"A LABORIOUS AND VEXATIOUS TASK"
The Medical Department of the Army of the Potomac from the Seven Days through the Gettysburg Campaign
Gregory A. Coco
"[The] battlefield sucks everything into its red
vortex for the conflict, so does it drive everything off in long,
divergent rays, after the fierce centripedal forces have met and
neutralized each other."
Oliver Wendell Holmes
For the medical department of the Army of the
Potomac, the Battle of Gettysburg may have been its most difficult test.
Whether or not it succeeded in that supreme moment will become clearer
as these pages unfold. First, however, it would not be out of place to
examine the important series of events which metamorphosed that
department prior to its climatic appointment in Pennsylvania.
From the very beginning of human civilization armies
have emerged to protect and uphold a nation's citizens' wealth and
territory. And in consequence thereof came the uncivilizing hand of war.
Combat, as well as the large concentrations of encamped soldiers
inherent in military campaigns, resulted in wounds, injuries, and
disease, all of which had to be dealt with for the physical and
emotional well-being of the forces involved. Although some small
advances had been made throughout the centuries, military medicine,
hospitalization, and the evacuation of the sick and wounded had, for its
worth, remained of little import within the overall scheme of an army's
organization, duties, and responsibilities.
By 1860 the United States had itself, barely moved
beyond the concept that "a collection of armed men constitutes an army,"
and similarly from the idea that civil practitioners were, if attached
to that body, competent enough to act as the "medical department." So by
1861, and the outbreak of hostilities between Northern and Southern
states, the prevailing medical philosophy basically remained a task of
the individual, or, every man for himself. In the U.S. Army,
unfortunately, there was regimental aid, and nothing more. But as the
tiny rebellion escalated, and 36,000,000 people became involved, these
old-fashioned ideas and methods were destined to be altered. That
inevitable adaptation though, came slowly and in spurts. Awkward and
haphazard at first, it was also forced to crawl over the self-righteous
protests of narrow-minded civilian and military bureaucrats. Revision
did come because of a natural necessity, and due to the uncounted and
horrible experiences of the men-at-arms who endured the backwardness of
the old system.
"The volunteer soldier offers his very dearest
possession to his country, his blood his limbs, possibly his life. When
the soldier is struck down shall his country leave him on the field
suffering from cold, pain, thirst, even hunger; to die perhaps, without
aid, unless he can drag himself away by his own painful exertions?
Certainly when he gives his dearest possession the country should not be
niggardly, when all it can give is dollars, but should supply an
abundance of the best possible means for his succor." 
The physician who is quoted above believed that the
value of preparedness surpassed all other virtues of an army or its
medical branch. It was akin, he said to that of a fire department to a
city. "It must always be prepared for its main function, and must be
prepared to respond instantly,..." 
This preparedness did not exist in the U.S. Army and
particularly in the Army of the Potomac in 1861 and much of 1862 for two
major reasons. First, the enormous growth of the war and its resulting
waterfall of casualties caught even the most ardent realists by
surprise; and secondly, the normal organization of the medical
machine did not lend itself to quick changes or to the adoption of new
ideas, theories, or techniques. Therefore, it ensured the lack of a
centralized and autonomous system for the evacuation of wounded, the
establishment of field hospitals i.e., "movable hospitals", and the
supplying of medicines, equipment, and provisions, which then became the
main ingredients for disaster in the wake of Civil War battles, great
and small. It took three years before the medical department was truly
capable of satisfactory conduct in transporting and caring for its hurt
and diseased personnel.
Excepting the usual minor and expected complications
encountered in the early battles and skirmishes, it still required the
frightful Peninsular Campaign and its aftermath in the spring and summer
of 1862 to fully thrust into the limelight the helplessness and disarray
of the U.S. Medical Department, as it coped with the casualties of a
growing modern war. A dozen or more engagements, fought by two huge
armies in a markedly unhealthy region of Virginia, complimented by
numerous long and stifling marches and retreats, produced a never before
convergence of sick and bleeding Americans. Added to these bleak
conditions was the lack of fresh water, and the predominance in the
ranks of green untested volunteers fresh from home. Well over 21,000
wounded alone in the Peninsula fighting, told some of the ghastly tale;
the shock to the Northern populace can surely be imagined, especially
when combined with the news of 8,500 additional injured at Shiloh,
Tennessee, during the same period.  And since
victims of disease far outranked the numbers of dead and wounded during
that timeframe, one may clearly understand the sheer magnitude,
unexpectedness and incredulity of these figures.
It was during this particular timeframe that several
significant transitions occurred in the Eastern army. Although not
always 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 the
Army of the Potomac. During King's term his position was frequently
without instruction as to its duties, privileges and powers, and King,
being attached to the commanding general's personal staff, had only such
control as his personal influence might win for him. "He was the only
possible coordinator of the battlefield relief work,yet was without
authority to organize and direct the medical officers and stretchermen
of the various regiments."  Consequently, each
regimental surgeon took responsibility for only his men, leaving all who
fell sick or injured away from his unit, "on their own hook."
Shortly before the onset of Tripler's appointment in
August 1861, the winds of change had begun to blow. These winds had been
assisted and even tactfully nurtured by the newly created United States
Sanitary Commission (U.S.S.C.), the brainchild of Reverend Henry W.
Bellows and Dr. Elisha Harris, both of New York. Concerned that the
sanitation and supply efforts to the armies of the Union were wholly
inadequate for the good of the troops, this private relief agency had
been organized, and had quickly grown. Although the commission's central
desire was quite modest, that of collecting and supplying articles
useful to the sick and wounded, it shortly found itself beset with
roadblocks. However modest as its aims were, initially the U.S.S.C. was
seen by the army's medical officiary in Washington as not only
impertinent and a nuisance, but plainly civilian interference.
Fortunately for the men in the field, as Dr. Tripler commenced his
duties, improvements launched by the Commission, (as its prominence
grew) and more strict adherence to existing army regulations, begun to
make a noticeable difference in the health and morale of the troops. 
Under General George B. McClellan, Tripler, who was
not regarded as an innovator but merely a fine administrator, did seize
the opportunity to institute some long overdue and much needed reforms.
Although constantly stymied by Surgeon General Clement A. Finley, he
still managed to improve evacuation methods, he outlined a clearer
declaration of surgeons' duties, insured better training of hospital
attendants, added more disease prevention, and established auxiliary
general hospitals in Washington and elsewhere. Many of his other ideas
were never implemented due to the indifferent disposition of the
department, the large influx of new enlistments, and other factors
beyond his control.
In April, 1862 a major blockage to progress was
broken up in Washington which would in many ways forever transform the
medical department of the U.S. Army. Surgeon General Finley, described
by one detractor as a "self-satisfied, supercilious, bigoted
blockhead... [who] knows nothing and does nothing..." was removed
from office through the efforts of the Sanitary Commission, major
newspapers, and other forward-looking thinkers. The Medical Corps under
Finley, said the New York Tribune, "is not accused of misifeasance or
malfeasance, but of non-feasance, [and has] done nothing since the war
began."  As a result, the complicated and long
campaign for his replacement eventually netted Dr. William A. Hammond, a
distinguished surgeon and scientist, who was a friend of McClellan's,
and even as an unknown entity was totally supported by the U.S. Sanitary
Commission. But in choosing Hammond they passed over men with seniority,
one in particular was Assistant Surgeon General R.C. Wood, who claimed
he had been promised the position. In the end these "seniors" would have
Dr. Hammond, at 34, could not have been a better
choice. With eleven years of frontier service, he was still open-minded
with a keen inquiring intelligence. These were weighty attributes, but
his eager willingness to tackle the serious problems within the army's
medical system was his chief merit. Regrettably for the country, and
especially its citizen soldiers, he was eventually forced out of office
by the petty and vindictive Dr. Wood and Secretary of War Edwin Stanton.
