Surgeon In Blue

by Scott McGaugh

  “Cases have come before me where suicides have been committed (and by men of cultivated intellect), for want of means to procure something to eat. They have been unfortunate . . . too proud to beg, too honest to steal, and prefer to die than do either. These are the persons whose wants should be supplied, and in the vast majority of cases all they ask for is ‘work’.” He was more distressed by the plight of many Chinese, the community that the Democrats had reviled in their successful quest to win the 1867 election.

  “I beg to call your attention to these (Chinese) people . . . it is well worthy of your serious consideration, not only from the filthy condition in which they live, the neglect they undergo from their own people when they are sick and can no longer work, but because they are accumulating in our Almshouses and Lunatic Asylums. While they are able to work they are looked after by the companies which have imported them, but when they become sick, imbecile or dangerously insane, they are left to themselves to lie on a piece of matting and die, or discarded by their own countrymen, taken up by the authorities and sent to the Almshouse or Lunatic Asylum. The companies who bring these people here should be compelled to take care of them when they are unable to take care of themselves.”13

  Letterman’s lack of resources had become tiresome for a man who had fought similar battles of professional poverty in the Civil War. “In a city like this, with people from all parts of the world, a great deal of labor devolves upon a Coroner . . . cases involving life depend upon his investigations; and yet he has no office, but must depend upon his own resources and rely on the courtesy of an undertaker to furnish a morgue, or dead-house. A cosmopolitan city like this should have a morgue, where bodies can be preserved (which the ends of justice often require), or until they can be recognized, and where the Coroner can have proper facilities for discharging the important duties devolving upon him.”14

  Anonymous deaths ate at Letterman, perhaps due to his war experience where untold numbers of soldiers—the sons, brothers, and fathers of families afar—were destroyed beyond recognition, never to be individually honored or returned to their shattered families. His report to the supervisors twice sought resources to enable more frequent identification of bodies. A morgue where bodies could be stored would give him more time to identify them. “There is in my mind something exceedingly repugnant in directing a body to be interred and ‘unknown’ marked upon the grave; and yet under the existing state of things in this city, many persons must be thus buried.” Letterman could do nothing in cases of drowning. “No provision is made for the recovery of persons who have been drowned, the Coroner not having the authority to offer a reward for their recovery, or when found to pay the expenses of bringing them ashore. This is all wrong.”15

  Letterman’s advocacy was based on the first 443 cases that came to his attention. One-fourth of them resulted in inquests. Overall, about three in four deaths were nonviolent. The most common causes were an embolism, pneumonia, smallpox, apoplexy, and malnutrition. San Francisco was relatively nonviolent at the time. Letterman listed eleven murders in his first two years in office, compared with thirty-nine cases of suicide.

  He decided to run for reelection in 1869, when the election at the state level would be less contentious than in 1867, but nonetheless would focus on emancipation and the Fifteenth Amendment. The Thirteenth and Fourteen Amendments had been ratified by the states in 1865 and 1868, respectively. Congress passed the Fifteenth, guaranteeing the right of all U.S. citizens to vote without abridgement based on race or color, on February 26, 1869. Its ratification by the states was considered inevitable but seen by some in California as another challenge to controlling the state’s Chinese immigrants. The amendment prohibited states from denying or limiting all citizens’ right to vote.

  Again, both major political parties in the state adopted strident anti-Chinese planks in their 1869 election platforms. They equated constitutionally mandated African American suffrage with potential Chinese naturalization and access to the right to vote. Many political leaders considered the latter a far greater threat to California society. The Chinese, claimed both parties, were at the root of most of what ailed California. Letterman’s party promised to oppose ratification of the Fifteenth Amendment, and took the line that electing Democrats was taking a symbolic stand against Chinese naturalization.

