Despite Letterman’s lack of respect for civilian doctors and confidence in Janes, he asked Surgeon General Hammond in mid-July to send twenty volunteer civilian surgeons to Gettysburg to support the 106 surgeons Letterman had left behind. In his official Gettysburg report, Letterman noted, “No reliance can be placed on surgeons from the civil life during or after a battle. They cannot or will not submit to the privations and discomforts which are necessary, and the great majority think more of their own personal comfort than they do the wounded. Little more can be said of those officers who have for a long period been in the hospitals.”29 Regardless, nearly two weeks after the fight Letterman knew his medical officers needed help at Gettysburg.
They also needed more ambulances. Letterman had left six ambulances and four wagons per corps at Gettysburg when his medical department left with the rest of the army on July 6. That quantity proved to be horribly inadequate, as thousands of wounded had to be transported to consolidated hospitals and then to the railroad depot for evacuation to larger cities.
Evacuation of patients who could stand the trip to Philadelphia, Baltimore, and other cities on the railroad network that had been repaired in the week following battle became a top priority. Soon 800 men a day were being loaded into railroad cars for the trip from various field hospitals to Philadelphia-area hospitals and others in the region. The trip could be as long as 150 miles, depending upon a wounded man’s final destination. Each train had a medical officer in charge, along with a bevy of relief agency representatives who distributed bed pans, urinals, and water to the wounded, who typically sat or lay on straw. Janes’s problem became finding enough ambulances to get the wounded to the railroad.
Not everyone could be evacuated, however, as the fighting at Gettysburg had produced a higher-than-average number of casualties with serious wounds. Thousands could not be left for an extended period of time in muddy barns that reeked of manure and torn flesh. Those requiring intensive care needed to be consolidated in a central general hospital that didn’t yet exist. On July 4, Letterman had ordered that a general hospital be built among the ruins of the battlefield.
Janes authorized an elevated eighty-acre knoll with a nearby timber lot for the new hospital. Located about a mile-and-ahalf east of Gettysburg on the George Wolf farm along the York Pike, sat about 500 feet from a railroad line. The site was an ideal location, regularly swept by a gentle, prevailing breeze, supplied by a reliable spring, and protected by natural drainage with an adequate supply of nearby firewood.
Janes organized the hospital as logically as a military outpost. Six rows totaling approximately 100 patient tents were laid out on a precise imaginary grid, separated by paths of wagon width. The cookhouse and bakery were built off to one side, near the spring. On the downwind side, there was a long latrine ditch, graveyard, and dead house for embalmers.30 Living quarters for officers and the enlisted completed the layout. Construction began on July 10, four days after Letterman had departed. In honor of the Army of the Potomac’s medical director, the largest military general hospital built on the battlefield to date was named Camp Letterman.
Shortly after Camp Letterman opened on July 22, more than 16,000 men had been evacuated from the region. That left about 5,000 seriously wounded patients, most of them suffering from penetration wounds to the head, chest, abdomen, and pelvis, as well as serious fractures. The central purpose of Camp Letterman was to get patients “train ready” as quickly as possible for convalescence in permanent hospitals elsewhere. By the end of the month, Janes’s staff closed the remaining Gettysburg hospitals located in the seminary, high school, and railroad office and transferred those patients to Camp Letterman.
In the three weeks following the fighting at Gettysburg, critics of Letterman’s post-battle medical plan emerged. Despite Letterman’s need to take most of his medical department with Meade in pursuit of Lee, some felt Letterman’s ambulance-and-wagon allocation per corps and the approximately 100 surgeons he left behind at Gettysburg were woefully inadequate for more than 14,000 wounded Union soldiers, plus thousands of wounded Confederates. Gettysburg produced more wounded than had Antietam, Fredericksburg, or Chancellorsville.
In response to some of the critics, Secretary of War Stanton sent Surgeon General Hammond on an inspection trip to Gettysburg. Hammond blamed the shortage of medical supplies on General Meade, noting that General Hooker also had reduced Letterman’s medical transportation at Chancellorsville as well. “I cannot but attribute a considerable amount of the suffering at Gettysburg to this cause,” wrote Hammond.31
At about the same time as his Gettysburg visit, Hammond transferred the responsibility for Gettysburg hospitals from Letterman to the Department of the Susquehanna’s medical director, W. S. King, and directed King to close all Gettysburg hospitals as soon as practical. King had geographic responsibility for the Gettysburg area. With the majority of those moderately wounded at Gettysburg having been sent to cities elsewhere by late July, Letterman no longer determined how the most seriously wounded would be treated in his namesake hospital. Camp Letterman would operate until November 1863.32
Although Letterman remained unapologetic for the numbers of surgeons and ambulances he had left at Gettysburg, on July 29 he sent one of his surgeons back to Gettysburg to assess the situation in the face of continuing criticism. Some army hospital inspectors had sided with Letterman’s post-battle allocation of surgeons and wagons because another confrontation with Lee was expected. Others decried the suffering for lack of adequate shelter, prompt medical attention, and supplies. Letterman’s inspector generally gave the situation passing marks, but reported that the need for tents remained.33
For several weeks, Meade’s march across western Maryland almost parallel to Lee’s retreat toward Virginia had resulted in a few skirmishes and modest casualties. That had given Letterman time to reorganize and resupply his medical department, and he believed he had prepared it for another battle of comparable intensity to the Battle of Gettysburg. He had received an additional fifty surgeons after leaving one-sixth of his surgeons behind to treat the wounded at Gettysburg. He had also taken receipt of 500 tents as rumors swirled that Meade was about to catch Lee and force another confrontation.