In the meantime, however, he formulated and implemented desperately
needed priorities for the remodeling of his bureau. Some William Hammond
of these immediate measures insured that expenditures for supplies went
up, "red tape" was cut, supplemental nurses and physicians could be
employed when needed, and a new ambulance organization was instituted.
Further on, he drafted designs to add extra surgeons to regiments and
staff, along with a new complement of medical inspectors for the field
armies and general hospitals. He authored the concept of an Army Medical
Museum and medical school, and sought pay increases and higher ranks for
his dedicated officers. Three of his most beneficial advances involved:
the removal of the transportation of medical supplies and patients away
from the Quartermaster's Department and into the jurisdiction of the
Medical Corps, the betterment and expansion of the general hospitals,
and the replacement of medical directors with younger men who showed
administrative ability, and were "not quite so thickly encrusted with
the habits, forms and traditions of the service." 
One of the men chosen by Surgeon General Hammond to
implement this transformation of the antiquated medical corps was
Jonathan Letterman, MD, a 37-year-old Pennsylvanian and 1849 graduate of
Jefferson Medical College in Philadelphia. Letterman had entered the
army upon receipt of his diploma, and had served in Florida against the
Seminoles, and subsequently spent almost five years on the frontier. In
the two years prior to the Civil War he was stationed at Ft. Monroe,
Virginia and participated in an expedition against Indians in
California. Returning to the East in November 1861 he took up the
position of Medical Director of the Department of West Virginia. On June
19, 1862 Dr. Letterman was ordered to duty as Medical Director of the
Army of the Potomac, succeeding Charles Tripler. He reported to General
McClellan at White House Landing on the Virginia Peninsula, July 1. Upon
receipt of the news of Letterman's orders, a nurse at the Landing named
Katharine Wormely wrote in a letter home: "A new Medical Director of
the army has been appointed, for which we are deeply thankful. He...has
just 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 cause
of suffering, full, it seemed to me, of a strong earnestness in his
work. 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 to
the feelings of others." Surgeon Letterman was also reported to
possess a healthy sense of humor, and a directness of speech and manner,
accompanied by a frank and sincere nature, who was unselfish in his
generous praise of others. General William W. Loring who had served with
Letterman in New Mexico, (and against him in the Civil War) pronounced
him both retiring and gentle, and an ardent student who sought the
"highest knowledge in the scientific advancement of his
During their tenures as Surgeon General and Medical
Director of the Army of the Potomac both Hammond and Letterman,
respectively, worked diligently and in a partnership to bring about
crucial modifications to a structure overloaded and burdened by every
problem imaginable. In following Letterman's handiwork, in combination
with Hammond's guidance during the twelve months prior to the Gettysburg
Campaign, it is possible to observe his accomplishments and failures,
and to understand whether basic lessons he taught and learned from the
end of the Seven Days' Battles through Chancellorsville did or did not
prepare that army's medical branch for its monumental crisis at
When, on July 1, 1862, Jonathan Letterman began his
duties at McClellan's headquarters he was immediately thrust into the
midst of a vast conglomeration of sick and exhausted soldiers who had
endured several months of hot weather, swampy terrain, and the
debilitating effects of long marches and hard fighting. These hardships
were unhappily coupled with a lack of proper diet, bad water, and the
"depression of failure."  Surgeon Tripler
had done his best up to Letterman's arrival, but the many negative
components within the medical department, plus the size and scope of the
campaign 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 of
McClellan's troops were then languishing in crowded hospitals at
Harrison's Landing where the Army of the Potomac had retreated after
Malvern Hill. Letterman immediately went to work, requesting 200 more
ambulances and 1000 additional tents. On August 3 he began the
evacuation of the sick and wounded which continued until August 15.
Finally released from this awesome burden, the army was free to move at
While engaged in this mammoth endeavor, Letterman
still found the spirit and energy to take up the long-standing ambulance
problem and work for its solution. Although the final resolution did not
evolve purely from him, Letterman did devise an innovative and workable
evacuation process and put it quickly into practice. Whereas many
medical officers had learned valuable lessons during the Peninsular
Campaign, (where Letterman had not been present), it was obvious that he
more than anyone had seriously considered the ambulance question and had
already mapped out a simple yet viable formula long before joining
McClellan in July. Letterman, explained the old methods thusly:
"[The ambulances] were under the control both of
Medical Officers and Quartermasters, and, as natural consequence, little
care was exercised over them by either. They could not be depended upon
for efficient service in time of action or upon a march, and were too
often used as if they had been made for the convenience of commanding
Emphasizing his main point, it was clear that during
a time of need, especially in battle, no officer, medical or otherwise
should have control over the ambulances, as these men had their own
duties and responsibilities to attend to. Logically, he saw other
officers, "appointed for that especial purpose, should have direct
charge of the horses, harness, ambulances, etc., and yet under such
regulations as would enable Medical officers at all times to procure
them with facility when needed for their legitimate purpose." 
Briefly, the order which was submitted to and
approved by General McClellan on August 2, (instead of being sent to
Washington where it would have reposed indefinitely) provided an
ambulance force for each army corps, commanded by its own
captain. Moreover, each division had a first lieutenant in charge, a
brigade, a second lieutenant, and a sergeant assigned to every regiment.
The enlisted element consisted of two privates and a driver for each
ambulance. This system allowed every infantry regiment one transport
cart and driver, one four-horse and two two-horse ambulances; plus one
two-horse ambulance for each battery of artillery, and two two-horse
ambulances for the headquarters of each army corps. (A two-horse
ambulance was actually a light, four-wheeled vehicle and a four-horse
ambulance was akin to an army wagon.) 
Albeit all ambulance corps officers and men came from
the line, they were under the sole control of the medical directors, and
the total number of ambulances allotted depended on the size of the
regiments in each division. For instance three ambulances were permitted
for a regiment of 500 or more. The aggregate was about one vehicle per
150 men. As an illustration, in June 1863, the Fifth Corps contained
12,509 men and had 81 ambulances on hand. More importantly, though,
everything boiled down to this major change: that all ambulances were
taken away from the regiments and were thereafter kept together in a
division train, which was sometimes combined in corps trains and
sometimes not. 
Meanwhile away from the field, Surgeon General
Hammond pressed forward his agenda in the nation's capital. He created a
medical inspector general and eight inspectors for the overall
management of military general hospitals and the improvement of sanitary
conditions in army camps. A corps of staff surgeons was added, a total
of 40 surgeons and 120 assistant surgeons to serve outside the
regimental framework. He tightened up the contract surgeon business, and
required strict exams for both entering military and temporary civilian
physicians. Convalescent camps were founded to clear general hospitals
of men caught between the front and the rear of an army, and where many
malingerers had found safe havens from duty. Furthermore, Hammond made
it easier for purveyors to do the job of supplying the department with
medicines, instruments and equipment by expanding their depot locations
and streamlining how requisitions were made, filled, and transported.
All the while he supported his field personnel as they fought for
front-line revisions. In one important move during the Battle of Second
Bull Run (August 29-30), he appointed Surgeon Jeremiah Brinton to the
new post of medical director of transportation, which freed Dr.
