While Sumner’s troops had bogged down along Sunken Road, General Ambrose Burnside launched an attack in the south. About 500 Confederate troops defended the bridge across Antietam Creek that Ambrose’s Ninth Corps sought. They were outnumbered by more than ten to one, but had dug in on a hill directly overlooking the narrow stone bridge. The creek and bridge at the foot of the hill, gave Burnside’s troops no room to assemble once they crossed the bridge. Confederate troops, in effect, held a hillside “castle” that was protected by a creek “moat” and single bridge that crossed it. Confederate troops fired almost straight down on exposed men as they raced across the bridge.
McClellan grew impatient with Burnside’s lack of progress. He sent senior aides to Burnside ordering him to take the bridge, no matter the cost. Waves of Union soldiers followed each other to the foot of the Confederate-held hill before being turned back. Hundreds lay wounded. Only a few could be carried back across the bridge to aid stations hidden in stands of trees.
At 1:30 p.m., Union soldiers reached the far side of the bridge or creek. It took another two hours before the bulk of Burnside’s men crossed the bridge and established a threat to Sharpsburg from the southeast. Still furious with the lack of advance, McClellan ordered Burnside’s exhausted troops to press their attack up the hill and open a route toward Sharpsburg. As Burnside’s units launched a late-afternoon advance toward Sharpsburg, Confederate forces unexpectedly appeared on the Union flank. General A. G. Hill had led 3,200 men on a ten-hour march across seventeen miles of countryside from Harpers Ferry to attack Burnside’s left flank and stall his advance. The costly assault ground to a halt. More than two thousand Union soldiers were killed or wounded during their river crossing and assault toward Sharpsburg.13 Shortly before dark they pulled back to the bridge with the Confederates back in control of the hillside. As the sun set on September 17, more than 23,000 Union and Confederate soldiers had become casualties, the bloodiest day in American history.
During a lull in the day’s fighting, Lieutenant Spurr had been moved to a safer location and placed on a bed of straw. Alongside him lay Union and Confederate soldiers, waiting for care. Thousands of dead and wounded littered the open battlefield. Nearly 8,000 bodies remained on the thirty-acre cornfield that had changed hands six times that day.14 The carpet of death horrified Union surgeon George Stevens, moving him to write, “At one point in our own front, for more than half a mile, the rebels lay so thickly as to almost touch each other. On the field where Hooker’s men had won and lost the field, the dead and dying were scattered thickly among the broken cornstalks, their eyes protruding and their faces blackened by the sun. Wherever the lines of battle had surged to and fro, these vestiges of the terrible work were left. . . . Some were shot while attempting to get over the fence; and their remains hung upon the boards. A more fearful picture than we saw here, could not be conceived.”15
America’s bloodiest day had ended at sunset. The early morning attacks had cost the Union army 7,300 wounded and killed. The midday phase produced nearly 2,900 casualties. All told, 11,600 Union troops had been killed or wounded. The Confederate toll stood at more than 9,000 killed or wounded. The equivalent of every resident of Atlanta, Georgia, and Alexandria, Virginia, had been killed or wounded in one day at Antietam.16
Soldiers had fallen wounded or dead at the rate of 2,000 per hour. Every two seconds, for twelve consecutive hours, a Union or Confederate soldier fell wounded or killed along the battlefront. Lee’s grand plan of driving deep into the heart of the North had been foiled. The cost in suffering, though, had been brutal. Jonathan Letterman’s battle at Antietam, however, had just begun.
