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A whirlwind of slaughter blew across the fields around Sharpsburg, Maryland, on September 17, 1862. Afterward the fertile ground looked as though it had been sown with acres of dead and woodlots and maimed. “The dead in rows—in piles—in heaps—the dead of the brute and of the human race mingled in a mass,” stated a surgeon. At places, the land seemed alive with the writhing of wounded men in their agony.

In the midst of the carnage, Union ambulance teams roamed, gathering up the staggering harvest of broken bodies. Stretcher-bearers carried the wounded to ambulances, which rolled to nearby field stations. There, surgeons dressed wounds and applied tourniquets before sending the worst cases farther to the rear. In barns and houses, more surgeons waited to perform surgeries and amputate limbs. There were not enough ambulances, and the system needed refinement. But the work was more significant than the inadequacies. It heralded a revolution in the treatment of battlefield wounded.

The man responsible for implementing a breakthrough in the removal and treatment of wounded men was 37-year-old career Army surgeon Dr. Jonathan K. Letterman. An 1849 graduate of Jefferson Medical College in Philadelphia, Letterman was an experienced officer who had served tours of duty in various posts before the Civil War started. On June 23, 1862, Maj. Gen. George B. McClellan appointed him, with the rank of major, as medical director of the Army of the Potomac.

Letterman joined the army in the aftermath of the Seven Days’ campaign. He reportedly found the medical department “in a condition far from being satisfactory.” Doctors lacked supplies to treat casualties, and bureaucratic snarls aggravated problems. Thousands of men suffered from scurvy, adding to the flood tide of men that overwhelmed the medical staffs. Wounded soldiers who needed more extensive care piled up, awaiting transfer by ship to hospitals in northern cities.

The new medical director turned his immediate attention to improving the troops’ health. While the army’s chief commissary officer secured large supplies of vegetables to combat scurvy, Letterman procured abundant quantities of medical supplies. By the end of July, he reported that the army’s health had been restored, with only 10,000 men unfit physically for duty.

“The subject of the ambulances, after the health of the troops,” Letterman wrote, “became a matter of importance.” Early in the war, medical officers and quartermasters had authority over the ambulance teams. The Seven Days’ campaign had shown that this arrangement “could not be depended upon during an action or on a march.” Doctors could not attend to wounded men and supervise ambulances at the same time during an engagement. “It became necessary,” Letterman concluded, “to institute some system for their management.”

On August 6, 1862, he issued an order creating an ambulance corps for the army. Letterman assigned a captain as commandant of the ambulance corps for each of the army’s infantry corps. A lieutenant directed the ambulances for each division and brigade, with a sergeant for each regiment. Letterman’s order allotted one transport cart and two ambulances for each regiment, an ambulance for a battery and two for each corps headquarters. The officers of the ambulance corps were responsible for the training of crews, the maintenance of vehicles and equipment and the welfare of the horses.

Letterman also implemented a three-tiered system of attending to wounded men on the battlefield. A casualty was to receive initial treatment at a field station close to the battle lines before being transported to a divisional hospital farther to the rear. Surgeons established these hospitals in private homes, public buildings and barns. Patients who required prolonged treatment were eventually sent on to general hospitals in larger towns and cities.

The initial test of Letterman’s reforms came during the 1862 Maryland campaign. Under a seeming avalanche of casualties, the system functioned fairly well. He estimated that the medical staffs attended to about 11,000 Union and Confederate wounded from the battles of South Mountain and Antietam. Less than two months later at Fredericksburg, the ambulance crews and surgeons functioned with evident efficiency. As a result, other Federal armies adopted Letterman’s system. After the Battle of Gettysburg, an extensive medical facility was erected southeast of the town and named Camp Letterman. In March 1864, Congress passed a law officially establishing Letterman’s medical system for all Union armies.

By then, however, Letterman was out of the Army, having resigned his commission on December 30, 1863. He settled in San Francisco, where he practiced medicine and wrote his memoirs. He suffered from depression after the death of his wife in 1867, and his health declined. Jonathan Letterman died on March 15, 1872, at the age of 47. His legacy, however, lives on. American fighting men and women in the past, present and future owe their lives in part to Letterman’s organizational genius.


Originally published in the September 2006 issue of Civil War Times. To subscribe, click here