Surgeon In Blue

by Scott McGaugh

They met with the president at the behest of two of Burnside’s major generals, William Franklin and William Smith. Other members of Burnside’s most senior officers shared the sentiments of Franklin and Smith. Lincoln now faced open revolt in a critical army. He summoned Burnside to the White House where, on New Year’s Eve, Burnside learned of the internal attack against him. Appalled and angered, he leveled accusations of his own, claiming that Secretary of War Stanton and General in Chief Halleck had lost the confidence of the nation. Burnside then offered his resignation.

  On January 1, Lincoln refused to accept it, so Burnside returned to his army’s headquarters to plan a midwinter assault against the Confederates that became known as the “Mud March.”The short-lived January 20 advance came at a time when the Army of the Potomac was suffering from significant desertions, increasing illness, and dismal living conditions. On January 25, the president finally took action. He fired Burnside and appointed the Army of the Potomac’s third commanding officer, Joseph Hooker.

  Hooker had fought in the Mexican War and subsequently built an undistinguished record in California, where he became better known for a lifestyle that included varying degrees of drinking, fine food, prostitutes, and gambling. He had fought in the Peninsula Campaign and at Antietam and Fredericksburg, so Letterman was familiar with his new commanding officer. Hooker was cocky, likable, and immensely popular with the troops. He had lobbied for the job earlier and had been openly critical of Burnside, saying he had a brain the size of a hickory nut.1 Lincoln reluctantly chose Hooker regardless. Politically, he could not return McClellan to command, and other senior generals in the Army of the Potomac had not distinguished themselves in battle. Hooker would have to suffice in the depth of the Virginia winter.

  When Hooker took charge, Letterman was “engaged in the details of the organization which I had instituted the previous autumn, carrying out measures for improving the health of the Army— such as those regarding the location and police of the camps, the food, cooking, and police of the men; the reestablishment of regimental hospitals, etc.”2 For the time being, he could set aside the continuing refinement of battlefield care that he had organized. Fredericksburg validated the Letterman system. Though the system was Letterman’s achievement, it had been built in part on the work of French surgeons more than sixty years before and of Union army surgeons under Ulysses S. Grant earlier in 1862.

  Napoleon’s chief surgeon, Dominique-Jean Larrey, developed the “flying ambulance” concept in which battlefield evacuation personnel followed advancing troops into battle. The tactical organization resembled the artillery supporting an army’s lead infantry. In 1797, during a campaign in Italy, Larrey assembled more than 300 men that he divided into three medical divisions in support of frontline troops. About the same time, another French surgeon developed the concept of training stretcher bearers and moving them forward with troops to speed the evacuation of the wounded. Medical proximity and mobility were already becoming part of the battlefield. More than half a century later, in 1862, three Union physicians in General Grant’s army, John Brinton, Henry Hewitt, and Bernard Irwin, began to redefine the roles of American battlefield hospitals.3

  In February 1862, at the battle for Fort Donelson on the Cumberland River in Tennessee, Brinton (as acting director of the Department of Cairo) and General Grant’s acting medical director, Hewitt, directed regimental medical officers to set up aid stations at the edge of the battlefield, and they established ambulance depots about one hundred yards away (but still within the enemy’s artillery range). The two men had recognized the need to create more organizational structure in the medical department during battle. Their approach became an embryonic version of tiered battlefield medical care.

  Two months later, at the Battle of Shiloh near Savannah, Tennessee, the resourceful Bernard Irwin served as medical director of General William Nelson’s division in the Army of Ohio. At thirty-one years of age, Irwin had already garnered national notoriety. A year earlier he had received the Medal of Honor for his part in leading reinforcements to rescue outnumbered Union troops that were surrounded by Indians in a remote mountain pass in the Southwest.

  The Confederates attacked Grant in early April and pushed his army two miles back to the Tennessee River. He left wounded soldiers and regiment tents in his wake. After reinforcements from the Army of the Ohio arrived during the night, Grant counterattacked the following day and drove the enemy back from ground and tents it had captured the day before.

  Irwin recognized Grant’s advance as a medical opportunity for treating more than 8,000 wounded men. He seized abandoned tents and organized them into a fledgling field hospital. Irwin commandeered enough tents to house 2,500 wounded soldiers. Creating the first field hospital entirely comprised of tents, he organized it in sections of 125 beds, with each section divided into four wards. Although it lacked substantial postoperative care, Irwin’s plan provided more comprehensive treatment for Grant’s wounded closer to the battlefield than had been seen before. In many ways, it became a precursor to Letterman’s field hospital organization at Antietam six months later.4

  While Irwin stayed in the field, in May 1862 Surgeon General William Hammond had summoned Brinton and Letterman to his office in Washington to become part of his new team of medical inspectors, examiners, and bureaucratic administrators. Hammond had read the Shiloh medical reports written by Irwin. In addition, Brinton likely had discussed his aid station concept with both Letterman and Hammond in the month that he and Letterman spent together in Washington before the latter received orders for the Army of the Potomac in early July.