Letterman from dealing with that battle's 8,000 casualties then being
moved to the hospitals in Alexandria, and between numerous facilities in
In early September, owing to Robert E. Lee's invasion
of Maryland, General John Pope's Army of Virginia was merged into the
Army of the Potomac, making Dr. Letterman overseer of a much enlarged
force, with his ambulance corps then only one month old. It soon became
an experiment on a grand scale.
By September 18, several engagements had been fought,
including the Battle of Antietam. Although the "Medical Department
had not, at this time, been reorganized...," Letterman still
instructed his corps' medical directors beforehand to form their
hospitals, "as nearly as possible, by divisions, and at such a
distance in the rear of the line of battle as to be secure from the shot
and shell of the enemy..." He further advised the selection of barns
for hospitals (as few tents were on hand due to the rapidity of the
advance from Virginia into Maryland) over houses, as they were
In recalling the aftermath of that tremendous battle,
where over 8,300 Federals clung to life after being struck by musketry
and artillery fire, Dr. Letterman disparaged the lack of medical and
surgical stores for these men and the 2,500 Rebels left in his hands,
along with the difficulty of obtaining these items from the depots in
Washington and Baltimore. He understood, however, that the "first
consideration is to supply the troops with ammunition and food - to
these every thing must give way, and became of secondary
Hospital scene, Antietam, 1862
Prior to the first martial contact of Southern and
Northern troops at South Mountain, Maryland, Letterman called for 12
hospital wagons and two hundred extra ambulances to be delivered to the
army. (Some of the regular ambulances were late in coming, again due to
the fast pace of army movements during the campaign.) Many of these
conveyances did arrive in time, but were unorganized, while some were
lost. Still, Dr. Letterman claimed that the majority of the wounded were
brought off the field in fairly good time, although handfuls of injured
men did lie on contested ground for over 24 hours. Additionally, he gave
his staff of doctors and attendants high marks for their willingness to
work, and their promptness, efficiently and devotion to the casualties
under their care. He also defended his physicians against
misrepresentations and rumors that pictured them as simply butchers,
saying that more often they should have been blamed for practicing
As for the new ambulance system, Antietam did not
become the ground for a model experiment. Critics were vocal in any
event, and bemoaned the evacuation service there as characterized by
"gross mismanagement and inefficiency,...[and a] lack of system and
control." In retrospect some of these faults may have been
attributed to the incorporation of General Pope's untrained drivers and
stretcher-bearers into the Army of the Potomac's better organized and
more disciplined and motivated crews.
Major Letterman had always believed that after a
severe engagement, such as that at Sharpsburg, the critically injured
must not be moved right away, but instead kept immobile nearby until
transportation would not endanger their lives. Therefore he set up two
"large camp hospitals," (besides the main ones in Frederick), or
mini-general hospitals if you will, near the battlefield. These were
capable of maintaining about 1200 patients. He claimed that these
institutions, "were the first of the kind attempted in this country,
and were succesful,...and demonstrated the propriety of their
A second prescription adhered to by the director was
the unique concept that allowing relatives to remove seriously wounded
men immediately to their homes was fraught with danger. He felt that not
only was the physical movement bad for the disabled soldier, but
then to be cooped up in stuffy, closed buildings was to compound an
already grievous mistake. Letterman said that the "absolute necessity
of a full and constantly renewal supply of fresh air..." is most
relevant to the health and well-being of the patient. As a result of
these beliefs, he was constantly appealing for the addition and
maintenance of a large number of tents available to the medical wing of
In examining all of Dr. Letterman's strategies and
methods, it becomes apparent that throughout his tenure as medical
director of the Army of the Potomac, one of his most important causes
was the retainment of wounded men as close to the army as possible. This
would ensure a quick return to their units enabling the successful
prosecution of the war effort. This "directive" had a two-fold benefit,
as it further allowed the men to be close to their own doctors and
comrades which promoted better care and a morale boost in the
As an after-shock of Antietam another significant
problem was attacked by Director Letterman. This was the inception of
"field hospitals," or hospitals-on-wheels, the mobile medical facilities
so common to past and present armies since his day. Up to September
1862, the field hospital concept had not yet been ordained. Regimental
hospitals were the norm, with these enterprises sometimes combined into
the advantage of brigade level cooperatives. Up to that time, the lack
of tentage, and the separation of personnel, supplies and equipment had
made divisional hospitals difficult to formulate and maintain. But after
much 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 was
the direction of a field hospital for each division, and provision of
the personnel and equipment for the same. In addition, a previously
written circular had ordered that from that time on (October 4) supplies
would be issued by brigade to the individual regiments as needed,
eliminating much of the waste and abandonment of these valuable
materials each time regiments moved. The new orders also guaranteed that
every physician and all other attendants knew exactly where they
belonged in the event of a battle, and that only the three most
qualified doctors of a division could be classified as surgical
"operators."  The value and superiority of these
revolutionary directives was shortly demonstrated in December 1862 at
the Battle of Fredericksburg, where, as Letterman explained, "they were
first tried, and when from the nature of the action they were severely
tested, they fulfilled in a great degree the expectations hoped for at
the time of their adoption." 
In review, and in fairness there is little in the way
of exaggeration contained in the major's preceding statement, as
Fredericksburg presented the medical corps with several serious concerns
and problems. Primarily, the battle was a major defeat for the Army of
the Potomac. Adding to this dilemma was the river, an obstacle which had
to be crossed and recrossed in consequence of the forward establishment
of hospitals, and then the retrograde movement of the same facilities.
And lastly, December was a time of year when severe shifts in weather
could hinder all post-battle activities.
After a long rest period following the Antietam
Campaign, General McClellan began his slow probing maneuvers toward the
Army of Northern Virginia then protecting Richmond in an advance
position near Fredericksburg. So lentitudinous were his movements that
he was relieved by the president, who placed Ambrose E. Burnside in
command. General Burnside sensing Lincoln's mood, hastened the march
over land to capture the Rebel capitol. In preparation of this upcoming
conquest, he transferred the Army of the Potomac to the vicinity of
Fredericksburg in middle November, ignoring the lateness of the season.
His strategy, to take that city as a safe water base enabling a direct
advance to Richmond, was thwarted by the Confederates, who forced
Burnside to attack them across the Rappahannock River where they held
superior, well prepared positions. The one-day battle fought on December
13, resulted in a Union defeat. With 9,600 injured stuck on the wrong
side of a river the situation looked bleak. However in this instance,
"for the first time in a great battle, the wounded of the United
States Army had adequate care and treatment." 
Rappahannock River, near Fredericksburg, Virginia
The success achieved by the medical corps after
Fredericksburg was in large part due to the snail-like pace of the
campaign, and the many weeks of preparation available since the Battle
of Antietam. In consequence of the directives instituted by Dr.
Letterman, the medical branch was able to amass supplies such as tents
and ambulances, and train its personnel into the revised theories
implemented in October. For example, 500 spare hospital tents had been
ordered and stored at the depot near Aquia Creek, while for once enough
ambulances were then on hand, about 1000. Several other conditions
enabled the wounded to be speedily and correctly cared for. The weather
remained quite mild for that time of year, as the normal cold
temperatures did not set in until four days after the fighting ended.
Furthermore, the nearby sturdy buildings of the town held by the
Federals provided protection for the injured men and attendants alike.
And curiously, for reasons never clearly understood, the Confederates
did not launch a counterattack against Burnside's defeated army, giving
his doctors the opportunity to stabilize their patients prior to transit
across the Rappahannock. The First Corps medical director, Dr. J.T.
Heard, explained that the prompt and excellent care given to the
casualties was due to a uniformity of action: "Every surgeon,
hospital steward, nurse, cook and attendant was assigned to his position
and knew it." 
