Letterman’s new system emphasized the role of division field hospitals in providing urgent care but also relied on the ability of those hospitals to evacuate the seriously wounded to general hospitals in major cities. Washington and other cities were already deluged with wounded. However, Letterman’s order came at a time when efforts were under way to create new hospital space. With Surgeon General William Hammond overseeing a massive urban hospital construction initiative, government buildings that had been converted into makeshift hospitals— with no security, minimal ventilation, unacceptable hygiene, and minimal capacity—were giving way to newly built general hospitals. Earlier efforts by army medical directors had been plagued by private contractor profiteering. One hospital project, anticipated to cost $75 a bed, produced contractor bids of up to $400 per bed.11
In many ways Hammond was a visionary. A few months after Letterman’s field hospital order, Hammond published a detailed treatise on the history and contemporary requirements of military hospitals. Early war experience had revealed proper ventilation as a vital control agent of contagious infections in frequently overcrowded general hospitals. Hammond recommended single-story hospital wards radiating from the center like spokes of a wheel, each 120 feet long under a tall roof with closeable openings at both ends to facilitate ventilation. Nearby buildings housed a kitchen, warehouse, operating rooms, ice house, pharmacy and offices. Both efficiency and hygiene were critical to caring for tens of thousands of wounded arriving from Letterman’s field hospitals.
But the most contemporary military hospitals of the day sometimes strained the compassion of those who worked in them. “If our men were brave on the field, they were still braver in the hospital,” wrote Union nurse Mary Livermore. “I can conceive that it may be easy to face death on the battlefield. . . . But to lie suffering in a hospital bed for months, cared for as a matter of routine and form, one’s name dropped, and one only known as ‘Number 10,’ ‘Number 20,’ or ‘Number 50’; with no companionship, no affection, none of the tender assiduities of home nursing, hearing from home irregularly and at rare intervals, utterly alone in the midst of hundreds; sick, in pain, sorehearted and depressed, I declare this requires more courage to endure, than to face the most tragic death.”12
Ingenuity led to modest and temporary advances in comfort. Poet Walt Whitman noted that in some hospitals soldiers dug a long trench under a row of hospital beds and then partially backfilled it with railroad iron and dirt. Fires built at either end of the trench where the railroad iron was exposed heated the metal, which conducted the warmth lengthwise to warm the surrounding soil under the hospital beds.
Letterman viewed one of his major priorities as maximizing McClellan’s fighting force. He believed he could do that by keeping the sick and wounded out of Hammond’s hospitals and as close to the army as possible, so they could return to duty more promptly. Too many Army of the Potomac soldiers disappeared when they traveled north into large cities to recover from wounds that could be treated nearby. Letterman also had to provide critical care for the seriously wounded as a prelude to evacuating them to the rear, and then ensure their efficient transportation to general hospitals in cities. His October 30 order reorganizing military hospitals in the field became the last step necessary to accomplishing those goals. Reorganized battlefield care, evacuation to a coordinated hospital structure, adequate supplies, and medical staff accountability were Letterman’s military medicine cornerstones. All was in place by October 31, 1862.
By early November, McClellan and his army had reached Warrenton. McClellan couldn’t conceal his unhappiness with the president’s mounting pressure to attack Lee. “[T]he advance was made against his will, against his protestations, and on the imperative order of the President,” wrote a reporter in the New York Times, a newspaper that supported McClellan in the partisan reporting of the war.13 McClellan also regularly shared his dissatisfaction with the president in letters to his wife.
Late on November 7, he sat in his tent writing a letter when General Ambrose Burnside and Brigadier General Catharinus Buckingham interrupted him. Buckingham carried orders from the president removing McClellan from his command. For the second time, Lincoln had decided to fire the man who proved adept at developing the Army of the Potomac and at imposing structure among demoralized troops, but who resisted attacking the enemy.