  In early 1869, another party took shape, the Taxpayers Union Party, which railed against government mismanagement, extravagance, and dependence upon the two-party system. The slate of candidates it formed for San Francisco offices included Dr. P. W. Randle, who would run against Letterman for coroner in the fall. Randle was relatively unknown, having served in the 1st California Volunteers as an assistant surgeon in the early days of the Civil War. On September 1, the politics of prejudice prevailed in another Democratic Party victory. Though Letterman’s margin of victory was slimmer than it had been in 1867, he received 54 percent of the votes to Randle’s 46 percent. At the state level, voters returned Governor Haight to office. The Democrats retained control in San Francisco and Sacramento.

  In early 1870, Letterman’s health became a more significant issue. In April 1870, newspapers reported he had suffered a broken leg and was confined to his room. The veteran who had escaped the Civil War unscathed had fractured his femur above the knee on February 21, when he was thrown to the pavement while stepping out of a carriage. Complications ensued, including bleeding in his lungs. He didn’t return to work until July 21, five months later.16 But his declining health could not diminish his reputation or weaken his credentials. In November, the University of California regents established a board of medical examiners to screen students applying to medical school. Letterman, who had spent much of his professional life examining and evaluating military doctors, was elected to the board. The year ended on a sad note when Letterman’s mother, Anna, fell ill on Christmas Eve and three days later died at seventy years of age.

  By 1871, the political and economic climate in San Francisco had shifted. The transcontinental railroad had reached Sacramento, and railroads from Vallejo and Oakland on the east side of the bay to Sacramento had been completed. These new lines drained much of the economic activity away from San Francisco, perched as it was at the end of a peninsula on the west side of the bay. Mining, manufacturing, and agricultural exports now headed east on the railroads instead of being shipped out of San Francisco’s port. When the impact of the transcontinental railroad became evident, a real estate bubble created by wild speculation on the prospects of finding mother lodes of mineral wealth burst. Those who borrowed heavily to purchase overpriced real estate lost their property. Some banks failed. Residents who had invested in mining stocks suffered too. The great tide of gold and silver that had carried San Francisco for years evaporated. The city’s electorate was in the mood for change.

  Letterman again ran for reelection, but the political pendulum had begun to swing against the Democrats. In San Francisco, the Democrat incumbents faced opposition by both the Taxpayers Union and by the Republican Party, two groups that had joined forces in some years and then split in others. In 1871, the Republican candidate for coroner, Dr. W. N. Griswold, withdrew on September 5, throwing his support to Taxpayer candidate J. D. B. Stillman. The Taxpayers Union mounted a vociferous campaign, advocating the abolishment of special-interest commissions.

  Along with other Democratic Party candidates, Letterman was turned aside by the voters. His margin of victory in 1869 was reversed in 1871, when he lost to Stillman by a 54 percent to 46 percent margin. Democrats also lost at the state level, when challenger Newton Booth defeated Governor Haight. Letterman resigned his post as California’s surgeon general when Booth took office on December 8.

  Four days earlier, his term as San Francisco coroner had expired. Letterman turned over the coroner’s office on Market Street that he had been authorized to establish by the County Supervisors eight months earlier, in April. His annual workload as coroner had grown to 660 cases in one year, compared with 443 c
ases the previous two years.17 After four years, and in the span of one week, Jonathan Letterman’s political career ended, and for the most part his career in public service ended. Beginning in 1849, he had spent nineteen of the ensuing twenty-two years as a surgeon, serving either in the army or the city of San Francisco.

  Letterman faced an uncertain and empty future in 1872. Service in the army had become a distant memory, as had the time he had spent with his wife. His daughters lived on the East Coast. A few military and medical friends, a small medical practice, and failing health became his universe. He continued to serve in one state-appointed post, as a Commissioner of Lunacy. The commission inspected the state’s asylums at a time when twice as many Californians were institutionalized as the national average. Overcrowding was common, according to those who inspected them. “Two of these wards, the second and tenth, intended for thirty patients each, now have about eighty each. These wards are poorly ventilated, low, and uncomfortable in the extreme, and should be erased from the face of the earth and the memory of man. They never were fit receptacles for any human being, and have been tolerated altogether too long.” California asylums were utilized to treat the insane as well as for detention of the destitute.18

  After retiring from public service in late 1871, Jonathan Letterman became critically ill on March 13, 1872. He was visited by Dr. S. A. Ferris and then continued to see patients the following two days. But on March 15 he collapsed and was taken to St. Mary’s Hospital. He died later the same day. He was forty-seven years old. Most contemporary newspaper reports indicated Letterman had been in poor health, with what was usually described as a stomach ailment or gastroenteritis. Both were frequent descriptions of chronic dysentery.

