The Army of the Potomac in the Gettysburg Campaign (2024)

"[The] battlefield sucks everything into its redvortex for the conflict, so does it drive everything off in long,divergent rays, after the fierce centripedal forces have met andneutralized each other."

Oliver Wendell Holmes

For the medical department of the Army of thePotomac, the Battle of Gettysburg may have been its most difficult test.Whether or not it succeeded in that supreme moment will become cleareras these pages unfold. First, however, it would not be out of place toexamine the important series of events which metamorphosed thatdepartment prior to its climatic appointment in Pennsylvania.

From the very beginning of human civilization armieshave emerged to protect and uphold a nation's citizens' wealth andterritory. And in consequence thereof came the uncivilizing hand of war.Combat, as well as the large concentrations of encamped soldiersinherent in military campaigns, resulted in wounds, injuries, anddisease, all of which had to be dealt with for the physical andemotional well-being of the forces involved. Although some smalladvances had been made throughout the centuries, military medicine,hospitalization, and the evacuation of the sick and wounded had, for itsworth, remained of little import within the overall scheme of an army'sorganization, duties, and responsibilities.

By 1860 the United States had itself, barely movedbeyond the concept that "a collection of armed men constitutes an army,"and similarly from the idea that civil practitioners were, if attachedto that body, competent enough to act as the "medical department." So by1861, and the outbreak of hostilities between Northern and Southernstates, the prevailing medical philosophy basically remained a task ofthe individual, or, every man for himself. In the U.S. Army,unfortunately, there was regimental aid, and nothing more. But as thetiny rebellion escalated, and 36,000,000 people became involved, theseold-fashioned ideas and methods were destined to be altered. Thatinevitable adaptation though, came slowly and in spurts. Awkward andhaphazard at first, it was also forced to crawl over the self-righteousprotests of narrow-minded civilian and military bureaucrats. Revisiondid come because of a natural necessity, and due to the uncounted andhorrible experiences of the men-at-arms who endured the backwardness ofthe old system.

"The volunteer soldier offers his very dearestpossession to his country, his blood his limbs, possibly his life. Whenthe soldier is struck down shall his country leave him on the fieldsuffering from cold, pain, thirst, even hunger; to die perhaps, withoutaid, unless he can drag himself away by his own painful exertions?Certainly when he gives his dearest possession the country should not benigg*rdly, when all it can give is dollars, but should supply anabundance of the best possible means for his succor." [2]

The physician who is quoted above believed that thevalue of preparedness surpassed all other virtues of an army or itsmedical branch. It was akin, he said to that of a fire department to acity. "It must always be prepared for its main function, and must beprepared to respond instantly,..." [3]

This preparedness did not exist in the U.S. Army andparticularly in the Army of the Potomac in 1861 and much of 1862 for twomajor reasons. First, the enormous growth of the war and its resultingwaterfall of casualties caught even the most ardent realists bysurprise; and secondly, the normal organization of the medicalmachine did not lend itself to quick changes or to the adoption of newideas, theories, or techniques. Therefore, it ensured the lack of acentralized and autonomous system for the evacuation of wounded, theestablishment of field hospitals i.e., "movable hospitals", and thesupplying of medicines, equipment, and provisions, which then became themain ingredients for disaster in the wake of Civil War battles, greatand small. It took three years before the medical department was trulycapable of satisfactory conduct in transporting and caring for its hurtand diseased personnel.

Excepting the usual minor and expected complicationsencountered in the early battles and skirmishes, it still required thefrightful Peninsular Campaign and its aftermath in the spring and summerof 1862 to fully thrust into the limelight the helplessness and disarrayof the U.S. Medical Department, as it coped with the casualties of agrowing modern war. A dozen or more engagements, fought by two hugearmies in a markedly unhealthy region of Virginia, complimented bynumerous long and stifling marches and retreats, produced a never beforeconvergence of sick and bleeding Americans. Added to these bleakconditions was the lack of fresh water, and the predominance in theranks of green untested volunteers fresh from home. Well over 21,000wounded alone in the Peninsula fighting, told some of the ghastly tale;the shock to the Northern populace can surely be imagined, especiallywhen combined with the news of 8,500 additional injured at Shiloh,Tennessee, during the same period. [4] And sincevictims of disease far outranked the numbers of dead and wounded duringthat timeframe, one may clearly understand the sheer magnitude,unexpectedness and incredulity of these figures.

It was during this particular timeframe that severalsignificant transitions occurred in the Eastern army. Although notalways permanent features they foreshadowed some promise for the future.Soon after the Battle of Bull Run in late July 1861, Dr. Charles S.Tripler succeeded Surgeon William S. King as medical director of theArmy of the Potomac. During King's term his position was frequentlywithout instruction as to its duties, privileges and powers, and King,being attached to the commanding general's personal staff, had only suchcontrol as his personal influence might win for him. "He was the onlypossible coordinator of the battlefield relief work,yet was withoutauthority to organize and direct the medical officers and stretchermenof the various regiments." [5] Consequently, eachregimental surgeon took responsibility for only his men, leaving all whofell sick or injured away from his unit, "on their own hook."

Shortly before the onset of Tripler's appointment inAugust 1861, the winds of change had begun to blow. These winds had beenassisted and even tactfully nurtured by the newly created United StatesSanitary Commission (U.S.S.C.), the brainchild of Reverend Henry W.Bellows and Dr. Elisha Harris, both of New York. Concerned that thesanitation and supply efforts to the armies of the Union were whollyinadequate for the good of the troops, this private relief agency hadbeen organized, and had quickly grown. Although the commission's centraldesire was quite modest, that of collecting and supplying articlesuseful to the sick and wounded, it shortly found itself beset withroadblocks. However modest as its aims were, initially the U.S.S.C. wasseen by the army's medical officiary in Washington as not onlyimpertinent and a nuisance, but plainly civilian interference.Fortunately for the men in the field, as Dr. Tripler commenced hisduties, improvements launched by the Commission, (as its prominencegrew) and more strict adherence to existing army regulations, begun tomake a noticeable difference in the health and morale of the troops. [6]

Under General George B. McClellan, Tripler, who wasnot regarded as an innovator but merely a fine administrator, did seizethe opportunity to institute some long overdue and much needed reforms.Although constantly stymied by Surgeon General Clement A. Finley, hestill managed to improve evacuation methods, he outlined a clearerdeclaration of surgeons' duties, insured better training of hospitalattendants, added more disease prevention, and established auxiliarygeneral hospitals in Washington and elsewhere. Many of his other ideaswere never implemented due to the indifferent disposition of thedepartment, the large influx of new enlistments, and other factorsbeyond his control.

In April, 1862 a major blockage to progress wasbroken up in Washington which would in many ways forever transform themedical department of the U.S. Army. Surgeon General Finley, describedby one detractor as a "self-satisfied, supercilious, bigotedblockhead... [who] knows nothing and does nothing..." was removedfrom office through the efforts of the Sanitary Commission, majornewspapers, and other forward-looking thinkers. The Medical Corps underFinley, said the New York Tribune, "is not accused of misifeasance ormalfeasance, but of non-feasance, [and has] done nothing since the warbegan." [7] As a result, the complicated and longcampaign for his replacement eventually netted Dr. William A. Hammond, adistinguished surgeon and scientist, who was a friend of McClellan's,and even as an unknown entity was totally supported by the U.S. SanitaryCommission. But in choosing Hammond they passed over men with seniority,one in particular was Assistant Surgeon General R.C. Wood, who claimedhe had been promised the position. In the end these "seniors" would havetheir revenge.

Dr. Hammond, at 34, could not have been a betterchoice. With eleven years of frontier service, he was still open-mindedwith a keen inquiring intelligence. These were weighty attributes, buthis eager willingness to tackle the serious problems within the army'smedical system was his chief merit. Regrettably for the country, andespecially its citizen soldiers, he was eventually forced out of officeby the petty and vindictive Dr. Wood and Secretary of War Edwin Stanton.In the meantime, however, he formulated and implemented desperatelyneeded priorities for the remodeling of his bureau. Some William Hammondof these immediate measures insured that expenditures for supplies wentup, "red tape" was cut, supplemental nurses and physicians could beemployed when needed, and a new ambulance organization was instituted.Further on, he drafted designs to add extra surgeons to regiments andstaff, along with a new complement of medical inspectors for the fieldarmies and general hospitals. He authored the concept of an Army MedicalMuseum and medical school, and sought pay increases and higher ranks forhis dedicated officers. Three of his most beneficial advances involved:the removal of the transportation of medical supplies and patients awayfrom the Quartermaster's Department and into the jurisdiction of theMedical Corps, the betterment and expansion of the general hospitals,and the replacement of medical directors with younger men who showedadministrative ability, and were "not quite so thickly encrusted withthe habits, forms and traditions of the service." [8]

One of the men chosen by Surgeon General Hammond toimplement this transformation of the antiquated medical corps wasJonathan Letterman, MD, a 37-year-old Pennsylvanian and 1849 graduate ofJefferson Medical College in Philadelphia. Letterman had entered thearmy upon receipt of his diploma, and had served in Florida against theSeminoles, and subsequently spent almost five years on the frontier. Inthe two years prior to the Civil War he was stationed at Ft. Monroe,Virginia and participated in an expedition against Indians inCalifornia. Returning to the East in November 1861 he took up theposition of Medical Director of the Department of West Virginia. On June19, 1862 Dr. Letterman was ordered to duty as Medical Director of theArmy of the Potomac, succeeding Charles Tripler. He reported to GeneralMcClellan at White House Landing on the Virginia Peninsula, July 1. Uponreceipt of the news of Letterman's orders, a nurse at the Landing namedKatharine Wormely wrote in a letter home: "A new Medical Director ofthe army has been appointed, for which we are deeply thankful. He...hasjust stood near me for a few moments,...so that I could observe him,...His [face] gave me a sad calmness. Such a worn face, - worn in the causeof suffering, full, it seemed to me, of a strong earnestness in hiswork. How much at this moment is freshly laid upon him!"