Since removal of the wounded to the north side of the
river was paramount to their safety from artillery fire, continued
combat, or enemy attack, it was ordered almost immediately. Dr. Heard
reported that his 1,500 cases were not only properly attended to in
three divisional hospitals, but every man was driven or carried across
before morning; and by December 16, all of the nearly 10,000 Union
wounded were sheltered in tents on the northern bank of the river.
Although Letterman protested, evacuation of these men to Washington
began on the same day. As always, he was convinced that to leave
soldiers with severe injuries immobile for awhile, as he had done after
Antietam, was the best policy. But Burnside expected renewed
hostilities, and the evacuation continued unabated. From existing
reports it appears that this relocation of the wounded to the capital
did not go as smoothly as it should have; the biggest problem being the
lack of warm clothing, blankets, and ample rations. In this aspect the
Sanitary Commission lent much aid, but even this organization was hard
pressed to furnish every need. The usual criticisms surfaced and were
directed toward Major Letterman, mainly his unwillingness to delegate
authority and the aforementioned supply problems.
After this battle the Northern army went into winter
encampments at Aquia and Belle Plain, Virginia. And except for
Burnside's last effort to rescue his reputation in the infamous January
four-day "Mud March campaign," all was quiet along the Potomac until the
spring of 1863.
Meanwhile, within the crowded bivouacs the defeated
and heavy hearted Army of the Potomac suffered on. Due to unsanitary
conditions prevalent in the large camps, and the adverse weather,
disease and sickness were by all accounts, rampant. "Letterman does
not appear to quite such advantage as a sanitarian as he does as an
organizer and manager in the field," said one modern historian. A
few of his contemporaries would have agreed.  The
loudest disapprovals as usual, seem to have emanated from his enemies in
the government, those doctors who, with Secretary Stanton, were always
busy trying to discredit both Surgeon General Hammond and even Director
The bloody year of 1862 did close, with some good
news, as is noted by these comments:
"It marked the end of an old era, the beginning of
a new one in the medical department of the United States army; the end
of working without authority, the beginning of control; the end of
confusion, the beginning of methods and order."
These changes were surely visible to almost anyone
willing to see. A short eighteen months earlier the entire U.S. Army
contained barely 100 medical officers, and was indifferently supplied
and organized. As 1863 dawned, it was comprised of 2,000 doctors and
nearly 10,000 men under their command or direction, complete with
general hospitals in the large cities containing more than 50,000 beds.
It was compacted, well trained, with an ambulance corps and purveyors
office unsurpassed. And it had just proven that one of its branches,
that of the Army of the Potomac, could reliably handle 10,000 casualties
in a single day. 
With the vast improvements in medical service
beginning to become apparent, 1863 should have been a banner year for
Medical Director Hammond and his emerging and efficient work force. But
with the battling nations recruiting and conscripting thousands of new
troops, and the armies brutally fighting each other with no end in
sight, the strain on the medical department continued undeterred both in
the Eastern and Western theaters of operation.
In the East, in late January, Joseph Hooker relieved
General Burnside. But unlike his predecessor, Hooker concentrated on
bringing the health of the army up to acceptable standards, for he saw
how diarrhea, scurvy, and various fevers were devastating his soldiery.
Dr. Letterman had always believed that a good diet, (including ample
vegetables) paired with enforced sanitation and better cooking methods
would strengthen the army's stamina and morale. By April Letterman's
policies, backed by General Hooker's authority and common sense, caused
the rate of sickness to drop; and in turn the physical and mental spirit
within 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 were
already full, he appointed two medical inspectors to act under him
within the Potomac army, and ordered that each corps medical director
add a similar officer to their units. During the previous winter,
medical boards had been established to examine and weed out deficient
surgeons, and by March he had again outlined how he wished his
department to operate during military engagements.
Immediately before the army decamped, Letterman, in
order to keep 8,000 sick soldiers near their commands, set up tent
hospitals along the railroad from Fredericksburg to the Aquia and
Potomac Creek depots. As expected, maneuvering soon began between
Hooker's and Lee's armies and the resulting combat at the Battle of
Chancellorsville, fought on May 1-4 threw 9,700 wounded Federals into
Letterman's system. These casualties had to be funneled from the
confused battlefield through Fredericksburg, then subsequently across
the Rappahannock River. Once over that barrier the men were placed
aboard trains and then run along a single track to the Potomac River and
thence by boat to Washington.  The evacuation of
these injured did not go as smoothly as it should have, and the army's
medical service was not, in this case, a perfect model of efficiency.
Due to the confused state of affairs during the fighting, and the
general inept handling of the army by Hooker, many small things went
wrong for Letterman's people. Field hospitals were frequently adjusted
owing to artillery fire or an unexpected enemy breakthrough. One doctor
in the Third Corps complained that his division facility had to be
uprooted five times, and in the end, 1,200 badly injured Yankee soldiers
eventually became captives of Lee's victorious forces.  Another embarrassment for Letterman was the admission
that a few of his physicians had cowardly run off during combat leaving
their charges, while others had become intoxicated on government issued
stimulants stockpiled for the sick and wounded.
Inasmuch as many of these minor complaints were true,
several unusual situations complicated the big picture at
Chancellorsville which could not be wholly blamed on the medical
department. For one, the defeat of the Union army inherently created an
atmosphere of confusion and fear as doctors and attendants exerted
themselves to avoid being overrun and captured. The rapid pullbacks and
retreats during the daily actions forced the U.S. ambulance corps to
hastily evacuate its bleeding cargoes over a long and rough 25-mile road
to the safety of more permanent corps hospitals in the rear. Moreover,
Hooker's very orders added to the load, when he prevented medical wagons
and all but two ambulances per division from crossing the Rappahannock
when the army marched toward Chancellorsville. Paralleling that order,
no stretchers or stretcher bearers were allowed over the river until
April 30, when shell fire had already forced the abandonment of at least
one hospital. 
In his final assessment, Dr. Letterman professed that
when looking at the entire operation, the frequent dislocations had been
reasonably managed, and his staff had performed as well as could be
expected under the circumstances. In acknowledging their valuable
services, he was especially pleased to report that in almost all cases
the 1862 field hospital directives of October 4 and 30 were carefully
followed and adhered to. This resulted, even under the difficulties
encountered, in generally excellent care and comfort provided to the
majority of the wounded of that battle.
In the most serious cases, where patients were too
hurt to be transported far, Letterman chose to keep them with the army
instead of dispatching them to Washington. In accordance with this
ideology, he set up large tent hospitals at Potomac Creek where the men
could be tended by their own physicians. Of these encampments, he
"I have never seen better hospitals. This opinion
was entertained by the professional and unprofessional men who visited
them, and I regretted the necessity which compelled me to break them up
about the middle of June in consequence of the march of the Army into
Maryland and Pennsylvania."
The Battle of Chancellorsville has often been called
"Lee's greatest victory." This may be so, but it led him down the
path to his most serious defeat, at Gettysburg, in the summer of that
Only speculation could infer what thoughts possessed
the mind of Jonathan Letterman as the Army of the Potomac marched
northward in hot pursuit of the resolute Confederate invaders. It had
been barely a month since he and his colleagues were mired knee deep in
thousands of casualties from a severe battle; now, they seemed to be
headed for another and possibly even more terrible confrontation.
