Dr. Jonathan Letterman was the Medical Director of the Army of the Potomac at the time of the Battle of Gettysburg. At the time, Letterman had only been in his position for a year but had instituted sweeping changes in the way the Army took care of the wounded. Letterman established the Army’s ambulance service, established field hospitals, aid stations, and an efficient medical supply system He also designed the first triage procedures used by the Army to evaluate the wounded. Medical care and survival rates improved dramatically under his leadership, and many of his procedures and concepts are still used today in battlefield medicine.
Letterman’s procedures were put to the test at the Battle of Gettysburg and its aftermath. There were over 14,500 Union wounded when the fighting was over, and some of the over 18,000 Confederate wounded had fallen into Union hands. Those numbers would overwhelm any system, but under Letterman’s procedures, the care of the wounded was much more organized and effective than it had been a year earlier, resulting in more lives saved.
In his official report on the Army of the Potomac’s medical department’s performance at the Battle of Gettysburg and its aftermath, Letterman criticized some decisions by army commanders that he believed inhibited his department’s effectiveness, praised the actions and efforts of the army’s medical personnel, and dismissed civilian doctors who volunteered to help as virtually worthless. Here’s Dr. Jonathan Letterman’s refreshingly blunt and honest assessment of the army medical department at Gettysburg.
HEADQUARTERS ARMY OF THE POTOMAC,
MEDICAL DIRECTOR’S OFFICE,
Camp near Culpeper Court-House, Va., October 3, 1863.
GENERAL: I have the honor to submit the following report on the operations of the medical department of this army at the battle of Gettysburg, July 1, 2, and 3:
As the subject of transportation has an important bearing upon the manner in which the wounded are attended to after a battle, it is necessary to make some allusion to the manner in which this department was supplied. It is scarcely necessary to say that if-the transportation is not sufficient to enable the officers of the department to conduct it properly, the effect must fall upon the wounded.
In the autumn of 1862, I investigated the subject very carefully, with the view to the adoption of some system instead of the irregular method and want of system which prior to that time was in vogue, to limit the amount necessary, and to have that amount always available. The transportation was one wagon to each regiment and one to each brigade. This gave all that was required, and it was not too much; and, it may be remarked, was a reduction of nearly one-half of that which had been in use prior to that time. This system worked well. At the battle of Chancellorsville, the department had upon the left bank of the Rappahannock means sufficient, had it been allowed to use them, for taking care of many more wounded than there came under its control.
On June 19, while the army was on the march, as it were, from before Fredericksburg to some unknown point north of the Potomac River, the headquarters being near Fairfax Court-House, Va., the transportation of the department was cut down by Major-General Hooker on an average of two wagons in a brigade, in opposition to my opinion, expressed verbally and in writing. This reduction necessitated the turning in of a large portion of the supplies, tents, &c., which were necessary for the proper care of the wounded in the event of a battle. Three wagons were assigned to a brigade of 1,500 men, doing away with regimental wagons. This method in its practical working is no system at all, as it is liable to constant changes, and proved to be, what I supposed at the time it would be, a failure to give the department the means necessary to conduct its operations.
The headquarters left Fairfax Court-House on June 26 ultimo, for some point as yet unknown in Maryland or Pennsylvania.
On the 25th of that month, I directed Assistant Surgeon [Jeremiah B.] Brinton, U.S. Army, to proceed to Washington, and obtain the supplies I had ordered the medical purveyor to have put up, and there await orders.
On the 26th, he was ordered to proceed with them to Frederick. This step was taken to obviate the want of supplies consequent upon the reduction of transportation. At this date it was not known that the army would be near Frederick; still, the risk had to be run, and the event justified the order, Dr. Brinton arriving at Frederick on June 28, the day after the arrival of headquarters there, with twenty-five army wagon loads of such supplies as would be most required in case of a battle. The train with these supplies followed that of headquarters until we reached Taneytown.
On July 1, the trains were not permitted to go farther, and, on the 2d, were ordered farther to the rear, near Westminster.
On the 1st, it was ordered that “corps commanders and the commander of the Artillery Reserve will at once send to the rear all their trains (excepting ammunition wagons and ambulances), parking them between Union Mills and Westminster.”
On the 2d, these trains were ordered still farther to the rear, and parked near Westminster, nearly 25 miles distant from the battlefield. The effect of this order was to deprive the department almost wholly of the means for taking care of the wounded until the result of the engagement of the 2d and 3d was fully known. I do not instance the effect of this order, excepting to show the influence of it upon the department. The expediency of the order I, of course, do not pretend to question, but its effect was to deprive this department of the appliances necessary for the proper care of the wounded, without which it is as impossible to have them properly attended to as it is to fight a battle without ammunition. In most of the corps the wagons exclusively used for medicines moved with the ambulances, so that the medical officers had a sufficient supply of dressings, chloroform, and such articles until the supplies came up, but the tents and other appliances, which are as necessary, were not available until July 5.