McClellan and Letterman had shared a passion for the welfare of the men in their charge. In McClellan’s case, it led to an aversion to aggressively engage the enemy. That cautiousness cost him his command. But McClellan’s ouster had been much of his own doing. His imperial nature and overt disdain of politicians had alienated potential allies in Washington. He appeared more fearful of defeat than eager to defeat the enemy. While that trait generated widespread and passionate loyalty among most of the troops, who felt he had their best interest at heart, Lincoln, Secretary of War Edwin Stanton, and others no longer could tolerate a defensive general who was thought by some to be intellectually overmatched by General Lee.
Letterman had lost a friend. Early in his relationship with McClellan he had found common ground, their mutual passion for the welfare of the troops. Most of Letterman’s few friendships similarly were based on professional relationships centered on a common cause. Those friendships ran deep. Now he would have to build a working relationship with McClellan’s replacement, a man who might not share or appreciate Letterman’s apolitical approach to battlefield medicine.
McClellan’s ego and leadership style had unfortunately politicized the Army of the Potomac. McClellan had promoted some officers more on the basis of personal loyalty than seniority. That emboldened officers who agreed with him, and placed those who didn’t in an impossible position. A key topic of disagreement was the purpose of the Civil War and what was required to end it. McClellan’s subordinates served a general who believed the war necessary to preserve the union but not necessarily to emancipate slaves. The sole requirement for peace, in his view, was reunion and that emancipation could follow at some point in the future.
Minutes before McClellan was formally dismissed, Burnside reluctantly had accepted command of the army. His demeanor matched the early winter snowstorm that blanketed Warrenton that night. When congratulated on his appointment later, Burnside responded, “That, Sir, is the last thing on which I wish to be congratulated.”14 Yet command was his, and responsibility for an army that remained largely supportive of the outgoing McClellan despite eroded confidence among some officers.
Jonathan Letterman now reported to a general who considered himself wholly unfit to lead an army. Burnside had accepted the job so a rival, General Joseph Hooker, couldn’t be offered the promotion. Jovial, fun-loving, quick to make friends, Burnside had a reputation among officers of an immensely likeable fellow devoid of leadership ability. It hardly inspired respect among fellow officers such as Letterman when the general resorted to his favorite expression, “trust to luck.”
Burnside left McClellan’s key senior officers, including Letterman, in place. He needed their experience and leadership, given his lackluster military career of modest accomplishment. He had graduated eighteenth in a class of thirty-eight at the U.S. Military Academy. He had left the army at one point, failed in business, and had turned to McClellan for help in 1858, when McClellan was an executive with the Illinois Central railroad.15 Now Burnside had replaced his friend and relied heavily on his predecessor’s military appointments. “He is a first-rate second-rate man,” wrote one reporter assigned to Burnside’s army.16
Mostly bald, he favored “side car” hair that extended down in front of his ears and spread into giant “mutton chops” that blanketed his checks before tapering and meeting as a moustache. He looked more barber than general, and his unique facial hair gave rise to the term “sideburns.” His soft, puffy face sagged under the unwanted pressure of command. Three days after General Burnside replaced McClellan, according to one observer, “I saw him walking up and down the balcony of the hotel which
he makes his headquarters, in an absorbed, distraught condition, seemingly overwhelmed by the weight of responsibility resting upon him.”17
The snowstorm that had greeted Burnside’s promotion signaled that the early winter window for a major offensive against Lee had grown short. Burnside reorganized his corps into three “grand divisions” and ordered his 115,000-man army to leave Warrenton for Fredericksburg, positioning it to both defend Washington and pose a serious threat to Richmond. Meanwhile, Lee’s 78,000 soldiers were divided about equally between General James Longstreet in Culpeper to defend Richmond and General Stonewall Jackson in the Shenandoah Valley, who looked to attack Burnside’s line of supply.
If Burnside could capture Fredericksburg, it would become an ideal staging area for an attack on Richmond along the route of the Potomac Railroad. It also had rail and water access back to Washington. The army marched from Warrenton on November 16, arriving at the bank of the Rappahannock River across from Fredericksburg three days later. Two months almost to the day after Antietam, the Army of the Potomac was ready to reengage the enemy.