The Union march to intercept General Lee was well
underway when it was announced that General George G. Meade, the Fifth
Corps commander, had replaced General Hooker as head of the army. This
came on June 28 when all of the corps except the Sixth, were within a
day's hard walk or less of Gettysburg. The march from Falmouth, Virginia
on June 12 to the very doorstep of Pennsylvania by the end of the month
had been one of the hardest on record for Lincoln's grand force of
approximately 100,000 men. Ruefully, not all of them made it to
Thousands dropped out and straggling climbed to new
heights, all in relation to the amount of dust and heat, or the number
of miles covered during a particular day or night. Scores of veterans
fell by the roadsides totally exhausted or dead, caused by the 25-30
mile per day treks. By the time the campaign ended in late July, many
regiments could claim a travel agenda of between 500 and 600 miles
covered on foot, while dining on hardtack, salt pork, and coffee, and
with 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 cavalry
and artillery are calculated, this amounted to over 50,000 horses and
mules present for duty. Meshed into this huge coalition were Dr.
Letterman's ambulances and two horse medical wagons, adding another
1,017 vehicles. 
When the army left the Fredericksburg area between
June 12 and 14, Dr. Letterman commenced the removal of 9,025 wounded and
sick with their supplies, from that city up Aquia Creek and on to
Washington. 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 packed
and sent to Frederick under the direction of Surgeon Jeremiah Brinton.
By the day General Meade assumed command, Brinton had traveled even
farther to Taneytown, Maryland, Jeremiah Brinton where headquarters were
then located. There the wagons remained, under Meade's orders until
after the Battle of Gettysburg.  Even more
disturbing was a decree issued several days earlier, on June 19, before
Meade's ascension. In it General Hooker directed that the "allowance of
transportation" that Letterman had deemed necessary for the medical
department in the fall of 1862, was to be reduced. This went against the
director's opinion and argument, and it compelled him to send away a
large portion of the "hospital tents, mess-chests, and other articles
necessary upon the battlefield, and proved," said Letterman, "as
I foresaw it would, a source of embarrassment and suffering, which might
have been avoided." 
In another, and more controversial move, Meade, to
keep the army's back door open, restricted the baggage of his force very
stringently. He directed that "Corps Commanders and the Commander of
the Artillery Reserve will at once send to the rear all their trains
(excepting ammunition wagons and the ambulances), parking these between
Union Mills and Westminster." This order came on July 1, prior to
any knowledge of General John F. Reynolds' collision with the Rebels at
Gettysburg. A day later, Dr. Letterman was frustrated to learn that
"while the battle was in progress, the trains (including the hospital
wagons and the trains of battle supplies, under charge of Dr. Brinton)
were sent still further to the rear, about twenty-five miles distant
from the battle-field."  This left the medical
staff of each corps with only ambulances and medicine wagons on hand
(which were already in short supply) to sustain the needs of many
thousands of wounded for almost a week. Without the correct number of
tents, tools, cooking utensils, special rations, and other supplies
normally called for immediately after combat, sick and injured soldiers
would suffer needlessly. Surgeon Justin Dwinell, the medical officer in
charge of the Second Corps hospitals, was only one of many who
complained of a lack of tents, blankets, provisions, axes, shovels,
cooking utensils, and medical stores before July 7, when the long
awaited trains finally arrived. Regarding this situation he affirmed:
"Nothing but to gain a victory should ever prevent these wagons from
following the ammunition train."
Thus the hundreds of medical officers and their
associates assigned to the Army of the Potomac were once again in debt
to the U.S. Sanitary Commission and other relief organizations who came
to their immediate aid with foodstuffs and other assorted materials.
Oddly, in contrast to six of Meade's corps, one, the Twelfth, did not
receive or respond to this order, hence none of its normal compliment of
hospital wagons was sent to the rear. Accordingly, this unit was able to
evacuate, bathe, dress, and feed its wounded completely within six hours
of the end of the battle. 
Allowing for the subtraction of thousands of Union
and Confederate soldiers who were sick, or had been previously wounded,
including those that had straggled or deserted, the two armies were
still able to field close to 150,000 troops during the three day battle
at Gettysburg. Of this number, 14,529 Northern and 6,802 Southern men
were left more or less seriously injured in U.S. hands within the
numerous field hospitals situated in and around the prosperous borough.
This 21,331 total was only about 6,700 bodies less than the 1860
population of Adams County, Pennsylvania, the locale where the battles
had raged. Intrinsically, both sides usually underestimated the
casualties, as scores of slightly hurt men were never counted, or stayed
in ranks with their units, or otherwise slipped through the cracks of
the reporting mechanisms. 
Even before the first projectiles flew on July 1, a
field hospital had been established in the town of Gettysburg as a
result of the arrival of General John Buford's 1st Cavalry Division on
June 30. A local citizen, Robert G. McCreary confirmed this, when on
that date a medical officer "requested accommodations for six or
eight of the command who were sick." The railroad depot on Carlisle
Street was opened for that purpose, and twenty beds were set up within
the structure. It was only hours later that the depot began admitting
wounded cavalrymen as Buford's division struggled to hold its positions
beyond Gettysburg. Later in the day as the battle of July 1 escalated,
and the infantry and artillery units began to retreat, the injured
troopers were removed from the depot to the Presbyterian Church on
Baltimore Street. Accompanied by several of their doctors, these men
like many of their comrades, fell into Confederate hands by sunset. The
depot itself was then secured by surgeons of the First Corps, and it,
the express office and nearby buildings became field hospitals for a
portion of that Corps' casualties. 
The story of the railroad depot might reflect the
general situation of many of the early field hospitals at Gettysburg.
During the first two days of fighting, battle lines were more or less
fluid and the ever-changing deployments of the combatants, and overshot
enemy artillery fire often forced the repositioning of aid stations and
Throughout the day on July 1 as the First and
Eleventh Corps clashed with Confederates north and west of Gettysburg,
the aid or dressing stations, usually manned by a regimental
assistant-surgeon and his attendants, followed their respective units
back and forth as the battle raged and waned one way or the other. These
aid stations were the first stops for the "walking wounded" or any
seriously injured Federal who was fortunate enough to be reached by the
stretcher-bearers. In recalling the earlier discussion of this subject,
it should be remembered that as of October 1862, all medical personnel
had particular assignments on the day of battle. Even before the opening
shots, surgeons, assistant-surgeons, operators, recorders, hospital
stewards, cooks, ambulance drivers, litter bearers, nurses, teamsters
and other attendants, knew their posts and duties. So as the impassive
missiles tore men from the regimental firing lines, these crippled and
blood soaked individuals headed for safe zones, knowing that the medical
department was ready and waiting. The initial stop was at the dressing
stations where literally, "first aid" would be administered to all
injured parties. No operations were performed at these primary sites.
The doctor there would simply stabilize and bandage the wound then
direct the ambulatory patient to his correct field hospital in the
army's hinterland. Concurrently, other attendants gathered the more
seriously injured to an ambulance collecting point for removal by
wheeled conveyances to the divisional field hospitals.
These division ambulance trains consisted of 30 to 50
vehicles of various types all for the transportation of the wounded.
Included too were 10 or 15 medical supply wagons unless, as was in the
case of the Battle of Gettysburg, these trains were jettisoned. Each
ambulance carried four stretchers or hand litters, plus a supply of
bandages, lint, astringents, chloroform, whiskey, brandy, condensed
milk, and concentrated beef soup. A regiment had approximately eleven
men attached to it from the ambulance corps, counting the sergeant in
In the late afternoon of July 1, after hours of some
of the most severe combat of the battle, units of the Union's First and
Eleventh Corps retreated to reserve positions on Cemetery Hill and
Cemetery Ridge just south of Gettysburg. In consequence of the rapid
redeployment of these corps, the ambulance teams were unable to recover
all of the wounded individuals from the 1st and 3rd Divisions of the
Eleventh, nor from all three divisions of the First Corps. During the
long and eventful day medical directors and surgeons of the two corps
set up sheltered division hospitals near to and in the borough itself.