  Brinton remained in Washington to begin a massive research and documentation project that would become the Medical & Surgical History of the War of the Rebellion. He also served on a medical examining board that reviewed the qualifications of volunteer surgeons. When the examiners rejected too many at first, Secretary of War Stanton threatened Brinton and his colleagues with elimination of the board unless they lowered their standards and accepted more volunteer doctors. More medical volunteers were soon entering the service.5

  So, when Letterman had forged a battlefield evacuation and hospitalization system in his first six months as medical director of the Army of the Potomac, it was partly based on the work of Irwin and Brinton. Letterman’s system had been tested by more than 24,000 casualties in two of the most brutal battles of the Civil War, which took place less than ninety days apart. Now, once those wounded in battle were treated and transferred to hospitals in the North, midwinter disease, diet, and sanitation became Letterman’s enemies.

  As Hooker disbanded Burnside’s “grand division” organization of the Army of the Potomac and returned to a corpsbased structure, Letterman also focused on organization as well as communication and accountability. In October, he had created a medical examination board of three doctors that investigated allegations of physician incompetence, and he reactivated it now. The board quickly confirmed a number of instances of bad medical care.

  Also in January, assistant surgeon Warren Webster became medical inspector of the army at Letterman’s request. Webster had graduated from Harvard’s medical school two years earlier. Only twenty-seven years old, Webster had been ordered to build hospitals in Washington shortly after the outbreak of the Civil War. He probably had gotten to know Letterman when Letterman served briefly on Surgeon General Hammond’s Washington staff.

  Webster supervised the corps medical directors who in turn appointed medical inspectors. In this way, Letterman established a chain of enforcement and accountability that extended from his office at the Army of the Potomac’s headquarters through the entire army as it expanded to nearly 120,000 men with the addition of fifty-six new regiments.

  Every wave of new regiments posed health problems for Letterman, particularly in the middle of winter. Venereal disease was particularly prevalent among new arrivals. Letterman established a venereal disease hospital in Washington and “hoped the result of treatment would be valuable to
science, and more easily obtained than from scattered records of the various hospitals through the country.”6

  Both Letterman and Hooker shared the belief that good food led to improved troop health and morale. The common soldier diet of salt pork boiled in bacon grease and beans weakened the men and allowed scurvy to take hold. If not strictly supervised and held accountable, commissary officers might not promptly distribute perishable supplies such as potatoes while soldiers might continue unhealthy food preparation habits such as rolling rice, beans, and flour into a ball before boiling the concoction in grease.

  Letterman wasted no time in asking his new commanding officer to issue new diet regulations. Within days of his promotion to command in late January, Hooker endorsed Letterman’s two-pronged attack against malnourishment by holding commissary officers and soldiers accountable for food distribution and preparation. On February 3, Letterman told his medical directors that potatoes should be issued three times a week, onions twice a week, and bread as often as possible. He ordered them to assess the availability of fresh vegetables in their weekly reports. Although the medical directors could not require the improved diet, a reporting mechanism now was in place. Four days later, Hooker ordered his chief commissary officer, Colonel Henry Clarke, to report when and why fresh vegetables were not being issued. With monitoring and accountability established by Hooker and Letterman, vegetable distribution improved and pilferage along the route of distribution declined. The health and morale of the troops improved. In the month following Letterman’s dietary improvements, he noted that cases of diarrhea declined by 32 percent in February and typhoid fevers decreased by 28 percent.7

  Meanwhile, Letterman began to focus on the sanitary conditions of an army encamped across twenty miles along the Rappahannock River. As dozens of new regiments arrived, the Army of the Potomac remained officially classified as on active duty. As a result, permanent winter living quarters were not built. The army maintained a state of readiness in the snowbound Virginia countryside with too few tents and too many makeshift huts. For sleeping quarters, soldiers often dug a wide, shallow pit in the near-frozen mud, erected primitive side walls of scavenged pine logs, and covered the top with canvas or mud mixed with brush.

  A massive supply depot at Aquia Creek furnished the more than 100,000 men with approximately 700 tons of food daily as well as 800 tons of forage daily for horses.8 Regardless, the soldiers’ living conditions in thousands of these crude huts with dangerous fireplaces, the scarcity of firewood, and the dearth of basic supplies worried Letterman.

  The apparent indifference of many regimental officers’ to squalid conditions also dismayed Letterman. On March 9, he issued housing orders, requiring soldiers to move out of temporary tents into better-built structures and transferring the soldiers who were living in muddy dugouts to more permanent huts. He also required that new huts’ roofs be removed twice a week and that bedding be hung outdoors daily, weather permitting. Letterman knew that ventilation had been proven critical to the troops’ health. The overall illness rate following his orders declined to about 8 percent.9

  Corps medical inspectors submitted weekly reports of their inspections to their corps commanders, who in turn submitted monthly summaries to the corps medical directors. That single reorganization placed senior line officers in the middle of the medical department’s preventive health and sanitation communication chain. No one could claim ignorance. Letterman tolerated no deviation from the reporting forms he devised. Uniformity was integral to accountability.