Letterman had used the time to complete his overhaul of his medical department while an exhausted army rested, recovered, and prepared to mobilize. He had addressed what has since become the three cornerstones of battlefield medicine: evacuation, tiered care, and medical supply. Representatives of the Sanitary Commission assigned to the Army of the Potomac were impressed. “In no Department of the Army was the improvement more marked than in the medical service. Dr. Letterman, the Medical Director, with uncommon capacity for organizing his work, had a very high appreciation of the nature of the duties devolving upon him, and showed great energy in insisting that all the details of the service should be thoroughly and faithfully carried out by his subordinates.”18
As civilians fled Fredericksburg, the Army of the Potomac massed on Stafford Heights, a bluff overlooking the Rappahannock’s northern bank, for three days beginning on November 17. The Rappahannock flows northwest to southeast. The town, only five blocks wide, sat on the southern bank. About 900 yards southwest of the town’s western boundary, Marye’s Heights rose nearly 500 feet. It formed the southwestern border of the Rappahannock valley.
For the first time, Burnside experienced some of the logistical frustration that McClellan had endured, when he discovered that he had no way to cross the river. Pontoon bridges failed to arrive as expected, the result of bungled communication, poor leadership, torrential rain, and bridge barges running aground on sandbars. General Henry Halleck, responsible for logistical support as general in chief to the president, had failed to insure that the pontoons arrive on schedule for the Fredericksburg attack. McClellan had thought the brusque, impersonal, and alienating Halleck was the “most hopelessly stupid of all men in high position.”19
While Burnside impatiently waited for the mobile bridges, Letterman prepared for battle. “Ample supplies of medicines, instruments, stimulants, and anesthetics were ordered from New York and Washington. . . . In addition to these supplies, large quantities, over and above what were required for issue, of beef stock, stimulants, dressings, milk, coffee, tea, blankets, and underclothing were ordered and kept on hand. . . . Horses, harness, stretchers, lanterns, and all that was necessary for putting the trains in serviceable order were procured, and officers were assigned, and men detailed to complete and render effective the organization,” he wrote.20
Letterman had been given a few days’ notice to prepare for Antietam. He had been forced to complete much of his planning while on the march. This time he had received several weeks’ notice, which was prolonged further by the delay in the pontoons’ arrival. He also had the benefit of reliable supply lines by rail and water so that large supply depots could be established. He scouted the area and established a division hospital site for each of the eighteen divisions in the army, and he could prepare the 550 medical officers in his command, who were responsible for 254 regiments.21 This time Letterman had enough time to assemble approximately 1,000 ambulances, about one ambulance per hundred men.
But he could not anticipate how General Burnside’s decisions during the battle might change medical needs on the battlefield or allow enemy fire to draw within range of field hospitals. He could not know when enemy fire might intensify in stagnated confrontations, producing unexpected casualties. Then, as counterattacks and breakthroughs unfolded, his medical supply depots could become vulnerable or too remote. There was no way Letterman could fully anticipate the course of a battle that would follow the largest cross-river landing in American military history to that time. Therefore, his pre-battle analysis and planning had to reflect the inevitable chaos of war.
For example, the pontoons’ delay had allowed General Jackson’s 40,000 men to complete a 175-mile march in twelve days to reinforce the 1,000 men defending Fredericksburg. By December 3, Union and Confederate armies were within sight of each other, while Jackson deployed his divisions in town and on ridges overlooking the river. The Army of the Potomac had lost another opportunity to overwhelm the enemy that now had deployed its forces along a seven-mile front.
When the fighting finally resumed, Letterman could be faced with massive casualties during an exposed river crossing. If the crossing proved successful, his medical officers could be confronted by one of the few instances of Civil War urban warfare if the Confederates chose to defend Fredericksburg, house by house. Or, he could face still more casualties if the Confederates defended the town and then fell back to the heavily fortified ridgeline and dared Union troops to cross an open plain.