Friends described the doctor as a man with a"truly modest disposition, great kindness of heart and sensibility tothe feelings of others." Surgeon Letterman was also reported topossess a healthy sense of humor, and a directness of speech and manner,accompanied by a frank and sincere nature, who was unselfish in hisgenerous praise of others. General William W. Loring who had served withLetterman in New Mexico, (and against him in the Civil War) pronouncedhim both retiring and gentle, and an ardent student who sought the"highest knowledge in the scientific advancement of hisprofession." [9]

During their tenures as Surgeon General and MedicalDirector of the Army of the Potomac both Hammond and Letterman,respectively, worked diligently and in a partnership to bring aboutcrucial modifications to a structure overloaded and burdened by everyproblem imaginable. In following Letterman's handiwork, in combinationwith Hammond's guidance during the twelve months prior to the GettysburgCampaign, it is possible to observe his accomplishments and failures,and to understand whether basic lessons he taught and learned from theend of the Seven Days' Battles through Chancellorsville did or did notprepare that army's medical branch for its monumental crisis atGettysburg.

When, on July 1, 1862, Jonathan Letterman began hisduties at McClellan's headquarters he was immediately thrust into themidst of a vast conglomeration of sick and exhausted soldiers who hadendured several months of hot weather, swampy terrain, and thedebilitating effects of long marches and hard fighting. These hardshipswere unhappily coupled with a lack of proper diet, bad water, and the"depression of failure." [10] Surgeon Triplerhad done his best up to Letterman's arrival, but the many negativecomponents within the medical department, plus the size and scope of thecampaign had done him in. The sick alone were a crushing encumbrance,numbering at least 20 per cent of the army. In fact over one-fourth ofMcClellan's troops were then languishing in crowded hospitals atHarrison's Landing where the Army of the Potomac had retreated afterMalvern Hill. Letterman immediately went to work, requesting 200 moreambulances and 1000 additional tents. On August 3 he began theevacuation of the sick and wounded which continued until August 15.Finally released from this awesome burden, the army was free to move atwill.

While engaged in this mammoth endeavor, Lettermanstill found the spirit and energy to take up the long-standing ambulanceproblem and work for its solution. Although the final resolution did notevolve purely from him, Letterman did devise an innovative and workableevacuation process and put it quickly into practice. Whereas manymedical officers had learned valuable lessons during the PeninsularCampaign, (where Letterman had not been present), it was obvious that hemore than anyone had seriously considered the ambulance question and hadalready mapped out a simple yet viable formula long before joiningMcClellan in July. Letterman, explained the old methods thusly:

"[The ambulances] were under the control both ofMedical Officers and Quartermasters, and, as natural consequence, littlecare was exercised over them by either. They could not be depended uponfor efficient service in time of action or upon a march, and were toooften used as if they had been made for the convenience of commandingofficers."

Emphasizing his main point, it was clear that duringa time of need, especially in battle, no officer, medical or otherwiseshould have control over the ambulances, as these men had their ownduties and responsibilities to attend to. Logically, he saw otherofficers, "appointed for that especial purpose, should have directcharge of the horses, harness, ambulances, etc., and yet under suchregulations as would enable Medical officers at all times to procurethem with facility when needed for their legitimate purpose." [11]

Briefly, the order which was submitted to andapproved by General McClellan on August 2, (instead of being sent toWashington where it would have reposed indefinitely) provided anambulance force for each army corps, commanded by its owncaptain. Moreover, each division had a first lieutenant in charge, abrigade, a second lieutenant, and a sergeant assigned to every regiment.The enlisted element consisted of two privates and a driver for eachambulance. This system allowed every infantry regiment one transportcart and driver, one four-horse and two two-horse ambulances; plus onetwo-horse ambulance for each battery of artillery, and two two-horseambulances for the headquarters of each army corps. (A two-horseambulance was actually a light, four-wheeled vehicle and a four-horseambulance was akin to an army wagon.) [12]

Albeit all ambulance corps officers and men came fromthe line, they were under the sole control of the medical directors, andthe total number of ambulances allotted depended on the size of theregiments in each division. For instance three ambulances were permittedfor a regiment of 500 or more. The aggregate was about one vehicle per150 men. As an illustration, in June 1863, the Fifth Corps contained12,509 men and had 81 ambulances on hand. More importantly, though,everything boiled down to this major change: that all ambulances weretaken away from the regiments and were thereafter kept together in adivision train, which was sometimes combined in corps trains andsometimes not. [13]

Meanwhile away from the field, Surgeon GeneralHammond pressed forward his agenda in the nation's capital. He created amedical inspector general and eight inspectors for the overallmanagement of military general hospitals and the improvement of sanitaryconditions in army camps. A corps of staff surgeons was added, a totalof 40 surgeons and 120 assistant surgeons to serve outside theregimental framework. He tightened up the contract surgeon business, andrequired strict exams for both entering military and temporary civilianphysicians. Convalescent camps were founded to clear general hospitalsof men caught between the front and the rear of an army, and where manymalingerers had found safe havens from duty. Furthermore, Hammond madeit easier for purveyors to do the job of supplying the department withmedicines, instruments and equipment by expanding their depot locationsand streamlining how requisitions were made, filled, and transported.All the while he supported his field personnel as they fought forfront-line revisions. In one important move during the Battle of SecondBull Run (August 29-30), he appointed Surgeon Jeremiah Brinton to thenew post of medical director of transportation, which freed Dr.Letterman from dealing with that battle's 8,000 casualties then beingmoved to the hospitals in Alexandria, and between numerous facilities inWashington. [14]

In early September, owing to Robert E. Lee's invasionof Maryland, General John Pope's Army of Virginia was merged into theArmy of the Potomac, making Dr. Letterman overseer of a much enlargedforce, with his ambulance corps then only one month old. It soon becamean experiment on a grand scale.

By September 18, several engagements had been fought,including the Battle of Antietam. Although the "Medical Departmenthad not, at this time, been reorganized...," Letterman stillinstructed his corps' medical directors beforehand to form theirhospitals, "as nearly as possible, by divisions, and at such adistance in the rear of the line of battle as to be secure from the shotand shell of the enemy..." He further advised the selection of barnsfor hospitals (as few tents were on hand due to the rapidity of theadvance from Virginia into Maryland) over houses, as they were"better ventilated."

In recalling the aftermath of that tremendous battle,where over 8,300 Federals clung to life after being struck by musketryand artillery fire, Dr. Letterman disparaged the lack of medical andsurgical stores for these men and the 2,500 Rebels left in his hands,along with the difficulty of obtaining these items from the depots inWashington and Baltimore. He understood, however, that the "firstconsideration is to supply the troops with ammunition and food - tothese every thing must give way, and became of secondaryimportance." [15]

Hospital scene, Antietam, 1862

Prior to the first martial contact of Southern andNorthern troops at South Mountain, Maryland, Letterman called for 12hospital wagons and two hundred extra ambulances to be delivered to thearmy. (Some of the regular ambulances were late in coming, again due tothe fast pace of army movements during the campaign.) Many of theseconveyances did arrive in time, but were unorganized, while some werelost. Still, Dr. Letterman claimed that the majority of the wounded werebrought off the field in fairly good time, although handfuls of injuredmen did lie on contested ground for over 24 hours. Additionally, he gavehis staff of doctors and attendants high marks for their willingness towork, and their promptness, efficiently and devotion to the casualtiesunder their care. He also defended his physicians againstmisrepresentations and rumors that pictured them as simply butchers,saying that more often they should have been blamed for practicing"conservative surgery."

As for the new ambulance system, Antietam did notbecome the ground for a model experiment. Critics were vocal in anyevent, and bemoaned the evacuation service there as characterized by"gross mismanagement and inefficiency,...[and a] lack of system andcontrol." In retrospect some of these faults may have beenattributed to the incorporation of General Pope's untrained drivers andstretcher-bearers into the Army of the Potomac's better organized andmore disciplined and motivated crews.

Major Letterman had always believed that after asevere engagement, such as that at Sharpsburg, the critically injuredmust not be moved right away, but instead kept immobile nearby untiltransportation would not endanger their lives. Therefore he set up two"large camp hospitals," (besides the main ones in Frederick), ormini-general hospitals if you will, near the battlefield. These werecapable of maintaining about 1200 patients. He claimed that theseinstitutions, "were the first of the kind attempted in this country,and were succesful,...and demonstrated the propriety of theirestablishment." [17]

A second prescription adhered to by the director wasthe unique concept that allowing relatives to remove seriously woundedmen immediately to their homes was fraught with danger. He felt that notonly was the physical movement bad for the disabled soldier, butthen to be cooped up in stuffy, closed buildings was to compound analready grievous mistake. Letterman said that the "absolute necessityof a full and constantly renewal supply of fresh air..." is mostrelevant to the health and well-being of the patient. As a result ofthese beliefs, he was constantly appealing for the addition andmaintenance of a large number of tents available to the medical wing ofthe army.

In examining all of Dr. Letterman's strategies andmethods, it becomes apparent that throughout his tenure as medicaldirector of the Army of the Potomac, one of his most important causeswas the retainment of wounded men as close to the army as possible. Thiswould ensure a quick return to their units enabling the successfulprosecution of the war effort. This "directive" had a two-fold benefit,as it further allowed the men to be close to their own doctors andcomrades which promoted better care and a morale boost in theprocess.

As an after-shock of Antietam another significantproblem was attacked by Director Letterman. This was the inception of"field hospitals," or hospitals-on-wheels, the mobile medical facilitiesso common to past and present armies since his day. Up to September1862, the field hospital concept had not yet been ordained. Regimentalhospitals were the norm, with these enterprises sometimes combined intothe advantage of brigade level cooperatives. Up to that time, the lackof tentage, and the separation of personnel, supplies and equipment hadmade divisional hospitals difficult to formulate and maintain. But aftermuch study and acquisition of the necessary authority, all this changed.In a simple and clearly worded circular dated October 30, 1862,Letterman inaugurated this extraordinary reform. Its main feature wasthe direction of a field hospital for each division, and provision ofthe personnel and equipment for the same. In addition, a previouslywritten circular had ordered that from that time on (October 4) supplieswould be issued by brigade to the individual regiments as needed,eliminating much of the waste and abandonment of these valuablematerials each time regiments moved. The new orders also guaranteed thatevery physician and all other attendants knew exactly where theybelonged in the event of a battle, and that only the three mostqualified doctors of a division could be classified as surgical"operators." [18] The value and superiority of theserevolutionary directives was shortly demonstrated in December 1862 atthe Battle of Fredericksburg, where, as Letterman explained, "they werefirst tried, and when from the nature of the action they were severelytested, they fulfilled in a great degree the expectations hoped for atthe time of their adoption." [19]

In review, and in fairness there is little in the wayof exaggeration contained in the major's preceding statement, asFredericksburg presented the medical corps with several serious concernsand problems. Primarily, the battle was a major defeat for the Army ofthe Potomac. Adding to this dilemma was the river, an obstacle which hadto be crossed and recrossed in consequence of the forward establishmentof hospitals, and then the retrograde movement of the same facilities.And lastly, December was a time of year when severe shifts in weathercould hinder all post-battle activities.