They seized the Lutheran Theological Seminary and college buildings, the
railroad depot and express office, several large warehouses, the
Washington House Hotel, the Union School, the county courthouse and
almshouse, and several churches. But even this was not enough, and an
overflow of perhaps 400-450 men ended up as patients in private
dwellings. When the troops at the front begun their withdrawal about 5
p.m. the ambulance drivers and attendants went right along, thus ending
the evacuation of U.S. casualties on the day's field by Union personnel
until July 4. If not found and taken up by Southern squads, which many
were, the abandoned wounded remained on the contested ground until after
the Confederate retreat. By dusk of that day the village was in sole
possession of the Rebel army, as were the Federal hospitals, and several
thousand prisoners, both hurt and not. When it was clear that Gettysburg
would be given up to the Confederates, some of the nearly 4,000 Northern
casualties were hurried out of town to safer locales. A handful of
doctors chose to stay with their men, usually one or two in each
facility; the balance joined the retreat and were directed to new field
hospitals 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,
"[It] was just before sunset. Looking from the
upper windows of the hospital, [at the railroad depot] I could see our
lines being repulsed, and falling back in utter confusion. Our front was
entirely broken, the colors trailing in the dust, and our men falling on
every side. The enemy were enveloping the town from that side, sweeping
past the hospital and completely filling the streets." 
By midnight, any of the first day's casualties that
had been fortuitously rescued before or during the collapse of the Union
forces, were deposited in makeshift temporary hospitals at farmsteads
along the Baltimore Pike and the Taneytown Road. Obviously the director
of the First Corps, Dr. T.J. Heard had learned his lesson, for he placed
his new facilities well out of range of enemy missiles. The biggest
concentration of this Corps' casualties were, by July 2, clustered
around the "White Church," three miles out on the turnpike to
Westminster and Baltimore, and on farms contiguous. The three Eleventh
Corps divisions were congregated on the Elizabeth and George Spangler
place, (not out of artillery range) east of that pike and just
south of Power's Hill, where they remained until early August. It is
surprising that inasmuch as the Eleventh Corps met with disaster,
confusion, and some demoralization on July 1, its medical staff managed
to regroup and rebound quickly; they set up and maintained a cohesive,
well regulated field hospital very near the battleground, although not
completely out of harm's way. 
Ambulances in action at Gettysburg near
Power's Hill. Section of sketch by Edwin Forbes
Just what was it like in one of these hospitals as
its staff struggled to stabilize the occupants, while the battle raged
nearby? A U.S. Volunteer surgeon has left this excellent account of the
scene in one such place.
"Behind a partially protected hill there is a field
hospital; the lines of stretcher-bearers and ambulances mark the way to
it. There are a few tents and rudely improvised tables; at the latter,
calm faced men, with bloody hands and instruments, are at work. Wounded
men are lying everywhere. What a horrible sight they present! Here the
bones of a leg or an arm have been shattered like glass by a minnie
ball. 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 with
blood from a wound of the lungs. By his side lies this beardless boy
with his right leg remaining attached to his body by only a few shreds
of blackened flesh. This one's lower jaw has been carried entirely away;
fragments of shell have done this cruel work. Over yonder lies an old
man, oblivious to all his surroundings, his grizzly hair matted with
brain 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 bruised
and mangled until the semblance of humanity is almost lost - a squadron
of cavalry charged over him. This one has been crushed by the wheel of a
passing cannon. Here is one dead, and over there another; they died
while waiting for help that never came. Here are others whose quivering
flesh contain balls, jagged fragments of shell, pieces of iron, and
splinters of wood from a gun blown to pieces by an exploding shell, and
even pieces of bone from the head of a comrade who was torn to pieces by
the explosion of a caisson. The faces of some are black with powder;
others are blanched from loss of blood, or covered with the sweat of
death. All are parched with thirst, and many suffer horrible pain; yet
there are few groans or complaints. The sum of human agony about was so
great that no expression can describe it. Although the surgeons work
with marvelous haste, the number demanding their attention seems always
to increase; some come hobbling by aid of an improvised crutch, others
are supported by comrades, while the bloody stretchers and ambulances
ever deposit their ghastly freight. Occasionally a shell flies over
head, its scream sounding like that of a fiend rejoicing over the
horrors below. The great diapason of the battle sounds loud or low, as
the contending hosts shift places on the field; [while] cowardly
stragglers gather about, spreading stories of disaster and
Heavy fighting broke out near 3 p.m. on July 2 and
continued almost unabated until nearly midnight. Casualties were high.
By day's end the Union army suffered over 8,500 wounded and 1,825
killed. Dedicated ambulance work was needed well into the evening, but
as some ground was lost to the Rebels, it was impossible to collect each
and every downed soldier. The ambulance corps was by most accounts,
skilled and efficient in its work, having enough practical experience
and drill since late 1862 to be able to handle any ordinary situation.
On the average at Gettysburg each infantry corps mustered between 80 and
100 ambulances, plus medical wagons, etc. The Eleventh for one, counted
100 ambulances, nine wagons, 270 men and 260 horses. 
Several valuable descriptions of the activities of
the ambulance corps on July 2 have survived. One, that of Dr. Joseph
Thomas, 118th Pennsylvania, gives an interesting perspective of the 1st
Division, Fifth Corps.
"About eleven o 'clock at night the ambulances
were busy collecting and carrying to the rear great loads of mangled and
dying humanity. The wagon-train, with tents and supplies, had not yet
arrived, and the wounded were deposited on the ground....As they were
removed from the ambulances they were placed in long rows, with no
reference to the nature or gravity of their injuries nor condition or
rank. Friend and foe alike, as they had been promiscuously picked where
they had fallen, were there laid side by side in these prostrate
ranks.... Soon the ambulances ceased their visits...[to await] as dawn
should appear to furnish light for the painful work. Opiates were
administered to alleviate pain, and water supplied to appease their
thirst.... Sounds of pain and anguish, invocation and supplication,
singing, and even cursing by some in their delirium or sleep,... At last
morning dawned, and at the same time orders were received to remove the
wounded farther to the rear and out of range of the enemy's
But for a more mechanical look at the evacuation,
there is this piece written by ambulance chief Lieutenant Joseph C. Ayer
of the same corps as Dr. Thomas.
"As soon as the division was placed in position
all my stretcher men, under their lieutenants and sergeants, were sent
to the front to follow their respective regiments; leaving one
lieutenant and three sergeants in charge of the train. I conducted the
train to a point two hundred yards in rear of the second and third
brigades, where it was rapidly loaded with severely wounded. Owing to
some misunderstanding there was a delay in locating the division
hospital and the wounded men remained in the ambulances about an hour,
when the hospital was established and the wounded unloaded. The
ambulances then commenced regular trips to the battlefield and were
constantly at work during the night."