For three weeks, the Confederates had built their defenses while Letterman planned for various casualty contingencies. The weather turned harsh and cold after five inches of snow fell on December 5. That night “[n]ot a fire could be started or a bed made for our men; but upon a bleak plain, destitute of every comfort . . . our poor men were compelled to remain all night standing in frozen pools, wet through the skin and famishing with hunger,” wrote surgeon Daniel Holt of the 121st New York Regiment.22
On December 9, Burnside announced his battle plan. He assigned General Edwin Sumner 30,000 men in the Right Grand Division to assault Fredericksburg slightly upriver and attack General Longstreet’s men in town and on Marye’s Heights. General William Franklin’s 50,000 troops in the Left Grand Division would cross the river south of town to face General Stonewall Jackson’s men. It represented a wholly expected pincer assault in plain view of the Confederates. The Grand Center Division’s General Joseph Hooker would hold his men in reserve on Stafford Heights. Several officers disagreed with what they considered a predictable strategy.
At 3:00 a.m. on December 11, the battle for Fredericksburg began when Union engineers began assembling the pontoon bridges that had finally arrived. Within minutes sand and shrapnel flew through the air as Confederate artillery blasted the assembly area. Burnside responded by ordering many of his 147 cannons on Stafford Heights to open fire on the town below. Dozens of homes, churches, stores, and stables shuddered and crumbled. Fires spread like an incoming tide. At mid-afternoon, pontoon boats filled with troops crossed the river, the lead elements firing on Confederates dug in along the river bank.
The first urban warfare in America’s history began when Burnside blundered into a trap. As Confederates pulled back, their artillery on Marye’s Heights pounded the Union soldiers as they entered the town a few feet from the river’s edge. In less than twenty minutes, the 20th Massachusetts Regiment lost 97 of 307 men. But by nightfall, most of the pontoon bridges were completed, and the Army of the Potomac had established a small beachhead in Fredericksburg.
On December 12, thousands of Union soldiers crossed into Fredericksburg in a dense fog. They indiscriminately ransacked the town, littering the streets with clothing, broken china, family heirlooms, shattered glass, and furniture. Soldiers searched buildings still standing for caches of food and alcohol. They yanked curtains from their rods to serve as future bandages.
Letterman and Gene
ral Lee had both concluded that the major battle would take place the next day across the open plain between town and the ridgeline of Marye’s Heights. While Lee reinforced his position, Letterman searched the city “for the purpose of examining that part of it . . . to its adaptability for hospital purposes, I found desolation everywhere visible from the effects of the bombardment. . . . Some houses were shattered, others in ruins, and others burned. The courthouse, several churches, and other such buildings as were deemed suitable, were selected. . . . As many hospital wagons as were required were sent over, and the organization of each hospital commenced.”23
A damp, cold fog had settled in the river valley by dawn on December 13. Thousands of men waited. Opposing skirmishers who had been within sight of each other on opposite sides of the river could only hear the movement of the enemy a few hundred yards away. Letterman’s medical officers waited. Each had double-checked his supplies during the night. Letterman knew the battle for Fredericksburg would start near the southern edge of town. At 10:00 a.m., when the fog thinned, General Franklin attacked, committing approximately one-fourth of his troops after misinterpreting vague orders from Burnside.
When General George Meade’s 3,800-soldier force assaulted Prospect Hill nearly three miles south of Fredericksburg, they were met by nearly 40,000 Confederates firing from an elevated and superior position. General Jackson had reinforced his line of defense, massing four men for every linear foot along his line of defense.24 A thundering artillery exchange lasted almost three hours before Meade’s men advanced across a half mile of open ground from the river toward Prospect Hill.
Meade finally drove through a weak spot in the Confederate line, reached a dense forest, and met the Confederates’ second line of defense. There Union elements lost contact with each other, enabling Jackson to counterattack and drive the Union’s advance force back into the open ground by early afternoon. The first phase of Burnside’s battle plan had failed, and the wounded were being carried to hospitals that had been established on farms along the Rappahannock River. In less than four hours, nearly half of Meade’s men were killed, wounded, or missing.25
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