After a long rest period following the AntietamCampaign, General McClellan began his slow probing maneuvers toward theArmy of Northern Virginia then protecting Richmond in an advanceposition near Fredericksburg. So lentitudinous were his movements thathe was relieved by the president, who placed Ambrose E. Burnside incommand. General Burnside sensing Lincoln's mood, hastened the marchover land to capture the Rebel capitol. In preparation of this upcomingconquest, he transferred the Army of the Potomac to the vicinity ofFredericksburg in middle November, ignoring the lateness of the season.His strategy, to take that city as a safe water base enabling a directadvance to Richmond, was thwarted by the Confederates, who forcedBurnside to attack them across the Rappahannock River where they heldsuperior, well prepared positions. The one-day battle fought on December13, resulted in a Union defeat. With 9,600 injured stuck on the wrongside of a river the situation looked bleak. However in this instance,"for the first time in a great battle, the wounded of the UnitedStates Army had adequate care and treatment." [20]

Rappahannock River, near Fredericksburg, Virginia

The success achieved by the medical corps afterFredericksburg was in large part due to the snail-like pace of thecampaign, and the many weeks of preparation available since the Battleof Antietam. In consequence of the directives instituted by Dr.Letterman, the medical branch was able to amass supplies such as tentsand ambulances, and train its personnel into the revised theoriesimplemented in October. For example, 500 spare hospital tents had beenordered and stored at the depot near Aquia Creek, while for once enoughambulances were then on hand, about 1000. Several other conditionsenabled the wounded to be speedily and correctly cared for. The weatherremained quite mild for that time of year, as the normal coldtemperatures did not set in until four days after the fighting ended.Furthermore, the nearby sturdy buildings of the town held by theFederals provided protection for the injured men and attendants alike.And curiously, for reasons never clearly understood, the Confederatesdid not launch a counterattack against Burnside's defeated army, givinghis doctors the opportunity to stabilize their patients prior to transitacross the Rappahannock. The First Corps medical director, Dr. J.T.Heard, explained that the prompt and excellent care given to thecasualties was due to a uniformity of action: "Every surgeon,hospital steward, nurse, cook and attendant was assigned to his positionand knew it." [21]

Since removal of the wounded to the north side of theriver was paramount to their safety from artillery fire, continuedcombat, or enemy attack, it was ordered almost immediately. Dr. Heardreported that his 1,500 cases were not only properly attended to inthree divisional hospitals, but every man was driven or carried acrossbefore morning; and by December 16, all of the nearly 10,000 Unionwounded were sheltered in tents on the northern bank of the river.Although Letterman protested, evacuation of these men to Washingtonbegan on the same day. As always, he was convinced that to leavesoldiers with severe injuries immobile for awhile, as he had done afterAntietam, was the best policy. But Burnside expected renewedhostilities, and the evacuation continued unabated. From existingreports it appears that this relocation of the wounded to the capitaldid not go as smoothly as it should have; the biggest problem being thelack of warm clothing, blankets, and ample rations. In this aspect theSanitary Commission lent much aid, but even this organization was hardpressed to furnish every need. The usual criticisms surfaced and weredirected toward Major Letterman, mainly his unwillingness to delegateauthority and the aforementioned supply problems.

After this battle the Northern army went into winterencampments at Aquia and Belle Plain, Virginia. And except forBurnside's last effort to rescue his reputation in the infamous Januaryfour-day "Mud March campaign," all was quiet along the Potomac until thespring of 1863.

Meanwhile, within the crowded bivouacs the defeatedand heavy hearted Army of the Potomac suffered on. Due to unsanitaryconditions prevalent in the large camps, and the adverse weather,disease and sickness were by all accounts, rampant. "Letterman doesnot appear to quite such advantage as a sanitarian as he does as anorganizer and manager in the field," said one modern historian. Afew of his contemporaries would have agreed. [22] Theloudest disapprovals as usual, seem to have emanated from his enemies inthe government, those doctors who, with Secretary Stanton, were alwaysbusy trying to discredit both Surgeon General Hammond and even DirectorLetterman.

The bloody year of 1862 did close, with some goodnews, as is noted by these comments:

"It marked the end of an old era, the beginning ofa new one in the medical department of the United States army; the endof working without authority, the beginning of control; the end ofconfusion, the beginning of methods and order."

These changes were surely visible to almost anyonewilling to see. A short eighteen months earlier the entire U.S. Armycontained barely 100 medical officers, and was indifferently suppliedand organized. As 1863 dawned, it was comprised of 2,000 doctors andnearly 10,000 men under their command or direction, complete withgeneral hospitals in the large cities containing more than 50,000 beds.It was compacted, well trained, with an ambulance corps and purveyorsoffice unsurpassed. And it had just proven that one of its branches,that of the Army of the Potomac, could reliably handle 10,000 casualtiesin a single day. [23]

With the vast improvements in medical servicebeginning to become apparent, 1863 should have been a banner year forMedical Director Hammond and his emerging and efficient work force. Butwith the battling nations recruiting and conscripting thousands of newtroops, and the armies brutally fighting each other with no end insight, the strain on the medical department continued undeterred both inthe Eastern and Western theaters of operation.

In the East, in late January, Joseph Hooker relievedGeneral Burnside. But unlike his predecessor, Hooker concentrated onbringing the health of the army up to acceptable standards, for he sawhow diarrhea, scurvy, and various fevers were devastating his soldiery.Dr. Letterman had always believed that a good diet, (including amplevegetables) paired with enforced sanitation and better cooking methodswould strengthen the army's stamina and morale. By April Letterman'spolicies, backed by General Hooker's authority and common sense, causedthe rate of sickness to drop; and in turn the physical and mental spiritwithin the hundreds of old and new regiments rose accordingly.

Well prior to the start of the spring campaign, Dr.Letterman began to prepare for the upcoming battles. As his hands werealready full, he appointed two medical inspectors to act under himwithin the Potomac army, and ordered that each corps medical directoradd a similar officer to their units. During the previous winter,medical boards had been established to examine and weed out deficientsurgeons, and by March he had again outlined how he wished hisdepartment to operate during military engagements.

Immediately before the army decamped, Letterman, inorder to keep 8,000 sick soldiers near their commands, set up tenthospitals along the railroad from Fredericksburg to the Aquia andPotomac Creek depots. As expected, maneuvering soon began betweenHooker's and Lee's armies and the resulting combat at the Battle ofChancellorsville, fought on May 1-4 threw 9,700 wounded Federals intoLetterman's system. These casualties had to be funneled from theconfused battlefield through Fredericksburg, then subsequently acrossthe Rappahannock River. Once over that barrier the men were placedaboard trains and then run along a single track to the Potomac River andthence by boat to Washington. [24] The evacuation ofthese injured did not go as smoothly as it should have, and the army'smedical service was not, in this case, a perfect model of efficiency.Due to the confused state of affairs during the fighting, and thegeneral inept handling of the army by Hooker, many small things wentwrong for Letterman's people. Field hospitals were frequently adjustedowing to artillery fire or an unexpected enemy breakthrough. One doctorin the Third Corps complained that his division facility had to beuprooted five times, and in the end, 1,200 badly injured Yankee soldierseventually became captives of Lee's victorious forces. [25] Another embarrassment for Letterman was the admissionthat a few of his physicians had cowardly run off during combat leavingtheir charges, while others had become intoxicated on government issuedstimulants stockpiled for the sick and wounded.

Inasmuch as many of these minor complaints were true,several unusual situations complicated the big picture atChancellorsville which could not be wholly blamed on the medicaldepartment. For one, the defeat of the Union army inherently created anatmosphere of confusion and fear as doctors and attendants exertedthemselves to avoid being overrun and captured. The rapid pullbacks andretreats during the daily actions forced the U.S. ambulance corps tohastily evacuate its bleeding cargoes over a long and rough 25-mile roadto the safety of more permanent corps hospitals in the rear. Moreover,Hooker's very orders added to the load, when he prevented medical wagonsand all but two ambulances per division from crossing the Rappahannockwhen the army marched toward Chancellorsville. Paralleling that order,no stretchers or stretcher bearers were allowed over the river untilApril 30, when shell fire had already forced the abandonment of at leastone hospital. [26]

In his final assessment, Dr. Letterman professed thatwhen looking at the entire operation, the frequent dislocations had beenreasonably managed, and his staff had performed as well as could beexpected under the circ*mstances. In acknowledging their valuableservices, he was especially pleased to report that in almost all casesthe 1862 field hospital directives of October 4 and 30 were carefullyfollowed and adhered to. This resulted, even under the difficultiesencountered, in generally excellent care and comfort provided to themajority of the wounded of that battle.

In the most serious cases, where patients were toohurt to be transported far, Letterman chose to keep them with the armyinstead of dispatching them to Washington. In accordance with thisideology, he set up large tent hospitals at Potomac Creek where the mencould be tended by their own physicians. Of these encampments, heremarked:

"I have never seen better hospitals. This opinionwas entertained by the professional and unprofessional men who visitedthem, and I regretted the necessity which compelled me to break them upabout the middle of June in consequence of the march of the Army intoMaryland and Pennsylvania."

The Battle of Chancellorsville has often been called"Lee's greatest victory." This may be so, but it led him down thepath to his most serious defeat, at Gettysburg, in the summer of thatsame year.

Only speculation could infer what thoughts possessedthe mind of Jonathan Letterman as the Army of the Potomac marchednorthward in hot pursuit of the resolute Confederate invaders. It hadbeen barely a month since he and his colleagues were mired knee deep inthousands of casualties from a severe battle; now, they seemed to beheaded for another and possibly even more terrible confrontation.

The Union march to intercept General Lee was wellunderway when it was announced that General George G. Meade, the FifthCorps commander, had replaced General Hooker as head of the army. Thiscame on June 28 when all of the corps except the Sixth, were within aday's hard walk or less of Gettysburg. The march from Falmouth, Virginiaon June 12 to the very doorstep of Pennsylvania by the end of the monthhad been one of the hardest on record for Lincoln's grand force ofapproximately 100,000 men. Ruefully, not all of them made it toGettysburg.