By the end of July, Lee’s army had encamped near the Rapidan River. A few miles away Meade’s Army of the Potomac had reached the Rappahannock River, a little more than a mile north of the Rapidan. Meade had pushed his army hard, sometimes through heavy rains that turned gear and clothing moldy. By July 28, some men had marched more than 400 miles in the previous forty-two days, and now suffered from a lack of shoes and stockings.34 The sultry Virginia summer heat sapped both energy and spirit. As some regiments’ enlistment obligations were met and soldiers sent home, dozens more arrived to replace them. Meanwhile, part of Lee’s Army of Northern Virginia was transferred to the fighting in the western theater. Neither Lee nor Meade had the means or strategic advantage to reengage.
August became an opportunity for Letterman to complete his vision of how a wounded soldier should be treated when he fell on the battlefield. In less than two years he had organized an ambulances corps on the battlefield. He had instituted a more comprehensive, tiered hospital system. He had elevated preventive medicine to a priority that became the responsibility of line officers. Systemization and accountability had been the cornerstones of each milestone. It became time to instill greater accountability and a true sense of military organization within the fledgling ambulance corps. Military discipline had to be as fully inculcated into the medical department as it was in the army’s cavalry or artillery.
The logic of Letterman’s next phase of reorganization in battlefield medicine appealed to Meade, the former civil engineer. On August 24, 1863, General Meade issued General Orders, No. 85, written by Letterman. The mandate overlaid military organization onto the Army of the Potomac’s ambulance system. A captain became responsible for the entire ambulance corps; a first lieutenant in charge of each division’s ambulance
allotment; a second lieutenant responsible in each brigade; and a sergeant became responsible in each regiment.
The new regulations delineated the duties of each to avoid any miscommunication and assign responsibility. The captain became responsible for the condition of the entire corps’ ambulances. He was required to conduct training drills that included the proper way to pick up a wounded man and place him in the standard two-wheel ambulance. The captain ensured ambulances were not used for any other purpose, including those dictated by the whims of line officers. Letterman also required weekly and monthly inspection reports, as well as reports following every battle.
The first lieutenant at the division level became an acting quartermaster. He issued his ambulances by receipt, and commanded a staff that included a blacksmith with a cavalry forge and saddler. In one stroke, Letterman had eliminated much of his medical department’s dependence on the army’s quartermaster. He also had taken the logistical management of ambulances out of the hands of his medical officers and placed it in the hands of officers solely responsible for those ambulances.
The order also required two medical officers and two assistants to accompany each division’s ambulances when on the march. Their job was to make sure only the sick and wounded rode in ambulances and that line officers did not appropriate the ambulances for other purposes. When in camp, the order also established stable standards for the ambulance horses and set specific requirements for ambulance maintenance.
Letterman considered recognition of newly elevated corps vital. This, in part, required an ambulance corps insignia, and Meade’s order also established a specific insignia for ambulance corps sergeants and privates. “This corps will be designated for sergeants, by a green band, one and a quarter inches broad, around the cap, and chevrons of the same material, with the point toward the shoulder, on each arm above the elbow. For privates, by a band, the same as for sergeants, around the cap, and a half chevron of the same material on each arm above the elbow.”35
Letterman went one step further. He purchased red, white, and blue flags consistent with each division’s flag to be displayed at the front of each division’s ambulance train. Division medical officers received unique flags as well. His ambulance corps now had clearly designated and largely independent authority, standards of accountability, and a unified organization. But as Letterman’s ongoing reorganization of the medical corps neared completion, Letterman’s longtime mentor, William Hammond, was losing his grip on the surgeon general’s post. Hammond’s fate could greatly influence whether key appointees such as Letterman, who also often were his friends, would keep their jobs.
William Hammond had been the maverick at the top of the army’s medical department who had been necessary for Jonathan Letterman to implement his organizational initiatives. Hammond’s path to the surgeon general’s post had been marked by scientific inquiry, robust self confidence, a proclivity to question military authority and medical tradition, and the strong support of the medical officers he trusted.
In 1854, when Hammond was stationed in Kansas, he and other military outpost officers became involved in a real estate development scheme in anticipation of the territory becoming a state and the capital being established nearby. When irregularities surfaced and an investigation ensued, Hammond’s testimony in part led to a senior officer being discharged from the army. Hammond also testified against the territorial governor, Andrew Reeder. Although Reeder was proslavery and Hammond owned slaves when stationed in Kansas, Reeder never forgave Hammond for his testimony.