The supply of Dr. Brinton reached the field on the evening of July 4. This supply, together with the supplies ordered by me on July 5 and 6, gave more than was required. The reports of Dr. Brinton and Dr. [John H.] Taylor show that I ordered more supplies than were used up to the 18th of July, when the hospitals were taken from under my control. Surgeon Taylor, medical inspector of this army, who was ordered on July 29 to Gettysburg, to examine into the state of affairs there, reports to me that he made “the question of supplies a subject of special inquiry among the medical officers who had remained with the wounded during and for a month subsequent to the battle. The testimony in every instance was conclusive that at no time had there been any deficiency, but, on the contrary, that the supply furnished by the medical purveyor had been and still continued to be abundant.” This is, perhaps, sufficient to show that not only were supplies ordered in advance, but that they were on hand when required, notwithstanding the difficulty in consequence of the inability of the railroad to meet the requirements made upon it, until after General Haupt took charge of it on July 9. I have not deemed it necessary to present any tables showing the amounts ordered and issued, considering what I have just given as ample enough to show the action of this department. The chief want was tents and other appliances for the better care of the wounded. I had an interview with the commanding general on the evening of July 3, after the battle was over, to obtain permission to order up the wagons containing the tents, &c. This request he did not think expedient to grant but in part, allowing one-half the wagons to come to the front; the remainder were brought up as soon as it was considered by him proper to permit it. To show the result of the system adopted upon my recommendation regarding transportation, and the effect of the system of field hospitals, I may here instance the hospital of the Twelfth Corps, in which the transportation was not reduced nor the wagons sent to the rear at Gettysburg.
Surgeon [John] McNulty, medical director of that corps, reports that “it is with extreme satisfaction that I can assure you that it enabled me to remove the wounded from the field, shelter, feed them, and dress their wounds within six hours after the battle ended, and to have every capital operation performed within twenty-four hours after the injury was received. I can, I think, safely say that such would have been the result in other corps had the same facilities been allowed–a result not to have been surpassed, if equaled, in any battle of magnitude that has ever taken place.
A great difficulty always exists in having food for the wounded. By the exertions of Colonel [Henry F.] Clarke, chief commissary, 30,000 rations were brought up on July 4 and distributed to the hospitals. Some of the hospitals were supplied by the commissaries of the corps to which they belonged. Arrangements were made by him to have supplies in abundance brought to Gettysburg for the wounded; he ordered them, and if the railroad could have transported them they would have been on hand.
Over 650 medical officers are reported as present for duty at that battle. These officers were engaged assiduously, day and night, with little rest, until the 6th, and in the Second Corps until July 7, in attendance upon the wounded. The labor performed by these officers was immense. Some of them fainted from exhaustion, induced by over-exertion, and others became ill from the same cause. The skill and devotion shown by the medical officers of this army were worthy of all commendation; they could not be surpassed. Their conduct as officers and as professional men was admirable. Thirteen of them were wounded, one of whom (Asst. Surg. W. S. Moore, Sixty-first Ohio Volunteers, Eleventh Corps) died on July 6 from the effects of his wounds, received on the 3d. The idea, very prevalent, that medical officers are not exposed to fire, is thus shown to be wholly erroneous. The greater portion of the surgical labor was performed before the army left. The time for primary operations had passed, and what remained to be done was to attend to making the men comfortable, dress their wounds, and perform such secondary operations as from time to time might be necessary. One hundred and six medical officers were left behind when the army left; no more could be left, as it was expected that another battle would within three or four days take place, and in all probability as many wounded thrown upon our hands as at the battle of the 2d and 3d, which had just occurred. No reliance can be placed on surgeons from civil life during or after a battle. They cannot or will not submit to the privations and discomforts which are necessary, an-d the great majority think more of their own personal comfort than they do of the wounded. Little more can be said of those officers who have for a long period been in hospitals. I regret to make such a statement, but it is a fact and often a practical one. Dr. [Henry] Janes, who was left in charge of the hospitals at Gettysburg, reports that quite a number of surgeons came and volunteered their services, but “they were of little use.” This fact is so well known in this army that medical officers prefer to do the work rather than have them present, and the wounded men, too, are much better satisfied to be attended by their own surgeons. I, however, asked the Surgeon-General, July 7, to send 20 medical officers to report to Dr. Janes, hoping they might prove of some benefit, under the direction of the medical officers of this army who had been left behind. I cannot learn that they were ever sent.
Dr. Janes was left in general charge of the hospitals, and, to provide against contingencies, was directed, if he could not communicate with me, to do so directly with the Surgeon-General, so that he had full power to call directly upon the Surgeon-General to supply any want that might arise.