Lieutenant Ayer further relates that shortly
afterward he too was called on to relocate the injured to a more secure
The officer in charge of the Second Corps recovery
teams was Captain Thomas Livermore, who had been assigned the position
of "chief of ambulances," only two days earlier on June 30. In an
instant Livermore had gone from a company line officer in charge of 30
men to, as he reveals, a "command [of] two or three hundred men, a
dozen officers, and a large train;...." He added that he went from
trudging along dusty roads with his foot soldiers, to riding away on a
"spirited and strong-limbed horse." Livermore described his new
organization in detail:
"The ambulance corps consisted of three trains,
one for each division of the army corps. Each train consisted of
forty-two horse ambulances, [about three to a regiment] with a few for
the artillery, several wagons with four horses to carry forage and
rations in, and a forge wagon for repairs and horseshoeing, with several
old-style four-horse ambulances. The men were selected proportionately
from the regiments, and consisted of a driver for each ambulance and
wagon, two stretcher-carriers for each wagon, and several blacksmiths
and supernumeraries.... The total force of the ambulance corps [Second
Corps] was, in round numbers, 13 officers, 350-400 men, and 300 or more
horses, with a little over 100 ambulances and 10 or 12 forage and forge
wagons;... Each two-horse ambulance was a stout spring wagon,...with
sides a little higher than theirs along each side. Inside this wagon
were two seats the whole length,...stuffed and covered with leather.
Hinged to the inner edges of each of these seats was another
leathercovered seat, which could be let down perpendicularly so as to
allow the wounded to sit on the first seats facing each other, or could
be raised and supported horizontally on a level with the first seats,
and, as they filled all the space between the first seats, thus made a
couch on which three men could lie lengthwise of the
"On each side of the ambulance there was hung a
canvas-covered stretcher to carry the wounded on, and the whole
ambulance was neatly covered with white canvas on bows. The horses were
all good ones and well kept; the men were stout, and the officers were
In his memoir, Captain Livermore purported his
"superintending and collection and dispatch" of the wounded of
the Second Corps from after twilight till midnight of the July 2, then
once again on July 3. On the second his trains parked in proximity to
the farm of Sarah Patterson on the Taneytown Road where the 2nd Division
hospital was laid out under Surgeon Dwinell. Dwinell later acknowledged
"the faithful and efficient services rendered by the
ambulances...[and] the great care and consideration they manifested for
the wounded." Initially the human cargo of the Corps was dropped off
at Patterson's. But the following day, Livermore was directed by the
Corps' medical director, Dr. A.N. Dougherty to pick a sheltered location
for a "general field hospital, where all the wounded could be carried
and provided with shelter and treatment until the battle was over."
He selected a spot on Rock Creek about a mile-and-a-half down stream
from the Baltimore Pike bridge. From that time on all of the casualties
of the Second Corps were removed from the Taneytown Road farms and
fields and relocated within the grounds of the new site. 
What emerges is that for many of the corps, the
primary hospital establishments had been placed absurdly close to the
front, eventually causing all to be uprooted and settled elsewhere. As
Dr. Dwinell testified: "We have almost invariably had occasion to
regret having...our Hospitals too near to the line of battle."
(click on image for a PDF version)
In relation to these aforementioned places, Dr.
Justin Dwinell, who was surgeon-in-charge of the Second Corps field
hospitals, left his peers with an official version of the activities
surrounding them. In this report he concedes that the overall debility
of the troops after the "protracted daily marches," caused them to be
ill prepared "to bear up under the shock of wounds and the subsequent
exhaustion of the system." As to the field hospitals on July 2, his
2nd Division was at Sarah Patterson's stone barn, the 3rd Division
camped at a barn 300 yards away on the same road, and the 1st Division
was adjacent to the Granite School House to the right and rear of the
3rd. The last named was soon shelled out of position by Rebel batteries
and 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 due
primarily to the absence of the supply trains. The operators at
Dwinell's establishment kept up with their surgery at four tables until
after 4 p.m. when the accumulation of so many wounded forced them to
lose momentum. On the 3rd food was obtained for the 500 casualties at
his hospital. By 1 p.m. on July 3 the wounded were in motion to the
second position spoken of by Captain Livermore, which was a mile and a
half 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 three
divisions were evacuated by nightfall. The operations continued, but
there 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 on
the 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 ground
about July 22 and into a clover field across Rock Creek and nearer to
the farm buildings of Jacob Schwartz. Altogether this facility cared for
3,260 Union and 952 Confederates, making it the largest field hospital
extant after the battle. Dwinell had between 17 and 30 doctors available
to him at various times between July 4 and August 8 when the hospital
closed. He emphatically voiced his distrust of the skill and dedication
of civilian volunteer and contract surgeons, citing them as too
"unreliable." Dr. Dwinell complained too of the hundreds of able-bodied
skulkers that invaded these safe areas, and who "consume the food and
occupy the shelter provided for the wounded." In that hospital there
were 437 deaths, of which 192 were Southerners. In conclusion, Dwinell
felt the medical department of the Second Corps was made up of practical
men of large experience and observation. "It is thoroughly organized,"
said he. "Every Surgeon knows beforehand whether he is to remain on
the field or return to the Hospital in the time of Battle. In either
case he knows the part he is to perform. They have become familiar with
their duties....they were indefatigable in the performance of their
labors,...and did all in their power to alleviate the sufferings of the
wounded." Ending his manuscript, he made this observation:
"[P]robably at no other place on this continent was there ever
congregated such a vast amount of human suffering. 
Justin Dwinell's last quote is correct. From one
single calamity the United States had never been exposed to as many
casualties caused by any natural or human incited event. It is also
likely that his statement still holds true today. The literally hundreds
of eyewitness versions that describe the horror of Gettysburg would
alone fill a large volume. Everyone who saw the catastrophe was
singularly impressed and often aghast at the hideous sea of misery which
surrounded the community. Within seventy-two short hours, over 7,100
people had been sent to eternity, while 33,300 more remained alive
weltering in their own blood and waste, anxiously awaiting and even
begging for medical treatment. Of these, several additional thousands
One of the thousands of idle spectators who traveled
to Gettysburg in the wake of the battle was a preacher named Cort from
Somerset, Pennsylvania who, like so many, could not resist the impulse
to set down their recollections of a visit to hell.
"The scenes of suffering among the many thousands
of wounded of both the Union and Confederate armies which came under my
observation in the few days I spend in and about Gettysburg on that
memorable occasion, are altogether indescribable. Human language is
inadequate to do it justice. The horrors of war were revealed in a way
that was sickening to the heart. The ghastly wounds, the moans and cries
and screams of anguish, the ravings of those whose reason had been
dethroned, and the appeals for water to allay thirst and morphine to
ease pain, were such as to move the stoutest hearts. One of the streams
had overflowed its banks, and a number of wounded confederates were
drowned and their bodies swept away by the raging waters. Great piles of
amputated limbs lay around. Experienced surgeons and medical students
fresh from the schools were at work like so many bloody butchers. The
putrid and swollen remains of slaughtered men and horses filled the air
with malaria, which soon brought disease and death to visitor from all
parts of the country, as well as to the inmates of the crowded
hospitals. Suffering and death were everywhere, and the efforts put
forth for alleviating the latter, though rendered by hundreds of willing
hands, seemed as but drops to a bucketfull when compared to the vast
aggregate all about us." 
Preacher Cort saw the field on July 8 after almost a
week of aid had been administered to the 22,000 wounded left behind by
the two armies. An active imagination might attempt to view the problems
encountered even earlier when the medical directors and surgeons were,
in the constant shifting of hospitals, doing their utmost to render
comfort to their wretched patients under more extreme and adverse
At the end of the third day not only had the First,
Eleventh and Second Army Corps field hospitals been safely reestablished
as previously encountered, so had the Third, Fifth, Sixth, and Twelfth
Corps. The Third and Fifth, after fierce fighting on the Union left
during July 2 had also mishandled the positioning of their hospitals on
the day of battle. This tactical error required realignment from spots
carelessly selected on farmsteads, in woods, and in meadows along the
Taneytown Road and out toward the Baltimore Pike, to protected and more
permanent camps south and southeast of Gettysburg. The Third Corps' two
divisions were lastly settled south of and along White Run 300 yards
from its junction with Rock Creek, a place southwest of the farm
buildings of Jacob Schwartz and east of those of Martha and Michael
Fiscel. The site was reportedly high, dry and "airy," with plenty of
water nearby. However, Surgeon J.W. Lyman, 57th Pennsylvania, described
part of it as "finely wooded and [on a] shady slope."