Thousands dropped out and straggling climbed to newheights, all in relation to the amount of dust and heat, or the numberof miles covered during a particular day or night. Scores of veteransfell by the roadsides totally exhausted or dead, caused by the 25-30mile per day treks. By the time the campaign ended in late July, manyregiments could claim a travel agenda of between 500 and 600 milescovered on foot, while dining on hardtack, salt pork, and coffee, andwith water taken where it could be found. The animals suffered too.Meade's force required in excess of 700 tons of supplies daily,therefore over 4,000 wagons accompanied it. If the needs of the cavalryand artillery are calculated, this amounted to over 50,000 horses andmules present for duty. Meshed into this huge coalition were Dr.Letterman's ambulances and two horse medical wagons, adding another1,017 vehicles. [27]

When the army left the Fredericksburg area betweenJune 12 and 14, Dr. Letterman commenced the removal of 9,025 wounded andsick with their supplies, from that city up Aquia Creek and on toWashington. This was successfully accomplished in short time. Meanwhile,as the Army of the Potomac skirted the capital on its northerly route,Letterman arranged for 25 wagon loads of battle supplies to be packedand sent to Frederick under the direction of Surgeon Jeremiah Brinton.By the day General Meade assumed command, Brinton had traveled evenfarther to Taneytown, Maryland, Jeremiah Brinton where headquarters werethen located. There the wagons remained, under Meade's orders untilafter the Battle of Gettysburg. [28] Even moredisturbing was a decree issued several days earlier, on June 19, beforeMeade's ascension. In it General Hooker directed that the "allowance oftransportation" that Letterman had deemed necessary for the medicaldepartment in the fall of 1862, was to be reduced. This went against thedirector's opinion and argument, and it compelled him to send away alarge portion of the "hospital tents, mess-chests, and other articlesnecessary upon the battlefield, and proved," said Letterman, "asI foresaw it would, a source of embarrassment and suffering, which mighthave been avoided." [29]

In another, and more controversial move, Meade, tokeep the army's back door open, restricted the baggage of his force verystringently. He directed that "Corps Commanders and the Commander ofthe Artillery Reserve will at once send to the rear all their trains(excepting ammunition wagons and the ambulances), parking these betweenUnion Mills and Westminster." This order came on July 1, prior toany knowledge of General John F. Reynolds' collision with the Rebels atGettysburg. A day later, Dr. Letterman was frustrated to learn that"while the battle was in progress, the trains (including the hospitalwagons and the trains of battle supplies, under charge of Dr. Brinton)were sent still further to the rear, about twenty-five miles distantfrom the battle-field." [30] This left the medicalstaff of each corps with only ambulances and medicine wagons on hand(which were already in short supply) to sustain the needs of manythousands of wounded for almost a week. Without the correct number oftents, tools, cooking utensils, special rations, and other suppliesnormally called for immediately after combat, sick and injured soldierswould suffer needlessly. Surgeon Justin Dwinell, the medical officer incharge of the Second Corps hospitals, was only one of many whocomplained of a lack of tents, blankets, provisions, axes, shovels,cooking utensils, and medical stores before July 7, when the longawaited trains finally arrived. Regarding this situation he affirmed:"Nothing but to gain a victory should ever prevent these wagons fromfollowing the ammunition train."

Thus the hundreds of medical officers and theirassociates assigned to the Army of the Potomac were once again in debtto the U.S. Sanitary Commission and other relief organizations who cameto their immediate aid with foodstuffs and other assorted materials.Oddly, in contrast to six of Meade's corps, one, the Twelfth, did notreceive or respond to this order, hence none of its normal compliment ofhospital wagons was sent to the rear. Accordingly, this unit was able toevacuate, bathe, dress, and feed its wounded completely within six hoursof the end of the battle. [31]

Allowing for the subtraction of thousands of Unionand Confederate soldiers who were sick, or had been previously wounded,including those that had straggled or deserted, the two armies werestill able to field close to 150,000 troops during the three day battleat Gettysburg. Of this number, 14,529 Northern and 6,802 Southern menwere left more or less seriously injured in U.S. hands within thenumerous field hospitals situated in and around the prosperous borough.This 21,331 total was only about 6,700 bodies less than the 1860population of Adams County, Pennsylvania, the locale where the battleshad raged. Intrinsically, both sides usually underestimated thecasualties, as scores of slightly hurt men were never counted, or stayedin ranks with their units, or otherwise slipped through the cracks ofthe reporting mechanisms. [32]

Even before the first projectiles flew on July 1, afield hospital had been established in the town of Gettysburg as aresult of the arrival of General John Buford's 1st Cavalry Division onJune 30. A local citizen, Robert G. McCreary confirmed this, when onthat date a medical officer "requested accommodations for six oreight of the command who were sick." The railroad depot on CarlisleStreet was opened for that purpose, and twenty beds were set up withinthe structure. It was only hours later that the depot began admittingwounded cavalrymen as Buford's division struggled to hold its positionsbeyond Gettysburg. Later in the day as the battle of July 1 escalated,and the infantry and artillery units began to retreat, the injuredtroopers were removed from the depot to the Presbyterian Church onBaltimore Street. Accompanied by several of their doctors, these menlike many of their comrades, fell into Confederate hands by sunset. Thedepot itself was then secured by surgeons of the First Corps, and it,the express office and nearby buildings became field hospitals for aportion of that Corps' casualties. [33]

The story of the railroad depot might reflect thegeneral situation of many of the early field hospitals at Gettysburg.During the first two days of fighting, battle lines were more or lessfluid and the ever-changing deployments of the combatants, and overshotenemy artillery fire often forced the repositioning of aid stations andfield hospitals.

Throughout the day on July 1 as the First andEleventh Corps clashed with Confederates north and west of Gettysburg,the aid or dressing stations, usually manned by a regimentalassistant-surgeon and his attendants, followed their respective unitsback and forth as the battle raged and waned one way or the other. Theseaid stations were the first stops for the "walking wounded" or anyseriously injured Federal who was fortunate enough to be reached by thestretcher-bearers. In recalling the earlier discussion of this subject,it should be remembered that as of October 1862, all medical personnelhad particular assignments on the day of battle. Even before the openingshots, surgeons, assistant-surgeons, operators, recorders, hospitalstewards, cooks, ambulance drivers, litter bearers, nurses, teamstersand other attendants, knew their posts and duties. So as the impassivemissiles tore men from the regimental firing lines, these crippled andblood soaked individuals headed for safe zones, knowing that the medicaldepartment was ready and waiting. The initial stop was at the dressingstations where literally, "first aid" would be administered to allinjured parties. No operations were performed at these primary sites.The doctor there would simply stabilize and bandage the wound thendirect the ambulatory patient to his correct field hospital in thearmy's hinterland. Concurrently, other attendants gathered the moreseriously injured to an ambulance collecting point for removal bywheeled conveyances to the divisional field hospitals.

These division ambulance trains consisted of 30 to 50vehicles of various types all for the transportation of the wounded.Included too were 10 or 15 medical supply wagons unless, as was in thecase of the Battle of Gettysburg, these trains were jettisoned. Eachambulance carried four stretchers or hand litters, plus a supply ofbandages, lint, astringents, chloroform, whiskey, brandy, condensedmilk, and concentrated beef soup. A regiment had approximately elevenmen attached to it from the ambulance corps, counting the sergeant incharge. [34]

In the late afternoon of July 1, after hours of someof the most severe combat of the battle, units of the Union's First andEleventh Corps retreated to reserve positions on Cemetery Hill andCemetery Ridge just south of Gettysburg. In consequence of the rapidredeployment of these corps, the ambulance teams were unable to recoverall of the wounded individuals from the 1st and 3rd Divisions of theEleventh, nor from all three divisions of the First Corps. During thelong and eventful day medical directors and surgeons of the two corpsset up sheltered division hospitals near to and in the borough itself.They seized the Lutheran Theological Seminary and college buildings, therailroad depot and express office, several large warehouses, theWashington House Hotel, the Union School, the county courthouse andalmshouse, and several churches. But even this was not enough, and anoverflow of perhaps 400-450 men ended up as patients in privatedwellings. When the troops at the front begun their withdrawal about 5p.m. the ambulance drivers and attendants went right along, thus endingthe evacuation of U.S. casualties on the day's field by Union personneluntil July 4. If not found and taken up by Southern squads, which manywere, the abandoned wounded remained on the contested ground until afterthe Confederate retreat. By dusk of that day the village was in solepossession of the Rebel army, as were the Federal hospitals, and severalthousand prisoners, both hurt and not. When it was clear that Gettysburgwould be given up to the Confederates, some of the nearly 4,000 Northerncasualties were hurried out of town to safer locales. A handful ofdoctors chose to stay with their men, usually one or two in eachfacility; the balance joined the retreat and were directed to new fieldhospitals then being formed south and southeast of Cemetery Hill.

Of this tragic and fearful time, Dr. Jacob Ebersole,a 19th Indiana Infantry surgeon, who remained with his charges,recalled:

"[It] was just before sunset. Looking from theupper windows of the hospital, [at the railroad depot] I could see ourlines being repulsed, and falling back in utter confusion. Our front wasentirely broken, the colors trailing in the dust, and our men falling onevery side. The enemy were enveloping the town from that side, sweepingpast the hospital and completely filling the streets." [35]

By midnight, any of the first day's casualties thathad been fortuitously rescued before or during the collapse of the Unionforces, were deposited in makeshift temporary hospitals at farmsteadsalong the Baltimore Pike and the Taneytown Road. Obviously the directorof the First Corps, Dr. T.J. Heard had learned his lesson, for he placedhis new facilities well out of range of enemy missiles. The biggestconcentration of this Corps' casualties were, by July 2, clusteredaround the "White Church," three miles out on the turnpike toWestminster and Baltimore, and on farms contiguous. The three EleventhCorps divisions were congregated on the Elizabeth and George Spanglerplace, (not out of artillery range) east of that pike and justsouth of Power's Hill, where they remained until early August. It issurprising that inasmuch as the Eleventh Corps met with disaster,confusion, and some demoralization on July 1, its medical staff managedto regroup and rebound quickly; they set up and maintained a cohesive,well regulated field hospital very near the battleground, although notcompletely out of harm's way. [36]

Ambulances in action at Gettysburg nearPower's Hill. Section of sketch by Edwin Forbes

Just what was it like in one of these hospitals asits staff struggled to stabilize the occupants, while the battle ragednearby? A U.S. Volunteer surgeon has left this excellent account of thescene in one such place.