The ambulance corps throughout the army acted in the most commendable manner during those days of severe labor. Notwithstanding the great number of wounded, amounting to 14,193, I have it from the most reliable authority and from my own observation that not one wounded man of all that number was left on the field within our lines early on the morning of July 4. A few were found after daylight beyond our farthest pickets, and these were brought in, although the ambulance men were fired upon when engaged in this duty by the enemy, who were within easy range. In addition to this duty, the line of battle was of such a character, resembling somewhat that of a horseshoe, that it became necessary to remove most of the hospitals farther to the rear as the enemy’s fire drew nearer.
This corps did not escape unhurt; 1 officer and 4 privates were killed and 17 wounded while in the discharge of their duties. A number of horses were killed and wounded, and some ambulances injured. These facts will show the commendable and efficient manner in which the duties devolving upon this corps were performed, and great credit is deservedly due to the officers and men for their praiseworthy conduct. I know of no battle-field from which wounded men have been so speedily and so carefully removed, and I have every reason to feel satisfied that their duties could not have been performed better or more fearlessly.
Before the army left Gettysburg, and knowing that the wounded had been brought in from the field, six ambulances and four wagons were ordered to be left from each corps, to convey the wounded from their hospitals to the railroad depot, for transportation to the other hospitals. From the Cavalry Corps but four ambulances were ordered, as this corps had a number captured by the enemy at or near Hanover a few days previous. I was informed by General Ingalls that the railroad to Gettysburg would be in operation on the 6th, and upon this based my action. Had such been the case, this number would have been sufficient. As it proved that this was not in good running order for some time after that date, it would have been better to have left more ambulances. I acted on the best information that could be obtained.
The number of our wounded, from the most reliable information at my command, amounted to 14,193. The number of Confederate wounded who fell into our hands was 6,802, making the total number of wounded thrown by that battle upon this department 20,995. The wounded of July 1 fell into the hands of the enemy, and came under our control on the 4th of that month. Instruments and medical supplies belonging to the First and Eleventh Corps were in some m-stances taken from the medical officers of those corps by the enemy.
Previous to leaving Gettysburg, I, on July 5 and 6, ordered supplies to be sent to Frederick from Washington and Philadelphia, to meet the wants of the department in the event of another battle, which there was every reason to suppose would occur shortly after the army left Gettysburg. While at the latter place, I asked the Surgeon-General to have 50 medical officers ready to meet me at such a point as I should thereafter indicate.
On July 7, I desired them to be sent to Frederick. Late in the night of July 9, 47 reported. These officers were designed to make up, as far as possible, the deficiency of medical officers existing in consequence of the large detail from this army left at Gettysburg.
Tents were ordered by my request, and the corps supplied as far as their transportation would permit, and the remainder kept in reserve. It is not necessary to enter into a detailed list of the articles ordered and on hand ready for the anticipated battle. I have the orders in my office, and it is with pleasure I can state for the information of the commanding general that, notwithstanding the short time in which I had to make the necessary preparations, this department was, when near Boonsborough, fully prepared to take care of the wounded of another battle of as great magnitude as that which this army heat just passed through at Gettysburg.
It is unnecessary to do more than make an allusion to the difficulties which surrounded this department at the engagement at Gettysburg. The inadequate amount of transportation; the impossibility of having that allowed brought to the front; the cutting off our communication with Baltimore, first by way of Frederick and then by way of Westminster; the uncertainty, even as late as the morning of July 1, as to a battle taking place at all, and, if it did, at what point it would occur; the total inadequacy of the railroad to Gettysburg to meet the demands made upon it after the battle was over; the excessive rains which fell at that time– all conspired to render the management of the department one of exceeding difficulty, and yet abundance of medical supplies were on hand at all times; rations were provided, shelter obtained, as soon as the wagons were allowed to come to the front, although not as abundant as necessary on account of the reduced transportation. Medical officers, attendants, ambulances, and wagons left when the army started for Maryland, and the wounded were well taken care of, and especially so when we consider the circumstances under which the battle was fought and the length and severity of the engagement.
The conduct of the medical officers was admirable. Their labors not only began with the beginning of the battle, but lasted long after the battle had ended. When other officers had time to rest, they were busily at work–and not merely at work, but working earnestly and devotedly.
I have not considered it necessary to give in this report other than a very general outline of the operations of this department at that time. To enter into a detailed account of them would, I presume, be more than the commanding general would desire.
I am, general, very respectfully, your obedient servant,
JON A. LETTERMAN,
Brig. Gen. S. WILLIAMS,
A. A. G., Army of the Potomac.
Official Records of the War of the Rebellion, Series I, Volume XXVII, Part 1.