The following day hundreds of wounded men lay on the battlefield as the two armies held their positions, Lee in Sharpsburg and McClellan along Antietam Creek. Neither army had the strength to fight a second day. Already the wounded packed Letterman’s hospitals, testimony to the previous day’s carnage. Located close to the battlefront, the hospitals had filled quickly on the previous night as one wagon arrived after another, loaded with wounded, “Indeed there was not a barn or farmhouse, or store, or church, or schoolhouse, between Boonsboro and Keedysville, Sharpsburg and Smoketown that was not gorged with wounded—Rebel and Union. Even the corncribs, and in many instances the cow stables, and in one place the mangers were filled,” wrote the Sanitary Commission’s Dr. Cornelius Agnew.17
Two large general hospitals established by Letterman, one at Smoketown able to treat 600 and another at Locust Springs able to treat up to 400 were at capacity. They reflected the reality that the seriously wounded could not withstand a long trip to a distant city for hospital care. Thousands of men wounded in a major battle could not be patched up and sent back to the front line or put on a train for a long trip to Baltimore, New York City, or Philadelphia. For the first time, general hospitals near the battlefield were established as the next logical link in Letterman’s emerging concept of battlefield care that moved seriously wounded soldiers from aid station to an intermediate makeshift field hospital and, when strong enough, to a general hospital as expeditiously as possible. It formed a concept Letterman would codify less than two months later, building on his crucial first step of establishing an ambulance corps.
The homes of area residents not designated as potential hospitals before the battle were commandeered on September 18, as Letterman’s staff desperately coped with legions of wounded. After telegraphing for more supplies on the night of the battle, Letterman searched for more as the magnitude of the previous day’s human destruction became clearer. The supply logjam at Monocacy River persisted as frustration mounted among underequipped doctors at the hospitals. It was worse for volunteer regimental surgeons, who were given a small allowance to purchase food instead of being provided Army food. “I am sometimes almost famished for want of something to eat,” wrote surgeon Daniel Holt of the 121st New York regiment. “As we have no camp or cooking utensils, and no means of carrying provisions we are all the while upon short allowance and every often upon no allowance at all. . . . Were it not for peaches and tomatoes with an occasional onion to eat with my ginger cakes it would go hard enough I assure you.”18
Many were unaware of Letterman’s efforts to get tons of supplies off the boxcars, loaded into wagons, and driven either to the supply depot at Frederick or further west into the rural constellation of hospitals. At 9:00 a.m. on the 18th he gratefully accepted a wagonload of medical supplies from the Sanitary Commission at Keedysville. He decided to use most of the supplies at Keedysville and nearby aid stations. A few hours later, he rode to Middletown to check on its hospital. There, another wagonload of Sanitary Commission supplies arrived for his distribution.19
Surgeons who had been operating on the most seriously wounded at the outset of the battle were still operating the following day as Letterman focused on supplies and the ongoing battlefield evacuation. In a letter to his wife, Union surgeon William Child wrote, “The days after the battle are a thousand times worse than the day of the battle—the physical pain is not the greatest pain suffered. . . . The dead appear sickening but they suffer no pain. But the poor wounded mutilated soldiers that yet have life and sensation make a most horrid picture. I pray God may stop such infernal work, though perhaps he has sent it upon us for our sins. Great indeed must have been our sins if such is our punishment.”20
There would be no more fighting at Antietam after Lee withdrew from Sharpsburg the night of September 18 and crossed the Potomac the following day. Fortified by the bulk of the Sixth Corps that had been held in reserve on the day of the battle, McClellan allowed Lee an unchallenged retreat. By the time Lee began his withdrawal, within twenty-four hours after the battle had ended, Letterman’s ambulance system had evacuated nearly all of the wounded off the battlefield, a landmark accomplishment in the evolution of battlefield care.21 Letterman toured the hospitals and battlefield, giving orders, overseeing the evacuation, and calling for supplies. He established a temporary supply depot at Sharpsburg on th
e 19th, much closer to the battlefield than Frederick. “Not only were our wounded supplied, but the wounded of the enemy, who fell into our hands, was furnished with all the medical and surgical appliances required for their use,” wrote Letterman.22
On September 20, McClellan moved his headquarters to the west side of Antietam Creek. Letterman put surgeon John Howard Taylor in charge of the Pry farm’s barn that now served as a field hospital for enlisted men, as well as in charge of hospitals on the R. F. Kennedy and Henry Neikirk farms a few miles away. At least 1,500 wounded men, initially short of adequate clothing and bedding, at the Hoffman farm and Pry Mill hospital among other locations, were the responsibility of Taylor.