"Behind a partially protected hill there is a fieldhospital; the lines of stretcher-bearers and ambulances mark the way toit. There are a few tents and rudely improvised tables; at the latter,calm faced men, with bloody hands and instruments, are at work. Woundedmen are lying everywhere. What a horrible sight they present! Here thebones of a leg or an arm have been shattered like glass by a minnieball. Here a great hole has been torn into an abdomen by a grape shot.Near by see that blood and froth covering the chest of one choking withblood from a wound of the lungs. By his side lies this beardless boywith his right leg remaining attached to his body by only a few shredsof blackened flesh. This one's lower jaw has been carried entirely away;fragments of shell have done this cruel work. Over yonder lies an oldman, oblivious to all his surroundings, his grizzly hair matted withbrain and blood slowly oozing from a great gaping wound in the head.Here is a bayonet wound; there a slash from a saber. Here is one bruisedand mangled until the semblance of humanity is almost lost - a squadronof cavalry charged over him. This one has been crushed by the wheel of apassing cannon. Here is one dead, and over there another; they diedwhile waiting for help that never came. Here are others whose quiveringflesh contain balls, jagged fragments of shell, pieces of iron, andsplinters of wood from a gun blown to pieces by an exploding shell, andeven pieces of bone from the head of a comrade who was torn to pieces bythe explosion of a caisson. The faces of some are black with powder;others are blanched from loss of blood, or covered with the sweat ofdeath. All are parched with thirst, and many suffer horrible pain; yetthere are few groans or complaints. The sum of human agony about was sogreat that no expression can describe it. Although the surgeons workwith marvelous haste, the number demanding their attention seems alwaysto increase; some come hobbling by aid of an improvised crutch, othersare supported by comrades, while the bloody stretchers and ambulancesever deposit their ghastly freight. Occasionally a shell flies overhead, its scream sounding like that of a fiend rejoicing over thehorrors below. The great diapason of the battle sounds loud or low, asthe contending hosts shift places on the field; [while] cowardlystragglers gather about, spreading stories of disaster anddefeat."

Heavy fighting broke out near 3 p.m. on July 2 andcontinued almost unabated until nearly midnight. Casualties were high.By day's end the Union army suffered over 8,500 wounded and 1,825killed. Dedicated ambulance work was needed well into the evening, butas some ground was lost to the Rebels, it was impossible to collect eachand every downed soldier. The ambulance corps was by most accounts,skilled and efficient in its work, having enough practical experienceand drill since late 1862 to be able to handle any ordinary situation.On the average at Gettysburg each infantry corps mustered between 80 and100 ambulances, plus medical wagons, etc. The Eleventh for one, counted100 ambulances, nine wagons, 270 men and 260 horses. [37]

Several valuable descriptions of the activities ofthe ambulance corps on July 2 have survived. One, that of Dr. JosephThomas, 118th Pennsylvania, gives an interesting perspective of the 1stDivision, Fifth Corps.

"About eleven o 'clock at night the ambulanceswere busy collecting and carrying to the rear great loads of mangled anddying humanity. The wagon-train, with tents and supplies, had not yetarrived, and the wounded were deposited on the ground....As they wereremoved from the ambulances they were placed in long rows, with noreference to the nature or gravity of their injuries nor condition orrank. Friend and foe alike, as they had been promiscuously picked wherethey had fallen, were there laid side by side in these prostrateranks.... Soon the ambulances ceased their visits...[to await] as dawnshould appear to furnish light for the painful work. Opiates wereadministered to alleviate pain, and water supplied to appease theirthirst.... Sounds of pain and anguish, invocation and supplication,singing, and even cursing by some in their delirium or sleep,... At lastmorning dawned, and at the same time orders were received to remove thewounded farther to the rear and out of range of the enemy'sbatteries,... [38]

But for a more mechanical look at the evacuation,there is this piece written by ambulance chief Lieutenant Joseph C. Ayerof the same corps as Dr. Thomas.

"As soon as the division was placed in positionall my stretcher men, under their lieutenants and sergeants, were sentto the front to follow their respective regiments; leaving onelieutenant and three sergeants in charge of the train. I conducted thetrain to a point two hundred yards in rear of the second and thirdbrigades, where it was rapidly loaded with severely wounded. Owing tosome misunderstanding there was a delay in locating the divisionhospital and the wounded men remained in the ambulances about an hour,when the hospital was established and the wounded unloaded. Theambulances then commenced regular trips to the battlefield and wereconstantly at work during the night."

Lieutenant Ayer further relates that shortlyafterward he too was called on to relocate the injured to a more secureregion. [39]

The officer in charge of the Second Corps recoveryteams was Captain Thomas Livermore, who had been assigned the positionof "chief of ambulances," only two days earlier on June 30. In aninstant Livermore had gone from a company line officer in charge of 30men to, as he reveals, a "command [of] two or three hundred men, adozen officers, and a large train;...." He added that he went fromtrudging along dusty roads with his foot soldiers, to riding away on a"spirited and strong-limbed horse." Livermore described his neworganization in detail:

"The ambulance corps consisted of three trains,one for each division of the army corps. Each train consisted offorty-two horse ambulances, [about three to a regiment] with a few forthe artillery, several wagons with four horses to carry forage andrations in, and a forge wagon for repairs and horseshoeing, with severalold-style four-horse ambulances. The men were selected proportionatelyfrom the regiments, and consisted of a driver for each ambulance andwagon, two stretcher-carriers for each wagon, and several blacksmithsand supernumeraries.... The total force of the ambulance corps [SecondCorps] was, in round numbers, 13 officers, 350-400 men, and 300 or morehorses, with a little over 100 ambulances and 10 or 12 forage and forgewagons;... Each two-horse ambulance was a stout spring wagon,...withsides a little higher than theirs along each side. Inside this wagonwere two seats the whole length,...stuffed and covered with leather.Hinged to the inner edges of each of these seats was anotherleathercovered seat, which could be let down perpendicularly so as toallow the wounded to sit on the first seats facing each other, or couldbe raised and supported horizontally on a level with the first seats,and, as they filled all the space between the first seats, thus made acouch on which three men could lie lengthwise of theambulance....

"On each side of the ambulance there was hung acanvas-covered stretcher to carry the wounded on, and the wholeambulance was neatly covered with white canvas on bows. The horses wereall good ones and well kept; the men were stout, and the officers wereintelligent."

In his memoir, Captain Livermore purported his"superintending and collection and dispatch" of the wounded ofthe Second Corps from after twilight till midnight of the July 2, thenonce again on July 3. On the second his trains parked in proximity tothe farm of Sarah Patterson on the Taneytown Road where the 2nd Divisionhospital was laid out under Surgeon Dwinell. Dwinell later acknowledged"the faithful and efficient services rendered by theambulances...[and] the great care and consideration they manifested forthe wounded." Initially the human cargo of the Corps was dropped offat Patterson's. But the following day, Livermore was directed by theCorps' medical director, Dr. A.N. Dougherty to pick a sheltered locationfor a "general field hospital, where all the wounded could be carriedand provided with shelter and treatment until the battle was over."He selected a spot on Rock Creek about a mile-and-a-half down streamfrom the Baltimore Pike bridge. From that time on all of the casualtiesof the Second Corps were removed from the Taneytown Road farms andfields and relocated within the grounds of the new site. [40]

What emerges is that for many of the corps, theprimary hospital establishments had been placed absurdly close to thefront, eventually causing all to be uprooted and settled elsewhere. AsDr. Dwinell testified: "We have almost invariably had occasion toregret having...our Hospitals too near to the line of battle."

In relation to these aforementioned places, Dr.Justin Dwinell, who was surgeon-in-charge of the Second Corps fieldhospitals, left his peers with an official version of the activitiessurrounding them. In this report he concedes that the overall debilityof the troops after the "protracted daily marches," caused them to beill prepared "to bear up under the shock of wounds and the subsequentexhaustion of the system." As to the field hospitals on July 2, his2nd Division was at Sarah Patterson's stone barn, the 3rd Divisioncamped at a barn 300 yards away on the same road, and the 1st Divisionwas adjacent to the Granite School House to the right and rear of the3rd. The last named was soon shelled out of position by Rebel batteriesand was moved to McAllister's Mill on the Baltimore Pike.

Again as in other corps, rations were hard to obtain,and cooking utensils were borrowed from nearby farmers, all dueprimarily to the absence of the supply trains. The operators atDwinell's establishment kept up with their surgery at four tables untilafter 4 p.m. when the accumulation of so many wounded forced them tolose momentum. On the 3rd food was obtained for the 500 casualties athis hospital. By 1 p.m. on July 3 the wounded were in motion to thesecond position spoken of by Captain Livermore, which was a mile and ahalf down the Taneytown Road and on the farm of George and Anna Bushman,east of the farmhouse in a bend of Rock Creek. All injured in the threedivisions were evacuated by nightfall. The operations continued, butthere was a great need for tents, straw, transportation, shovels, axes,blankets, and eatables. On the fourth, 6000 rations of tea, coffee,sugar, soup, crackers, salt, candles, pork, and 3000 pounds of beef onthe hoof were provided. The U.S. Sanitary Commission added soft bread,wines, oranges, lemons, and other dietary items, plus clothing.

This hospital changed its locality to higher groundabout July 22 and into a clover field across Rock Creek and nearer tothe farm buildings of Jacob Schwartz. Altogether this facility cared for3,260 Union and 952 Confederates, making it the largest field hospitalextant after the battle. Dwinell had between 17 and 30 doctors availableto him at various times between July 4 and August 8 when the hospitalclosed. He emphatically voiced his distrust of the skill and dedicationof civilian volunteer and contract surgeons, citing them as too"unreliable." Dr. Dwinell complained too of the hundreds of able-bodiedskulkers that invaded these safe areas, and who "consume the food andoccupy the shelter provided for the wounded." In that hospital therewere 437 deaths, of which 192 were Southerners. In conclusion, Dwinellfelt the medical department of the Second Corps was made up of practicalmen of large experience and observation. "It is thoroughly organized,"said he. "Every Surgeon knows beforehand whether he is to remain onthe field or return to the Hospital in the time of Battle. In eithercase he knows the part he is to perform. They have become familiar withtheir duties....they were indefatigable in the performance of theirlabors,...and did all in their power to alleviate the sufferings of thewounded." Ending his manuscript, he made this observation:"[P]robably at no other place on this continent was there evercongregated such a vast amount of human suffering. [41]

Justin Dwinell's last quote is correct. From onesingle calamity the United States had never been exposed to as manycasualties caused by any natural or human incited event. It is alsolikely that his statement still holds true today. The literally hundredsof eyewitness versions that describe the horror of Gettysburg wouldalone fill a large volume. Everyone who saw the catastrophe wassingularly impressed and often aghast at the hideous sea of misery whichsurrounded the community. Within seventy-two short hours, over 7,100people had been sent to eternity, while 33,300 more remained aliveweltering in their own blood and waste, anxiously awaiting and evenbegging for medical treatment. Of these, several additional thousandsshortly perished.