  Perhaps out of respect for Letterman’s wife, his funeral was held in St. Mary’s Cathedral near Chinatown, a few blocks inland from the waterfront. A soft breeze floated up from the bay, breaking a days-long hot spell. The towering church had been built twenty-seven years earlier with granite imported from China, New England-minted bricks, local sandstone, and an altar imported from Rome. It was the first cathedral in California. For Letterman’s funeral, the church was filled with civic leaders and members of the California military, according to newspaper reports. Jonathan Letterman was buried next to his wife.19

  Within days of his death, medical and military associations across the country issued proclamations. The California National Guard passed a resolution that summarized Letterman’s legacy: “[W]hile in his death the medical profession loses one of its brightest intellects, his life has not been unfruitful of most important results, our late civil war having afforded the opportunity for the exercise of that rare administrative ability which organized and perfected the ambulance system of the Army of the Potomac, a system deemed worthy of adoption in the armies of Europe, and by which it is believed that the unavoidable concomitant horrors of war are greatly ameliorated.”20

  Some of the most passionate tributes came from military officers who had known Letterman early in their careers. In this encomium quoted earlier, W. W. Loring, who had commanded Letterman at Fort Union, New Mexico, wrote: “I never knew an officer who was all the time more ready to render timely aid to the suffering, whether at the summons of an officer or the call of the private soldier. . . . Socially he was modest and retiring, gentle, almost childlike in his character. No one who had the pleasure of knowing him but formed a very high estimate of his ability, and of his varied experience. . . . From my close intimacy with him, I became aware that he was an ardent student, and no man in his corps sought more earnestly to attain the highest knowledge in the scientific advancement of his profession.”21

  Bennett Clements, one of Letterman’s medical inspectors who rose to become his assistant medical director, wrote a warmhearted memoir of him more than a decade after Letterman died. Its detail and tone indicate Clements and Letterman had forged a friendship beyond their association as medical officers. “The writer of this paper, though honored with the friendship of Dr. Letterman, and intimately associated with him in his administration of the Medical Department of the Army of the Potomac, would gladly have left to abler hands the grateful task of endeavoring the rescue from oblivion the record of his able, faithful, and useful services. But there seemed to be no other one to render to his memory this last office of justice and of friendship; and he presents this memoir, however inadequate it may be, to the Army, to the Medical Profession, and especially to the surviving Medical Officers of the Army of the Potomac, as a tribute due to the memory of a most faithful officer, who devoted his great talents and all his energy to the welfare of the men of that Army, and to the honor of his profession and of his corps.”22

  By the time Letterman died, the army’s medical department bore little resemblance to the massive organization it had become during the Civil War. As the army demobilized following the war, the medical department withered as well. The 65,000 army patients of June 1865 had dwindled to less than 100 the following year. While the army disbanded the ambulance corps, the government sold surplus hospitals, supply depots, and transports. The medical corps similarly shrank to less than 200 officers responsible for nearly 300 garrisons spread across the country as the Indian War era loomed.23

  The army recast the medical department to its earlier militaryoutpost-medicine structure, which Letterman had encountered twenty-three years earlier when he had entered military service. Renewed shortages of medical officers forced the department to rely on contract civilian surgeons to augment the regular army medical corps. Yet some key aspects of military medicine had been fundamentally changed by the wartime experience.