By that point, Letterman faced a new challenge and with it came an opportunity. Repairs to the railroad bridge over Monocacy River at Frederick neared completion. Soon the flow of supplies toward the battlefield would accelerate. Letterman could then utilize the empty boxcars as patient transports back to recently expanded convalescent hospitals in Baltimore, Washington, and elsewhere. Wounded men who could withstand the journey in the back of a wagon were taken from hospitals near Sharpsburg to the rail head and nearby hospitals in Frederick. More than 10,000 men were admitted to Frederick’s thirty-four hospitals, most on their way to larger cities.
The timing of their departure had to be meticulously planned so that their arrival in Frederick more than fifteen miles away coincided with the evacuation trains’ schedule and capacity. “It was imperative that the trains [convoys of ambulance wagons] should leave at the proper hours, no one interfering with another; that they should halt at Middletown, where food and rest, with such surgical aid as might be required, could be given to the wounded; that food should be prepared at this village at the proper time, for the proper number; that the hospitals at Frederick should not be overcrowded, and the ambulances should arrive at the railroad depot in Frederick at the required time to meet the Baltimore trains,” wrote Letterman.23 His medical officers sent wounded men to the nearest hospital that still had capacity. They transferred Lieutenant Spurr by ambulance to Hagerstown, Maryland, for treatment of the gunshot wound in his thigh.
Thousands of wounded men, unable to travel to general hospitals in cities, remained at large hospitals at Keedysville, Smoketown, and in other nearby rural towns. These “hospitals,” to which the majority of wounded men were taken, comprised a collection of tents. If the men were lucky, the tents were located in stands of trees that provided shade. A rural church, barn, or courthouse served as the hospital headquarters, operating room, recovery, and intensive care unit.
Letterman’s Keedysville hospital was typical. “The principal hospital was established in the brick church near the upper end of town. Boards were laid on top of the seats, then straw and blankets, and most of the worse cases of wounded were taken to this, the headquarters. Comrades with wounds of all conceivable shapes were brought in and placed side by side as thick as they could lay, and the bloody work of amputation commenced. The Surgeons, myself and a corps of nurses with sleeves rolled up, worked with tender care and anxiety to relieve the pain and save the lives of all we could. A pit was dug under the window at the back of the church and as soon as a limb was amputated I would take it to the window and drop it outside into the pit. The arms, legs, feet and hands that were dropped into that hole would amount to several hundred pounds. On occasion I had to fish out a hand for its former owner, as he insisted that it was all cramped up and hurt him. As soon as the hand was straightened out he complained no more of the pain in the stump,” wrote hospital orderly George Allen of the 76th New York Infantry.24
In other instances, in contemporary accounts, the term hospital in the singular represented a summary description of several impromptu medical facilities. “Smoketown hospital” represented field hospitals at several farms near the small settlement of Smoketown. The main hospital in a stand of oaks contained eighty tents, a post office, kitchen, chapel, dispensary and storerooms.
“The hospital is arranged nearly in the form of a square; the wards in which the patients are placed form one side of the square. There are now eight of these, each ward consisting of six or seven large tents, each ten being fourteen feet square. . . . There are streets running between them, which are swept every morning, if the weather permits. . . . The beds are all made of iron, with good ticks well filled with straw, and plenty of blankets. . . . Each tent has a good stove with an oven in it. There are five patients in each tent,” wrote a newspaper reporter.25
As battlefield reports detailed the wasteland of death and injury in western Maryland, Letterman faced a new invasion: relatives and friends of the wounded. “Immediately after the battle, many persons came within our lines to remove their relatives or friends who had been injured—whose lives, in many instances, depended upon their remaining at rest. It was impossible to convince them that the removal of a dangerously wounded man would be made at the risk of his life—that risk they were perfectly willing to take, if he could only (at the end perhaps of a long and painful journey) be placed in a house. No greater mistake could be made. . . .A marked contrast could been seen, within a few yards, between the wounded in houses and barns, and those in the open air. Those in houses progressed less favorably than those in barns, those in the latter buildings less favorably than those in the open air; though all were treated alike in other respects,” wrote Letterman.26
For all the authority granted Letterman, decisions by others in command had to become a source of frustration at times. It must have saddened him to see families take wounded sons, brothers, and fathers out of the field hospitals Letterman had worked hard to establish and take them to less healthy environments. Probably just as frustrating, McClellan allowed some state relief society representatives to take wounded soldiers back to their home states. Thousands of men were lost to the Army of the Potomac in this way, with their return to duty uncertain at best.