One of the thousands of idle spectators who traveledto Gettysburg in the wake of the battle was a preacher named Cort fromSomerset, Pennsylvania who, like so many, could not resist the impulseto set down their recollections of a visit to hell.

"The scenes of suffering among the many thousandsof wounded of both the Union and Confederate armies which came under myobservation in the few days I spend in and about Gettysburg on thatmemorable occasion, are altogether indescribable. Human language isinadequate to do it justice. The horrors of war were revealed in a waythat was sickening to the heart. The ghastly wounds, the moans and criesand screams of anguish, the ravings of those whose reason had beendethroned, and the appeals for water to allay thirst and morphine toease pain, were such as to move the stoutest hearts. One of the streamshad overflowed its banks, and a number of wounded confederates weredrowned and their bodies swept away by the raging waters. Great piles ofamputated limbs lay around. Experienced surgeons and medical studentsfresh from the schools were at work like so many bloody butchers. Theputrid and swollen remains of slaughtered men and horses filled the airwith malaria, which soon brought disease and death to visitor from allparts of the country, as well as to the inmates of the crowdedhospitals. Suffering and death were everywhere, and the efforts putforth for alleviating the latter, though rendered by hundreds of willinghands, seemed as but drops to a bucketfull when compared to the vastaggregate all about us." [42]

Preacher Cort saw the field on July 8 after almost aweek of aid had been administered to the 22,000 wounded left behind bythe two armies. An active imagination might attempt to view the problemsencountered even earlier when the medical directors and surgeons were,in the constant shifting of hospitals, doing their utmost to rendercomfort to their wretched patients under more extreme and adverseconditions.

At the end of the third day not only had the First,Eleventh and Second Army Corps field hospitals been safely reestablishedas previously encountered, so had the Third, Fifth, Sixth, and TwelfthCorps. The Third and Fifth, after fierce fighting on the Union leftduring July 2 had also mishandled the positioning of their hospitals onthe day of battle. This tactical error required realignment from spotscarelessly selected on farmsteads, in woods, and in meadows along theTaneytown Road and out toward the Baltimore Pike, to protected and morepermanent camps south and southeast of Gettysburg. The Third Corps' twodivisions were lastly settled south of and along White Run 300 yardsfrom its junction with Rock Creek, a place southwest of the farmbuildings of Jacob Schwartz and east of those of Martha and MichaelFiscel. The site was reportedly high, dry and "airy," with plenty ofwater nearby. However, Surgeon J.W. Lyman, 57th Pennsylvania, describedpart of it as "finely wooded and [on a] shady slope."

The Third's medical director Thomas Sim was notpresent; he was ordered to accompany Corps commander Daniel Sickles, whohad lost a leg in the fray, to Washington. Under Surgeon ThaddeusHildreth this camp handled about 2600 U.S. wounded, and 259 of theenemy, and closed its operation on August 8. One division there reported813 casualties - of these there were 97 operations performed, 53 beingamputations. [43] Immediately after the battle, anarmy physician stationed at this site declared that most of his patientswere "lying on the wet ground without any shelter whatever. Thepeople in this district have done nothing for them."

On July 9 this same Pennsylvania doctor, WilliamWatson, was posted as one of the operators of his division and withseven other medicos serviced the ills of 813 wounded and 100 capturedConfederates, who were "in a most distressing condition." He indicatedthese facts on July 18: "The mortality among the wounded is fearful -caused principally by Gangrene, Erysipelas, Tetanus and SecondaryHemorrhage. Our secondary operations have been very unfavorable. Most ofthe cases die." [44]

The U.S. Fifth Corps, like its July 2 companionfighting force, the Third Corps, grouped all three divisions much toonear the battle lines, mainly around the Jacob Weikert farm and fieldsadjacent along the Taneytown Road, just in rear of the Round Tops. Onelocation was about a half mile from the base of Big Round Top andcontained 250-300 casualties from the 1st Division. The 2nd Divisionunder Assistant Surgeon John S. Billings commandeered the Weikert place,and with three Autenreith medicine wagons, and the farmer's food onhand, he "performed a large number of operations, [and] received andfed 750 wounded." He too acknowledged assistance from the SanitaryCommission.

On July 3 at 7 a.m. orders led to the abandonment ofthis farm hospital to another site, "in a large grove of trees,entirely free from underbrush, on the banks of a little creek, about amile from the Baltimore Pike." Two thousand rations arrived, andwith some common infantry shelter tents the suffering men were arrangedas comfortably as possible. The fifth of July brought up many of themedical supply wagons, so tents and other articles allowed the 800injured of this division to be protected and fed. On the same day,Jeremiah Brinton of the transportation section finally arrived withLetterman's special supply train, and quickly distributed the valuablematerial to all of the corps' hospitals. Dr. Billings alone received 17large hospital tents and many tent flies, which were immediatelyerected. Tools were his greatest need; a few had been procured fromlocal farmers, and were put to use digging graves and latrines. SurgeonCyrus Bacon, a colleague of Billings, also left a memoir of service inthe Fifth Corps hospitals. He states that only the most serious caseswent into tents, and that many of the worst wounds caused by the Miniebullet resulted in Pyaemia setting in. It was one repercussion aftercapital operations and "almost invariably proved fatal." Baconunderscored the reality that of the eleven surgeons on duty, atdifferent periods, eight were taken ill, including the narrator himself,who was seized with an inflammatory diarrhea.

The final dispositions of these hospitals, under Dr.A.M. Clark were as follows: 1st Division, on Sarah and Michael Fiscel'sfarm, north of the house and south of Rock Creek, with the barn used forthe worst cases; 2nd Division, south of Jane Clapsaddle's house, acrossLittle's Run; and 3rd Division one-half mile west of Two Taverns, onJesse and Ann Worley's farm. The three sheltered 1,400, out of a totalFifth Corps loss of 1,611. [45]

The most fortunate body of Federal troops in serviceat Gettysburg was the Sixth Corps. Its medical director, CharlesO'Leary, assigned Dr. C.N. Chamberlain to manage the hospitals whichsuperintended about 315 wounded. Many of the Corps' infantrymen werethoroughly worn down by a rapid forced march of 32 miles prior toreaching Gettysburg. Previously it had covered 100 miles in four days,yet percentage-wise, few men had fallen out of the columns. Since it wasnot heavily engaged the Corps suffered only 27 killed and 185 wounded.[46] Yet the field hospital on the 165 acre farm ofJohn and Suzannah Trostle along Rock Creek, cared for an assortment ofmaimed Southerners and an overflow of men from the Fifth, Third, andSecond Corps. The injured here received especially good treatment andattention, and had quarters in tents and in Trostle's house, barn, andoutbuildings, although one soldier complained of the lack of enoughfood. In early August, as was usual, this facility was closed, and theremaining patients transferred to Camp Letterman east of Gettysburg orto the railroad for shipment to other governmental general hospitalsmiles away. [47]

George Bushman House, Twelfth Corps Hospital

The two divisions of the Twelfth Corps foughtprincipally on the right flank of the army and tallied 406 wounded inthe 1st and 397 in the 2nd, these mainly shot while entrenched in thevicinity of Culp's Hill. Strangely, their permanent field hospitals werepitched along a farm road leading from the Baltimore Pike past Power'sHill to the lower crossing of Rock Creek, and east and north of thehouse of George and Anna Bushman which stood nearby. In sizing up thetopographical nuances of the field, it would seem more appropriate tohave assembled these camps nearer to the Corps' actual area of combatoperations. As previously noted, the medical supply wagons for theTwelfth accompanied the ambulances, thereby preventing undue sufferingto hamper the battle harmed infantrymen and artillerymen assigned tothis organization. Medical Director John McNulty claimed to havesuccessfully removed, fed, and treated all 1,006 injured under hissupervision (along with 125 Confederates) within six hours after the endof hostilities. Due, he said, to the presence of the medical wagons andtheir invaluable contents. Surgeon John H. Love, 13th New Jersey, in ahomebound letter from the Bushman farm indicated that he knew of twelvephysicians who remained with these patients. Another doctor, H.C. May,145th New York, was fortunate enough to have the services of his spouse,a volunteer nurse in attendance in a ward on site. Dr. May continued toserve at Camp Letterman and then was put in charge of the hospital traincarrying wounded to York, Pennsylvania. [48]

Returning to the first day's casualties that weresheltered on the premises of the First and Eleventh Corps hospitals, wefind that by the end of the first week of July these stations were instable condition, especially as they sat near the Baltimore Pike, themain supply route into Gettysburg, and were close to the depotsestablished by the Sanitary and Christian Commissions, and by Dr.Brinton for the army itself. They were also fortunately in proximity tohard roads leading to the railroad depot and eventually CampLetterman.

Included in these hospitals were those men capturedby the Confederates inside the town field hospitals. The three divisionsof the First Corps had a sum of 3,231 casualties out of about 9,000engaged, or about 36 percent. The 1st Division sheltered its men at andnear Mark's German Reform or the "White Church" out on the pike, andjust south of White Run, and on the farm of Barbara and Isaac Lightnereast of the road; the 2nd bivouacked on Peter and Ellen Conover's farm,south of White Church and west of the turnpike; the 3rd Division lay onthe Jonathan Young property northeast of Two Taverns. Evidence supportsthat many of the 260 Southerners cared for in these hospitals werecamped convenient to the church. [49]

Northward on the Spangler farm which was nestled justbelow the rounded summit of Power's Hill, doctors of the Eleventh Corps'three divisions struggled to stabilize and provide for the needs of atleast 1,400 of its 1,922 wounded that had been carried to that locale.Since it was the closest permanent multi-divisional facility to thefront lines, it was periodically awakened from any boredom by thearrival of various and sundry Rebel cannonballs and shells. During thebattle, thirteen medical officers were struck by enemy fire, and one,the only fatality, occurred here when Dr. W.S. Moore, 61st Ohio, wasseverely injured on July 3 and died on the sixth. One witness observedthree operating tables in use at the barn, which resembled "more abutcher shop than any other institution...." About 100 Confederateswere in residence, including General Lewis Armistead who died there lateon July 3. Comments concerning this facility seem to put it in a goodlight, as the Sanitary Commission gave much aid to the staff. But therewere reports of delicacies meant for the soldiers, being improperly usedby "gluttonous surgeons" and other "hangers-on," and the usual cowardlyriff-raff absent from the line units.