  Letterman’s mentor, Surgeon General William Hammond, had laid the groundwork for what would become the nation’s foremost medical library. He bought medical books and journals for the surgeon general’s library and made sure each regimental surgeon received five of what Hammond considered the most relevant medical texts. In 1864, one of Letterman’s surgeons, John Shaw Billings, had been assigned to the surgeon general’s office, in part to manage a library collection that had grown to more than 2,000 books and periodicals by the close of the war.

  The collection, together with volumes of wartime surgeon and medical officer reports— including those written by Letterman—was critical to another landmark initiative. Hammond’s successor, Joseph K. Barnes, assigned medical officers to compile a comprehensive Medical and Surgical History of the War of the Rebellion. When the first two of six volumes had been published in 1870, they were based on the medical records of more than 200,000 wounded army patients, and relied on much of the library’s 10,000 volumes of reference material.24

  Jonathan Letterman’s daughters, Cassie and Madeline, never returned to San Francisco. Charles Carroll Lee raised his two nieces along with three daughters and two sons in New York City. He rose to prominence as a gynecologist, ultimately serving as the president of the Medical Society of the County of New York. It was a privileged life, in which Letterman’s daughters became young women who mingled with New York City’s most prominent citizens.

  In 1906, Cassie moved her parents’ bodies to Section C in Arlington National Cemetery. The text at the base of her father’s tombstone, a tall white cross, is as concise as Letterman was direct. “Jonathan Letterman. Who brought order and efficiency to the medical service and was the originator of modern methods of medical organization in the armies.” Mary Letterman lies interred next to Jonathan. Her tombstone reads, “Blessed are the dead who died in the Lord.”They lie along a ridge overlooking Washington, DC, the city he helped protect more than forty years earlier.

  Cassie Letterman achieved a fleeting degree of notoriety in the early 1900s, when she became the social secretary for Helen “Nattie”Taft, the wife of President William Taft, in 1910. Nattie had suffered a stroke in 1909 and temporarily lost her ability to speak. Cassie Letterman, Nattie’s daughter, and three sisters managed the First Lady’s affairs until she regained some degree of speech by 1911. In a White House era of f
ormality, musicals, formal dinners, and garden parties, Cassie became known as “Washington’s ‘Chatty Knollys,’” a reference to England’s Queen Alexandra’s personal assistant, Charlotte Knollys, widely known as “Chatty.”25

  When the Taft presidential term ended in 1913, Cassie became director of the American Women’s Club in Berlin. Neither daughter developed a public profile following that posting, and they appeared to remain close throughout their lives. Madeline spent much of her life in Europe. Public records indicate the sisters were residents of New Mexico shortly after World War II and spent the remainder of their lives in the Albuquerque area. In 1957, both were hospitalized at Presbyterian Hospital. Neither left the hospital. Cassie died on October 14, and her sister followed on December 15.26

  Letterman, however, had not been forgotten by the American military. During the Civil War, his bold reorganization prior to Antietam had quickly earned praise ranging from the surgeons at aid stations to Washington politicians. “You can’t imagine how deeply we all are indebted to Letterman for telling us what to do, and showing us how to do it,” volunteer surgeon Sam Holman told Letterman’s assistant medical director and memoirist, Bennett Clements. Within months of taking medical command of the Army of the Potomac, the nation’s military medical corps recognized the ramifications of his administrative genius. “How thoroughly Dr. Letterman performs his duties, may be in part judged from the important orders emanating from him. . . . His reorganization of the field hospital and ambulance corps is a signal proof of his ability and fitness to credibly fill his position. . . . In a quiet, unobtrusive way, with that modesty that is indicative of true greatness, Dr. Letterman has done, and is doing much to place the medical department of the Army of the Potomac on a footing that will challenge the admiration of the country. In this important work he has the countenance and hearty co-operation of the energetic surgeon-general. We trust that through their influence Congress will remove the clogs that prevent the medical department of our army from accomplishing all the good that it is capable of,” wrote a reporter for the Medical and Surgical Reporter. 27