at war for a year. Frequent reports of filthy hospitals, the wounded lying on battlefields, rampant disease, and horrific loss of life had fueled public outrage. Approximately five years earlier, Americans had read similar reports of suffering in the Crimean War between Russia, France, and Britain. The British in particular had been indignant over how poorly their wounded and sick soldiers had been treated. In the first six months of the Crimean War, the British illness rate exceeded 100 percent. In one month, one in ten British soldiers died of disease, with illness killing three times as many men as the enemy.1 The American military medical establishment had clearly learned little from the British experience. The American public demanded improvement both on the battlefield and in the hospital.

  When Letterman officially took over from Tripler on July 4, he faced the evacuation of nearly 13,000 casualties to Fort Monroe on the peninsula and aboard steamers to hospitals in the North. Worse, “[t]he nature of the military operations had also unavoidably placed the Medical Department in a very unsatisfactory condition. Supplies had been almost exhausted or necessarily abandoned; hospital tents abandoned or destroyed, and the medical officers deficient in numbers or broken down by fatigue,” wrote McClellan.2

  Letterman hadn’t known exactly what he would face. “It was impossible to obtain proper reports of the number of sick in the army when it reached Harrison’s Landing. . . . The data on which to base the precise percentage of sick and wounded could not then be obtained but
from the most careful estimate which I could make, the sickness amounted to at least twenty percent,” wrote Letterman.3 The army of which he took medical command was also ravaged by scurvy. Letterman’s experience in the West told him that thousands more, in addition to those diagnosed with the vitamin deficiency, “do not feel sick, and yet their energy, their powers of endurance, and their willingness to undergo hardship, are in a great degree gone, and they know not why. In this way the fighting strength of the army was affected to a much greater degree than was indicated by the number of those who reported sick.”4

  For all that he confronted, Letterman had unparalleled authority from Surgeon General Hammond, who had broken his predecessors’ habit of micromanaging medical directors. Hammond’s letter of appointment gave Letterman widespread authority, coupled with autonomy moderated solely by the requirement that Letterman keep him advised of actions taken and submit requests for necessary supplies.

  Hammond specifically told Letterman that he carried the authority to hold medical officers accountable for inadequate supplies. At the same time Letterman had authority to draw supplies at his sole discretion from large depots in the North, regardless of whether they were authorized by the surgeon general’s office. Letterman also had authority to report deficient medical officers to the commanding general of the army. Further, he did not have to wait for additional medical officers to be sent by the surgeon general. “You will hire such physicians, nurses, etc., as you may require, and as you can obtain on the spot, making known to me immediately your deficiencies in that respect at the earliest possible moment, so I can supply you,” wrote Hammond.5

  No medical director in the history of the United States Army had been given such widespread authority. Hammond placed the health of the Union army’s highest profile command in the hands of a man he had grown to trust, despite Letterman’s lack of battlefield experience. Letterman followed suit when he brought assistant surgeon Edward Dunster from West Virginia to become his director of transportation.

  Letterman’s initial evacuation of wounded soldiers took place on steamers recently taken over by the surgeon general’s office and that had earlier been operated by the Sanitary Commission. The commission continued to work with army medical directors, including Letterman. Its relationship with Letterman was strained at best. The Unitarian minister who had founded the Sanitary Commission, Dr. Henry Bellows, held a grudging respect for the Army of the Potomac’s new medical director. While Bellows characterized Letterman as having a “strong professional ambition and zeal,” he resented what he viewed as Letterman’s intent to keep the commission in its place and subservient to the medical department, and he thought Letterman difficult to work with due to a lack of ‘personal humanity.’ Bellows found him to be an incessant smoker and “dry, taciturn, and impenetrable.” Yet, “[o]ut of confusion . . . (Letterman) fashioned order and a system. Never again would the commission have to serve as the (medical) bureau’s crutch,” wrote Bellows.6

  As Letterman dealt with thousands who needed evacuation and thousands more who required treatment, a devastated General McClellan resolutely asked President Lincoln for more troops to replenish the Army of the Potomac’s fighting strength. Lincoln called the general’s request for 50,000 men “absurd.” Letterman found himself answering to a general who believed his army remained undermanned and felt unappreciated by his president, at a time when public debate over the Army of the Potomac’s defeat turned caustic and partisan.

  Some editorials thought McClellan had offered a dishonest explanation for his army’s retreat, while others characterized the same retreat as bold. The polarizing general was painted as either the architect of failure in the Peninsula assault or the victim of a president who didn’t provide the necessary personnel and equipment that he needed to achieve success. Conspiracy theories abounded. Some felt Secretary of War Stanton had withheld troops to force a McClellan defeat, while others suspected strict abolitionists in the Lincoln administration worked behind the scenes to hamstring the general because he favored gradual emancipation. The withering criticism wasn’t lost on McClellan, who described Stanton as an “unmitigated scoundrel” in a letter to his wife and admitted he had lost all respect for Lincoln.7 His troops, too, remained divided. Some were bitter over the lack of reinforcements while others thought McClellan had been outwitted by the Confederate generals.