Following Hammond’s appointment as surgeon general in April 1862, largely due to the political strength of the Sanitary Commission, he and Secretary of War Edwin Stanton quickly grew to dislike each other. Stanton felt the Sanitary Commission unnecessarily meddled in medical department affairs, including its campaign to get Hammond appointed surgeon general over a number of more senior medical officers. Stanton resented Hammond’s ego and grand self-image. Many Washington politicos considered Stanton opinionated, stubborn, intent, focused, and vengeful. He often felt he was superior to others in the room. He could be openly disrespectful of the president when he disagreed with Lincoln’s position or a member of his administration. Given Stanton’s combative personality, a confrontation with Hammond became inevitable.
The feud between the two had been developing for more than a year when Stanton launched a campaign in July 1863 to discredit and fire Hammond. He appointed a committee to look into Hammond’s medical department affairs, and stacked it with Hammond critics. He found his opening for the campaign after decisions by the surgeon general had generated critics on the battlefield as well as in Washington.
On May 4, 1863, Hammond had banned the routine use of two cathartics, calomel and tartar emetic, by army surgeons. Hammond and many educated physicians were concerned with the dangers of calomel, which contained mercurous chloride, as well as tartar emetic, which contained antimony and potassium. Concentrations of mercury could cause extreme salivation and facial ulcers that could leave patients horrifically and permanently disfigured. The heavy use of these drugs produced massive diarrhea and vomiting as part of “heroic treatment” used by many doctors who believed it necessary to balance a patient’s system. Hammond did not believe in the heroic treatment philosophy, considering it ill-advised and potentially dangerous. Many military surgeons, however, vehemently disagreed with the surgeon general, and some sought non-military sources for the cathartics so they could continue treating sick soldiers the way they saw fit. Hammond’s order cost him allies within the medical department, and the American Medical Association criticized Hammond’s order.36
Stanton named Andrew Reeder from Kansas to head the three-man investigative committee, the same Reeder who had been damaged politically by Hammond’s real estate trial testimony more than eighteen years earlier. Reeder’s goal became clear, according to a close friend, Samuel Gross, who wrote in his autobiography: “Andrew Reeder was employed to collect testimony in this city by the examination of witnesses against the late Surgeon-General (Hammond) and I have never saw a man who entered more eagerly upon the discharge of his duties of his office. His object was to revenge himself upon his Kansas enemy.”37
One of the investigators assigned to the committee was Silas Swetland who earlier had lobbied Hammond for an appointment as a liquor inspector. Despite Swetland’s endorsement by several Congressmen, Hammond declined, noting he saw no need for a liquor inspector in his medical department. Now Swetland’s job was to find misconduct, negligence, or incompetence by Hammond. Toward that end, Stanton also asked for every medical report from every medical director, dating back to the start of the Civil War.
Stanton wanted Hammond out of Washington and out of reach of his political allies in the early months of his committee’s investigation. So, in August, he sent Hammond on an inspection tour of military posts in the West and as far south as New Orleans, a tour that Stanton had declined to authorize earlier.
That same month, Stanton promoted army surgeon Joseph K. Barnes to inspector general, replacing a beleaguered Thomas Perley, who had criticized Letterman after Fredericksburg but ultimately had proven to be poorly suited as inspector general. Barnes and Stanton were particularly close. Barnes had served as Stanton’s personal physician for more than a year, as Stanton suffered from a variety of maladies, including congestive heart failure, asthma, and liver problems. Their wives vacationed together.38 With Stanton as his political patron, Barnes became a potential candidate to replace Hammond as surgeon general. As Stanton positioned his political allies, Hammond remained confident that nothing substantial would come out of the investigation.
By his actions and in his reports to superiors, Letterman had demonstrated an analytical mind and a keen awareness of what transpired around him. He had seized the initiative when the opportunity for reform presented itself. A self-reliant man, he had been quick to praise professional medical officers who were reliable, required minimal oversight, and had the conf
idence to make critical decisions under fire. An inner resolve had surfaced in his style of leadership that bore little regard for ego or hurt feelings. Yet he remained a privately emotional man, and the human carnage of war placed an exhausting burden on the man responsible for an army’s survival. While the bulk of Letterman’s personal correspondence from the war no longer exists, the handful of photographs of him taken in the war reveal a man who aged markedly in less than three years, as heavy dark rings developed under his eyes, casting a somber pall across his face.
In four battles, he and his medical corps had been confronted by more than 60,000 casualties, likely the most faced by any single army medical director to that time.39 Thirty-eight years old and never married, he had served in the military for more than a third of his life. He had been stationed in the swamps of Florida, among the red mesas of Arizona, and in Pennsylvania farm country where a man fell wounded every six seconds over twenty-four hours’ total fighting. Now, with characteristic personal reserve, Jonathan Letterman made private plans far from the battlefield.
9
VALIDATION
“Little more remained to be done.”
Between some of the Civil War’s bloodiest and most horrific battles, Jonathan Letterman had fallen in love. He had met Mary Digges Lee when her brother, Dr. Charles Carroll Lee, took Letterman to the Lees’ Maryland home near Burkittsville on October 8, 1862, following the Battle of Antietam. Lee had entered the Civil War an assistant surgeon with the 1st Maryland Cavalry, which had been attached to the Army of the Potomac.
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