  He subscribed to the “you get what you inspect” school of military command when he wrote, “It cannot be too strongly impressed upon your attention that the object of these inspections is to secure reliable information as to the actual condition of the Medical Department of this Army, and to bring to notice all errors, neglects, deficiencies, and wants of every kind; to bring to notice also the cases of prompt and intelligent attention to duty, and of earnest endeavor to promote the best interests of the service; to bring to light the good as well as the bad.”10

  His new standards did encounter resistance. Many line officers did not hold medical officers in high regard, regardless of the medical officers’ rank. Many perceived the medical department as secondary to the fighting units. Some line officers apparently resented a more regimented preventive health program. Though the new medical department regulations written by Letterman carried the signature of General Hooker, in some cases line officers simply ignored them.

  In one of the rare instances where Letterman revealed his anger, he wrote, “It is a popular delusion that the highest duties of Medical officers are performed in prescribing a drug or amputating a limb . . . it is a matter of surprise that such prejudice should exist in this enlightened age . . . and were it well if commanding officers would disabuse their minds of it, and permit our armies to profit more fully by the beneficial advice of those who, for years, have made the laws of life a study.”11

  By April the health of Hooker’s army had improved considerably. In a written report to Hooker, Letterman’s outlined the reasons for the improvement. “This favorable state of the health of the army, and the decrease in the severity of the cases of disease, is in great measure to be attributed to the improvement in the diet of the men, commenced about the first of February by the issue of fresh bread and fresh vegetables, which has caused the disappearance of the symptoms of scurvy that in January began to assume a serious aspect throughout the army; to the increased attention to sanitary regulations; to the more general practice of cooking by companies; and to the zeal and energy displayed by the medical officers of the corps.”12

  Improved morale fueled Hooker’s confidence in an army that had increased to twice the size of General Lee’s force a few miles away on the other side of the Rappahannock, near Fredericksburg. Letterman was proud of what had been accomplished. “I have necessarily impressed upon all officers of this department, the primary importance of carrying into effect sanitary measures to prevent sickness, and my directions and suggestions have been carried out with an intelligence and zeal which it affords me great satisfaction to bring to the notice of the Commanding general,” he wrote.13

  As Hooker prepared his battle plan for the coming combat season, Letterman inadvertently found himself at the center of a national controversy. An officer in Surgeon General Hammond’s office mistakenly allowed a reporter from the Washington Morning Chronicle to read one of Letterman’s reports. From Letterman’s detailed sickness rates, General Lee calculated the size and organization of Hooker’s army, less than a month before what would become the Battle of Chancellorsville. Lee estimated Hooker’s total strength at 159,000 men. Hooker later said his intelligence officer would have paid $1,000 for similar information about Lee’s troop strength.

  By mid-April, Letterman knew that the fighting would begin within a few weeks. Hooker planned to march a major force west-northwest along the Rappahannock, flanking Lee’s left. His men would then turn south and cross the Rappahannock and Rapidan Rivers, work their way through the rugged area called the “Wilderness,” and take control of key transportation routes near Chancellorsville to cut Lee’s army off from Richmond.

  A smaller force would again attack at Fredericksburg, but only as a diversionary tactic. Unlike Burnside, who had concentrated his men around Fredericksburg, Hooker planned to attack on two fronts, ten miles apart, posing new challenges for Letterman and his medical department. In Letterman’s battlefield experience, both Antietam and especially Fredericksburg had been relatively concentrated battles.

  However, experience and advance notice enabled Letterman to be far better prepared for the huge numbers of wounded such a battle likely would produce. He established hospitals along the railroad route from Fredericksburg to the Aquia Landing depot. He organized them by division and corps, reflecting Letterman’s belief that wounded men fared better when hospitalized with men from the same unit. He concentrated the hospitals so that a single supply officer could be ass
igned to all of them. Efficiency, too, was a priority for him.

  The imminent battle would be the first time Letterman had the time to prepare adequately for the specific location and expected course of fighting. Perhaps because of this, he appeared confident in his department’s ability to handle the coming casualties. He telegraphed Hammond and requested that civilian surgeons be barred from the battlefield. He also required Sanitary Commission agents with supplies to travel with the medical department and not act independently of his staff.

  Now a combat veteran, on April 27, Letterman issued a number of orders to his medical department in anticipation of the renewed fighting. Among them, he required detailed information on available troop strength. He also notified his officers that he expected action reports during battle. Previously he had designated medical record keepers, made it clear what he expected of them, and noted he didn’t care if the reporting system was cumbersome or intrusive. “The knowledge which the officers of this department have had, and may yet have opportunities of gathering, is of such a character and of such an extent as will, when made known, go far toward filling the hiatus which now exists in that branch of the science in which we are now engaged—that of military surgery,” he wrote.14

  Also on April 27, many of Hooker’s officers learned the march toward the enemy would begin the following day. As rain pelted orchards of blooming peach and cherry trees and then slackened on April 28, the Army of the Potomac began skirting the enemy. Confederate lookouts in Fredericksburg rang church bells when they spotted tens of thousands of men on the far side of the river heading toward the west. Although General Sedgwick remained across the river from Fredericksburg with two corps, Hooker had no intention of suicidal front assaults against Lee. Hooker’s rested men prepared to engage Lee at a time and place of Hooker’s choosing. It would be up to Letterman’s medical department to keep up.