  As newspaper headlines battled for supremacy in the postbattle campaign, Letterman wasted no time in resurrecting what had become a gutted army medical department. He asked Hammond for 1,000 tents to shelter the sick, so patients could remain with the army and return to duty sooner. He also sought 200 ambulances to speed the pace of evacuation of others.

  Deplorable sanitation and rising rates of disease at Harrison’s Landing also demanded his immediate attention. Disease had always been the foremost enemy of armies at war. Dysentery, caused by parasites in contaminated water or food, was the scourge of many military camps. Far more soldiers died of disease than from enemy fire in the Mexican War. The British lost eight times as many men to disease as to the enemy in the Napoleonic Wars. A lack of sanitation was a principal cause of a sickly army. An army could be smelled before it appeared. Soldiers bathed infrequently and warm water was a rarity. Dead animals, butchered livestock, open sewers, and raging infections of open wounds gagged hospital stewards. Preventive medicine was not a core element of medical school curriculum, and no state had a health department at the start of the Civil War.8

  Letterman found such chaos unacceptable. He drafted medical orders for consideration by McClellan so radical that only a commanding general who had complete faith in his medical director would entertain them. In addition, Letterman could forge a massive overhaul of army health care because he had unfettered authority granted by a surgeon general who embraced new approaches based on experience, considered study, and analysis. Hammond, Letterman, and McClellan had come together at a critical juncture in the war. Rampant disease and the neglect of the wounded no longer could be tolerated.

  McClellan needed Letterman. The egotistical general fumed over the failed Peninsula Campaign and the stinging criticism that followed. Regardless, he needed a much stronger and healthier army for his grand plans to take the fight to General Lee. Less than a week after his arrival, Letterman presented McClellan with a plan that would become the first step in recasting battlefield medicine.

  On July 8, McClellan issued Special Order No. 197 and later General Orders No. 139 and 150 to establish fundamental medical department organization and to mount a campaign against disease. Together, the three orders required Letterman’s approval for a soldier’s admission to a hospital on the peninsula or to be evacuated north; sanitary inspections, with reports sent to senior officers; and a regular supply of fresh vegetables to prevent scurvy. Bathing and human waste disposal policies were established. McClellan also endorsed a letter by Letterman on how to cook food properly for the troops. The series of orders centralized fundamental army health responsibility by taking it out of the regiments and placing it in army headquarters. Letterman laid a foundation of standardization, enforcement, and accountability that would become the cornerstones of the battlefield care overhaul he was about to implement.

  Within a few weeks of his arrival in Virginia, Letterman’s impact became apparent. The medical department was no longer paralyzed by a fractured chain of command. By the third week of July, hundreds of tents had arrived. Tons of potatoes, onions, cabbage, tomatoes, squash, and fresh bread arrived in quantities that outstripped the army’s ability to transfer it to the troops in the field. As a result, some produce rotted on the dock.

  Army morale improved along with army health. A long proven army command axiom held that there were three essentials to good troop morale: a soldier had to believe he would be taken care of if he was wounded on the battlefield; he had to have generally good health; and he had to know he could rely on a steady and edible food supply.

  Letterman’s first priority had bee
n the overall health of the army, starting with diet and extending to camp routine and sanitation. Within two weeks of assuming medical command, he also submitted specific recommendations to McClellan that fundamentally would change the organization and operation of military camps in the Army of the Potomac. Letterman wanted two men in each company designated as permanent cooks, who would follow instructions in making nutritious soups and other meals. Experience had shown that inexperienced soldiers overcooked their personal food and suffered from malnutrition. Summer rains in Virginia that turned military camps into muddy quagmires led Letterman to recommend that tents be relocated every week onto new ground covered with freshly cut pine boughs to avoid sleeping directly on the ground. He also believed the troops should be limited to two forty-five-minute drills per day, be allowed to sleep until sunrise and then have breakfast, and be required to take one fifteen-minute bath per week in a nearby river.

  Refuse and waste also were a priority, in Letterman’s view. He specified how to cover outhouse trenches with six inches of earth daily and that, when they filled to within two feet of the surface, they be moved to a new location. He also addressed the disposal of kitchen refuse in freshly dug pits, and how the remains of slaughtered cows and other livestock should be buried at least four feet deep; and he recommended that regimental commanders be held accountable for heightened camp sanitation standards. “I think if these suggestions be carried into effect that we may with reason expect the health of this army to be in as good a state as that of any army in the field,” wrote Letterman.9