Like the several other corps, the Eleventh'sinstallations took in its share of artillerymen and cavalrymen, sincethese combat arms did not regularly maintain totally separate fieldhospitals.

By the second week after the battle, all of the Unionhospitals were fairly well supplied with volunteer nurses, and the 20extra physicians sent by Surgeon General Hammond. Provisions provided bythe army's chief commissary, Colonel Henry F. Clarke, were arriving,while miscellaneous items were offered by relief organizations, such asthe Sanitary Commission, and by a scattering of citizens in Adams Countyand elsewhere. [51] Regretfully, there were greatcriticisms directed at some local civilians, excluding many inGettysburg proper, for the lack of food and attention donated to thethousands of helpless individuals in their midst. These condemnationswere usually heaped upon the heads of the German or "Dootch" farmers inthe countryside encircling the town, and were expressed vehemently byscores of witnesses from general officers to the lowest private. [52]

In the days directly succeeding the three daycontest, both the Army of the Potomac and the Army of Northern Virginiavacated south central Pennsylvania in a continuum of the campaign asthey marched southward into Maryland and Virginia. Dr. Letterman,fearing a resumption of combat, assimilated most of his 650 medicaldepartment physicians and hundreds of attending nurses and stewards,plus 3,000 ambulance personnel back into the army which was thenpursuing Lee's scattered and retreating forces. With this untimely butnecessary decision, only 106 doctors were allowed to remain with nearly22,000 injured Federal and Confederate soldiers, who lay inapproximately 50 makeshift field hospitals in and surroundingGettysburg. Fortunately, these few surgeons were supplemented by theaddition of Hammond's bequest and the crop of civilian and contractphysicians still in the vicinity.

As the middle of July arrived, the heavy rains thatfollowed the battle began to roll away. With that clearing came a breakin the bleak prognosis given to the thousands of wounded still atGettysburg. Several changes improved the climate for these patients. Thefirst was that Letterman, upon his departure, placed Dr. Henry Janes incharge of all of the field hospitals at Gettysburg. Janes was a U.S.Volunteer surgeon formerly of the 3rd Vermont Infantry, a Sixth Corpsunit. He quickly moved to consolidate the entirety of medical facilitiesboth U.S. and C.S., whether in private dwellings, on farms, or indivisional tent/field hospitals, into one general and more permanentestablishment east of the town.

The "general hospital on the field" concept hadalways appealed to the director. It was soon ordered by General Meadeand approved by both Hammond and Letterman because it was easier tosupply and maintain. This approach also prevented the too hurriedremoval and secondary injury of the more seriously hurt but convalescentpatients. By the waning days of July this large camp was in fulloperation; however, Dr. Janes permitted three other clinics to remainviable, one each in the Lutheran Theological Seminary, express office,and the Public School building on High Street in Gettysburg.

The second stroke of efficiency on Letterman's partwas the enormous effort maintained to evacuate every wounded soldier whowas able to travel on to major medical facilities in Annapolis andBaltimore, York, Chester, Philadelphia, and New York, where over 12,000beds were unoccupied and available. Normally the Army of the Potomac'scasualties went to Washington or Alexandria, but these city hospitalswere still heavily dominated by the battle residue from Chancellorsvilleand Fredericksburg. Letterman was castigated by at least one of hispeers for leaving only four wagons and six ambulances with each corpsmedical unit for this massive transportation effort, and for allowingone doctor for every 150 patients. The press of duties lessened somewhatwhen 50 additional ambulances were received from Washington along withthe aforementioned supplemental physicians.

On July 29, U.S. Medical Inspector E.P. Vollum, whowas sent to study the situation at Gettysburg by the Surgeon General onJuly 7, reported to his superior Colonel John M. Cuyler thesetransportation facts:

"Including the 1,462 patients sent away from thebattlefield before his arrival, by the 23rd of July a total of 15,425wounded had been removed to various general hospitals on the EasternSeaboard. These numbers included 3,817 Confederates, leaving atGettysburg on July 23, 1,925 Rebels (of the 6,802 in Yankee hands) and2,922 Northerners. [54] Part of his report containedthis interesting comment: "For a correct number of rebel wounded, thosemust be counted that were left at Chambersburg, Carlisle, Hagerstown,Funkstown, Martinsburg, Winchester, and the various farm houses andbarns on the way, which will doubtless foot up to about 15,000 makingthe probable number of wounded on both sides 35,000 in roundnumbers." [55]

During the Gettysburg Campaign, General Herman Hauptwas in charge of transportation and construction on the U.S. MilitaryRailroad system. He supervised not only the funneling of supplies to thearmy before the battle, but in consequence of the fighting he beganrunning five trains grouped together, making available 15 trains eachway daily from Baltimore to Westminster, Maryland until the ruined railbranches to Littlestown, Hanover, and Gettysburg were repaired andreopened between July 5 and 7. With these trains he was able to putthrough, under the direction of Dr. J.D. Osborne, 4th New Jersey, 150cars containing 2,000-3,000 injured and sick daily. With the base ofsupplies and transportation in Baltimore, 55 miles away, cars began toply from Gettysburg on the 7th, habitually leaving several times a daybetween 9 a.m. and 5 p.m. For instance on July 12 six trains departedGettysburg carrying 1,219 patients from both armies. For a time thewounded were arriving at the terminus of the railroad faster then theycould be taken away, resulting in hundreds of "poor wretches [left]to pass the night there without food, shelter or attendants." Thisgrim status was soon amended by the Sanitary Commission who erected two"lodges," one about a mile eastward on the York Turnpike where thedestroyed railroad terminated, then later another next to the railroaddepot in Gettysburg itself.

These sanitary lodges provided the essentialspatients needed while awaiting transportation, such as a kitchen toprepare food, tents, beds, and nurses. The commission later claimed tohave fed every man of the 16,125 that left Gettysburg in the earlystages, and "to have sheltered 1,200, and to have furnished very manywith clothing."

A woman who worked with this agency explained how thelodges operated:

"Twice a day the trains left for Baltimore orHarrisburg, and twice a day we fed all the wounded who arrived for them.Things were systematized now, and the men came down in long ambulancetrains to the cars; baggage-cars they were, filled with straw for thewounded to lie on, and broken open at either end to let in the air. AGovernment surgeon was always present to attend to the careful liftingof the soldiers from ambulance to car....

"When the surgeons had the wounded allplaced,...on board the train, our detail of men would go from car to carwith soup,..fresh bread and coffee,...[or] ale, milk-punch orbrandy."

Rebels and Yankees were always kept together, shesaid, and for the ones who had to remain over night, clean bandages wereapplied, along with donated basins of water, soap, and towels; last camenew socks, slippers, shirts, drawers, and the most coveted of all,"wrappers" which were multi-colored dressing-gowns. [56]

For the men too ill or hurt to stand evacuationimmediately a general hospital had been authorized and was laid out onemile east of Gettysburg on the south side of the York pike. Constructionbegan on July 16 and the facility opened on July 22 in charge of a 10thMassachusetts doctor, C.N. Chamberlain. In total it held up to severalthousand inhabitants, where, upon an elevated and attractive site, wereerected as many as 400 tents, most situated in six double rows, ten feetapart, with each tent capable of holding 8-12 patients. The entire camp,named after the medical director, was on a plot of 80 acres, with a goodspring of water, and stood just a few hundred yards north of therailroad where it began to parallel the pike, and opposite the site ofthe first sanitary lodge.

During the four months of its operation, on averagethe camp weekly fostered between 1,200-1,700 of the most critical cases,several hundred of which were Confederates. The medical staff counted nofewer than 400 doctors and attendants, and at various times outnumberedthe patients themselves. Each surgeon, including a score or so ofSouthern physicians who remained with their wounded, supervised from 40to 70 recuperating soldiers. Since the injuries were so severe, many mendied at Camp Letterman, a majority being Confederate, and all 350-400dead were buried in a cemetery south of the main compound. In one sampleit was shown that of the 345 individuals there with gunshot fractures ofthe femur, amputations were performed on 158 cases, and of these 101deaths occurred.

As quickly as a patient could be transported, he wascarried to the railroad for removal, so the number of convalescentsfluctuated from over 1,000 in mid July to 1,600 on August 30 then to 326on October 18. The last man left about the third week in November.Officially, Letterman Hospital closed at the end of that month, but askeleton staff remained under Surgeon Janes to break up the camp, andsend off all government supplies and material. With the shutdown of CampLetterman, the Army of the Potomac's medical role in the Battle ofGettysburg came to an end. [57]

In evaluating the medical department's handling ofthe enormous calamity which they inherited during and after this, thelargest battle of the Civil War, the first question asked could be: howwell did Medical Director Jonathan Letterman believe his organizationfunctioned during the emergency? Reporting to General Meade in October,1863 he summed up the mistakes made during the campaign, and describedthe problems encountered and whether or not they had been eliminated. Healso complimented his officers and men where they deserved credit.Overall, Letterman was most unhappy with the number of medical supplywagons that accompanied the army, and with the absurd practice ofabandoning them to the rear when the troops went into battle. Supplies,such as tents, were usually abundant he made clear, but getting them tothe wounded was the greatest challenge. Making note of Surgeon McNulty'ssatisfaction of having the Twelfth Corps' trains remain with theirtroops, Letterman admonished:

"I can, I think, safely say that such would havebeen the result in other corps had the same facilities been allowed - aresult not to have been surpassed, if equaled, in any battle ofmagnitude that has ever taken place."

He, like Surgeon Dwinell, also placed no reliance ondoctors from civil life, saying that they "cannot or will not submit tothe privations and discomforts which are necessary" during or after abattle. Of his own 650 staff and regimental physicians he reminded thecommanding general that they "were engaged assiduously, day andnight, with little rest, until the 6th, and in the Second Corps untilJuly 7, in attendance upon the wounded. The labor performed by theseofficers was immense. Some of them fainted from exhaustion, induced byover-exertion, and others became ill from the same cause. The skill anddevotion shown by the medical officers...were worthy of allcommendation; they could not be surpassed."