Families also scoured the battlefield in search of a relative or friend. Letterman could not ignore the sanitation hazards posed by the dead and dismembered body parts. Nearly a week after the battle, “the dead were almost wholly unburied, and the stench arising from it was such as to breed a pestilence in the regiment. We were ordered to bury the dead, collect arms, and accoutrements left upon the field. . . . I have seen, stretched along, in one straight line, ready for interment, at least a thousand blackened, bloated corpses with blood and gas protruding from every orifice, and maggots holding high carnival over the heads,” wrote surgeon Holt.27
In the weeks following battle, the flow of wounded to the east matched waves of supplies finally reaching Maryland. “There was probably no campaign throughout the war which was conducted under greater disadvantages in respect to supplies of all kinds . . . the immense losses and terrible exhaustion of a week of battles, the consequent confusion and disorganization, and the impossibility of providing adequate means of transportation for the most necessary supplies, the Army which fought at Antietam was placed in the worst possible condition so far as its ability to care properly for its wounded was concerned,” wrote Sanitary Commissioner Charles Stille.28 Letterman may have disagreed with that statement, as his inspections convinced him they were reasonably supplied, with the exception of food in the days immediately following the battle. He could hardly deny the initial shortage of food as the Sanitary Commission, independent of the military-controlled railroad line, delivered 28,763 pieces of dry goods, 2,620 pounds of condensed milk, 3,188 pounds of farina, 5,000 pounds of beef stock and meat, 3,000 bottles of wine, and tea, sugar, spices, and crackers to area hospitals following the battle.29
Antietam demonstrated that both the military and civilian medical communities were needed to treat thousands of men who fell wounded within a few hours’ fighting. Although some Sanitary Commission agents had found Letterman to be aloof, Antietam galvanized a relationship of mutual respect that overcame the army’s reluctance to accept assistance from civilians. “I am pleased to state that the true relat
ion of the Sanitary Commission to the Medical Department was fully recognized and appreciated as a body designed to supplement and not supplant the regular operations of the army,” wrote a Sanitary Commission doctor.30 After a year of war, the civilian-led Sanitary Commission, army medical professionals led by Surgeon General Hammond, and army medical directors such as Letterman began to tolerate and accept their respective roles in caring for tens of thousands of casualties. Those numbers became more overwhelming in the battles still to come.
Although the Confederates had been driven back into Virginia at Antietam, critics condemned McClellan’s failure to decisively destroy Lee’s army in the battle. Letterman’s medical department came in for criticism as well. While his ambulance system had evacuated the entire battlefield in twenty-four hours, a respected publication of the day, the American Medical Times, characterized his efforts as “gross mismanagement and inefficiency . . . lack of system control,” and reported allegations of theft by some ambulance drivers.31
Some Sanitary Commission agents also were critical. One focused on Letterman’s department, complaining that some of the wounded were given only water the first day and then coffee and crackers the second day as they waited for a doctor. Yet according to Letterman, the Deputy Medical Inspector General of the British Army, in a visit to Antietam, “expressed the pleasure it afforded him to see the manner in which the wounded were attended, and remarked that although he had been on many battle-fields, he had never found them more carefully provided for, or attentively treated.”32
Praise from a fellow medical officer meant more to Letterman than the opinions of civilians. He held a dim view of their ability to judge the unique challenges of military medicine and valued the professionalism and order he found in the military. His self-awareness and confidence left no need for accolades from those he felt unqualified to judge his emerging system.
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