So too was his admiration for the ambulance corps. Indescribing their actions throughout the battle and afterward, he claimedit "acted in the most commendable manner during those days of severelabor," and of the army's [14,529] combat injured, "not onewounded man of all that number was left on the field within our linesearly on the morning of July 4." In accomplishing this feat, fivemen were killed and 17 wounded from this corps. And in the end,considering that 21,331 Union and Confederate patients were thrown byfate onto his department's resources, which "conspired to render themanagement [of it] one of exceeding difficulty," Letterman couldstill say that "the wounded were well taken care of...especially sowhen we consider the circ*mstances under which the battle was fought andthe length and severity of the engagement."

Although Major Letterman naturally placed hisdepartment in the very best possible light, he and his subordinates hadfaced some formidable tasks. Most were overcome, but not without causingundue pain, suffering and death to many of their charges. Medicalsupplies were insufficient at Gettysburg, due to the holding back of thetrains. But the main cause was the abnormally high number of wounded.Ten thousand could have been handled conveniently, and the 14,000 U.S.line casualties could have been at least well managed, but with inexcess of 21,000, coupled with the absence of supplies, these factorspiled up a mass of difficulties that transcended the departments bestcapacity. Other areas of concern which went beyond Letterman'sabilities, or control, were the unusually severe wounds encountered atGettysburg inducing a very high death rate. There was also the conditionof the infantrymen themselves; the inordinately long and difficultmarches preceding the battle wore down the men and generated a climateof sickness, which made them less able to counter the adverse effects ofeven a slight injury. Then too, following the fighting, the area'srailroad system was in complete turmoil, and near total breakdown, withdestroyed roadbeds and bridges, and numerous damaged engines and cars,all tied to a civilian work force which were not motivated to quicklyclean up the mess.

According to General Haupt, even as late as July 9 hefound "things in great confusion. Road blocked; cars not unloaded;stores ordered to Gettysburg, where they stand for a long time,completely preventing all movement there; ordered back withoutunloading, wounded lying for hours, without the ability to carry themoff..." He was also highly distressed to find an "utterindifference manifested by the railroad companies toward the sufferingsand wants of our wounded at Gettysburg,....The period of ten daysfollowing the battle...was the occasion of the greatest amount of humansuffering known to this nation since its birth, [and] the railroadcompanies, who got the only profit of the battle, and who had thegreatest opportunities of ameliorating the sufferings of the wounded,alone stood aloof and rendered no aid."

Along with these areas of concern stood Letterman'sweak managerial style and organizational abilities and in his lack ofplanned evacuation facilities. One historian noted that, "there wereno supporting medical services between the division and the generalhospitals in the rear. He [Letterman] could handle an engagement andtake good care of the wounded but this tied up his division hospitalsand ambulances, and required considerable time after an engagement toreorganize and again be ready to handle a considerable number ofwounded." This imperfection would have been most apparent, had itnot been somewhat corrected by his successor during 1864, when Meade andGrant chose to hammer Lee's army for several months without letup. Inthese campaigns, the need for "an elaboration of Letterman'sorganization was shown. This elaboration, however, was not thoroughlydeveloped until the [First] World War."

Jonathan Letterman's systems of evacuating thewounded, supplying the department, and establishing field hospitals andwork directives for his staff, were models of simplicity and excellenceand were sorely tested throughout his one year and five months with theArmy of the Potomac (he resigned in December 1863). Although notperfected, these devices did allow the army to cross many hurdles andpass through rigorous trials, and as improvements came over time theyset up some of the best military and civilian standards for medicalservice available even well into the Twentieth Century. [58]

Epilogue

Today at Gettysburg, hundreds of granite, marble andbronze memorials cover the fields, woods, and hillsides where two greatarmies clashed in the summer of 1863. The ground is a shrine, a mecca,for thousands of Americans who come to the battlefield out of curiosityor remembrance, or to pay tribute to the men and deeds of that fiercecontest. But of all the monuments, less than a dozen speak for thevaliant services of the medical departments of both armies. And worse,the military hospital sites themselves, due to their remoteness from thefield of battle, rarely see visitors, and are slowly being encroachedupon and destroyed by the polluting hand of humankind. The grounds, thefarms, the old structures, with no agency to protect them, and nobenevolent patriarch to support and care for them, fall prey to therelentless march of progress and soon most will become shopping centers,parking lots, golf courses, and housing developments.

NOTES

1. Duncan, Louis C. The MedicalDepartment of the United State Army in the Civil War. Washington, DC(1910): 16.

2. Duncan, 25.

3. Duncan, 27.

4. Livemore, Thomas L. Numbers& Losses in the Civil War in America: 1861-1865. Bloomington, IN(1957): 79-86.

5. Adams, George W. Doctors inBlue. New York, NY (1952): 25.

6. Adams, 5 & 22.

7. Adams, 27 & 29.

8. Adams, 31-35.

Gillett, Mary C. The Army Medical Department1818-1865. Washington, DC (1987): 177-80.

9. Womeley, Katharine P., " TheOther Side of War, " an article in the papers of the Military Orderof the Loyal Legion of the U.S. (MOLLUS), Massachusetts Commandery. vol.III, Wilmington, NC, 1993.

Clements, Bennett A. Memoir of JonathanLetterman. New York, NY: 1883, 25-26.

10. Duncan, 96.

11. Letterman, Jonathan, MD.Medical Recollection of the Army of the Potomac. New York, NY(1866: 22-23.

12. Letterman, 23-25.

13. Duncan, 98-99.

14. Gillett, 179-191.

15. Letterman, 38-39, 41.

16. Gillett, 192.

17. Letterman, 46-47.

Official Records of the War of the Rebellion.Washington, DC (1887): vol. 19, part I, 106-117.

18. Duncan, 103.

Gillett, 193.

Letterman, 58-63.

Official Records, vol. 19, part I,114-116.

19. Official Records, vol.19, past I, 116.

20. Duncan, 172.

21. Duncan, 191.

22. Duncan, 202.

Gillett, 194.

23. Duncan, 203.

24. Gillett, 208-210. Letterman,116-119.

25. Fatout, Paul, ed. Letters ofa Civil War Surgeon. Lafayette, IN (1961): 60.

Gillett, 210.

26. Gillett, 209-210.

27. Letterman, 142-144.

Gould, Benjamin A. investigations in the Militaryand Anthropological Statistics of American Soldiers. New York, NY(1869): 603-605.

Duncan, 214.

Official Records, vol. 27, part III, 213.

28. Letterman, 153.

29. Letterman, 153.

30. Letterman, 154-155.

31. Dwinell, Justin, MD. Unpublishedmedical report of the Battle of Gettysburg. MSC 129, National Library ofMedicine, Bethesda, MD, no date, no page number.

Gillett, 211.

Letterman, 157.

32. Official Records, vol.27, part I, 187.

33. McCreary, Robert G. UnitedStates Christian Commission for the Army and Navy. First AnnualReport, Philadelphia, PA (1863): 59-60.

Hard, Abner, G. History of the Eight CavalryRegiment Illinois Volunteers.... Dayton, OH (1984): 257-258.

Ebersole, Jacob, MD., "Incidents of Field HospitalLife With The Army of The Potomac," an article in the popes of theMOLLUS-Ohio Commandry, vol. IV, 328. ALIGN="justify">34. Letterman, 24-30, 55.

National Park Service (NPS) pamphlet entitled,"Field Hospitals During the Battle of Gettysburg, "no date,1.

35. Ebersole, 329.

36. National Park Service (NPS)pamphlet entitled, "Hospital Markers Army of the Potomac MedicalDepartment," no date, 1, 3.

Duncan, 235-247.

37. Weist, J.R., MD, "The MedicalDepartment in the War," an article in the papers of the MOLLUS-OhioCommandry, vol. II, 92-93.

Duncan, 225.

38. Smith, John L. History of theCorn Exchange Regiment Philadelphia, PA (1888): 253.

39. Stewart, Miller J. Moving theWounded Ft. Collins, CO (1979): 47.

40. Livermore, Thomas L. Days andEvents, 1860-1866. Boston, MA (1920): 237-240, 243, 258. Dwinell, nopage number.

41. Dwinell, no page number.

42. Hoke, Jacob. HistoricalReminiscences of the War.... Chambersbsurg, PA (1884): 194-195.

43. Medical and Surgical Historyof the War of the Rebellion. Washington, DC (1875-1885): Appendix,vol. I, 147.

Duncan, 239-240.

NPS, "Hospital Markers,"/I> 2.

44. Fatout, 70-73.

45. Duncan, 245-240.

Medical and Surgical History.... Appendix,vol. I, 145-147.

Duncan, 246.

46. Duncan, 246-247.

Coco, Gregory A. A Strange and Blighted Land:Gettysburg, The Aftermath of a Battle. Gettysburg, PA, (1995):207.

47. Duncan, 249-230.

48. Love, John H., MD Copy of letterdated "July 7. 1863" in the New Jersey Historical Society, Trenton, NJ,1.

May, Mrs. H.C. Copy of letter dated "August 29, 1886"in the collection of the Gettysburg National Military Park Library(GNMP).

49. Duncan, 235.

50. Duncan, 248-249.

Coco, 208-209.

NPS, "Hospital Markers," 3.

Official Records, vol. 27, part 1, 197.

51. Official Records, vol.27, part I, 197.

U.S. Army, The Battle of Gettysburg.Unpublished pamphlet by The Medical Field Service School, CarlisleBarracks, PA 1929, 22.

52. Coco, 248-254.

53. Letterman, 158-159.

Official Records, vol. 27, part III, 533.

54. Letterman, 158. Gillett,213.

Duncan, 21.

55. Medical and SurgicalHistory.... Appendix, vol. I, 143-145.

Vollum, Edward P. Letter dated "July 29, 1863,Washington, DC," RG94, National Archives, copy in GNMP Library.

Official Records, vol. 27, part I, 27-28.

56. Medical and Surgical History.... Appendix, vol. I, 144.

Duncan, 214, 258-260.

U.S. Sanitary Commission. A Sketch of Its Purposesand Its Works. Boston, MA (1863): 128-131.

Official Records, vol. 27, part I, 25-26.

57. Duncan, 260-261.

Coco, 226-237.

Coco, Gregory A. A Vast Sea of Misery A Historyand Guide to the Union and Confederate Field Hospitals at Gettysburg,July 1 - November 20, 1863. Gettysburg, PA (1988): 167-173.

58. Official Records, vol.27, part I, 195-199.

Official Records, vol. 27, part III, 619.

Official Records, vol. 27, part I, 28.

U.S. Army, 23.