The Third's medical director Thomas Sim was not
present; he was ordered to accompany Corps commander Daniel Sickles, who
had lost a leg in the fray, to Washington. Under Surgeon Thaddeus
Hildreth this camp handled about 2600 U.S. wounded, and 259 of the
enemy, and closed its operation on August 8. One division there reported
813 casualties - of these there were 97 operations performed, 53 being
amputations.  Immediately after the battle, an
army physician stationed at this site declared that most of his patients
were "lying on the wet ground without any shelter whatever. The
people in this district have done nothing for them."
On July 9 this same Pennsylvania doctor, William
Watson, was posted as one of the operators of his division and with
seven other medicos serviced the ills of 813 wounded and 100 captured
Confederates, who were "in a most distressing condition." He indicated
these facts on July 18: "The mortality among the wounded is fearful -
caused principally by Gangrene, Erysipelas, Tetanus and Secondary
Hemorrhage. Our secondary operations have been very unfavorable. Most of
the cases die." 
The U.S. Fifth Corps, like its July 2 companion
fighting force, the Third Corps, grouped all three divisions much too
near the battle lines, mainly around the Jacob Weikert farm and fields
adjacent along the Taneytown Road, just in rear of the Round Tops. One
location was about a half mile from the base of Big Round Top and
contained 250-300 casualties from the 1st Division. The 2nd Division
under Assistant Surgeon John S. Billings commandeered the Weikert place,
and with three Autenreith medicine wagons, and the farmer's food on
hand, he "performed a large number of operations, [and] received and
fed 750 wounded." He too acknowledged assistance from the Sanitary
On July 3 at 7 a.m. orders led to the abandonment of
this farm hospital to another site, "in a large grove of trees,
entirely free from underbrush, on the banks of a little creek, about a
mile from the Baltimore Pike." Two thousand rations arrived, and
with some common infantry shelter tents the suffering men were arranged
as comfortably as possible. The fifth of July brought up many of the
medical supply wagons, so tents and other articles allowed the 800
injured of this division to be protected and fed. On the same day,
Jeremiah Brinton of the transportation section finally arrived with
Letterman's special supply train, and quickly distributed the valuable
material to all of the corps' hospitals. Dr. Billings alone received 17
large hospital tents and many tent flies, which were immediately
erected. Tools were his greatest need; a few had been procured from
local farmers, and were put to use digging graves and latrines. Surgeon
Cyrus Bacon, a colleague of Billings, also left a memoir of service in
the Fifth Corps hospitals. He states that only the most serious cases
went into tents, and that many of the worst wounds caused by the Minie
bullet resulted in Pyaemia setting in. It was one repercussion after
capital operations and "almost invariably proved fatal." Bacon
underscored the reality that of the eleven surgeons on duty, at
different 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's
farm, north of the house and south of Rock Creek, with the barn used for
the worst cases; 2nd Division, south of Jane Clapsaddle's house, across
Little's Run; and 3rd Division one-half mile west of Two Taverns, on
Jesse and Ann Worley's farm. The three sheltered 1,400, out of a total
Fifth Corps loss of 1,611. 
The most fortunate body of Federal troops in service
at Gettysburg was the Sixth Corps. Its medical director, Charles
O'Leary, assigned Dr. C.N. Chamberlain to manage the hospitals which
superintended about 315 wounded. Many of the Corps' infantrymen were
thoroughly worn down by a rapid forced march of 32 miles prior to
reaching Gettysburg. Previously it had covered 100 miles in four days,
yet percentage-wise, few men had fallen out of the columns. Since it was
not heavily engaged the Corps suffered only 27 killed and 185 wounded.
 Yet the field hospital on the 165 acre farm of
John and Suzannah Trostle along Rock Creek, cared for an assortment of
maimed Southerners and an overflow of men from the Fifth, Third, and
Second Corps. The injured here received especially good treatment and
attention, and had quarters in tents and in Trostle's house, barn, and
outbuildings, although one soldier complained of the lack of enough
food. In early August, as was usual, this facility was closed, and the
remaining patients transferred to Camp Letterman east of Gettysburg or
to the railroad for shipment to other governmental general hospitals
miles away. 
George Bushman House, Twelfth Corps Hospital
The two divisions of the Twelfth Corps fought
principally on the right flank of the army and tallied 406 wounded in
the 1st and 397 in the 2nd, these mainly shot while entrenched in the
vicinity of Culp's Hill. Strangely, their permanent field hospitals were
pitched along a farm road leading from the Baltimore Pike past Power's
Hill to the lower crossing of Rock Creek, and east and north of the
house of George and Anna Bushman which stood nearby. In sizing up the
topographical nuances of the field, it would seem more appropriate to
have assembled these camps nearer to the Corps' actual area of combat
operations. As previously noted, the medical supply wagons for the
Twelfth accompanied the ambulances, thereby preventing undue suffering
to hamper the battle harmed infantrymen and artillerymen assigned to
this organization. Medical Director John McNulty claimed to have
successfully removed, fed, and treated all 1,006 injured under his
supervision (along with 125 Confederates) within six hours after the end
of hostilities. Due, he said, to the presence of the medical wagons and
their invaluable contents. Surgeon John H. Love, 13th New Jersey, in a
homebound letter from the Bushman farm indicated that he knew of twelve
physicians 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 to
serve at Camp Letterman and then was put in charge of the hospital train
carrying wounded to York, Pennsylvania. 
Returning to the first day's casualties that were
sheltered on the premises of the First and Eleventh Corps hospitals, we
find that by the end of the first week of July these stations were in
stable condition, especially as they sat near the Baltimore Pike, the
main supply route into Gettysburg, and were close to the depots
established by the Sanitary and Christian Commissions, and by Dr.
Brinton for the army itself. They were also fortunately in proximity to
hard roads leading to the railroad depot and eventually Camp
Included in these hospitals were those men captured
by the Confederates inside the town field hospitals. The three divisions
of the First Corps had a sum of 3,231 casualties out of about 9,000
engaged, or about 36 percent. The 1st Division sheltered its men at and
near Mark's German Reform or the "White Church" out on the pike, and
just south of White Run, and on the farm of Barbara and Isaac Lightner
east 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 on
the Jonathan Young property northeast of Two Taverns. Evidence supports
that many of the 260 Southerners cared for in these hospitals were
camped convenient to the church. 
Northward on the Spangler farm which was nestled just
below the rounded summit of Power's Hill, doctors of the Eleventh Corps'
three divisions struggled to stabilize and provide for the needs of at
least 1,400 of its 1,922 wounded that had been carried to that locale.
Since it was the closest permanent multi-divisional facility to the
front lines, it was periodically awakened from any boredom by the
arrival of various and sundry Rebel cannonballs and shells. During the
battle, thirteen medical officers were struck by enemy fire, and one,
the only fatality, occurred here when Dr. W.S. Moore, 61st Ohio, was
severely injured on July 3 and died on the sixth. One witness observed
three operating tables in use at the barn, which resembled "more a
butcher shop than any other institution...." About 100 Confederates
were in residence, including General Lewis Armistead who died there late
on July 3. Comments concerning this facility seem to put it in a good
light, as the Sanitary Commission gave much aid to the staff. But there
were reports of delicacies meant for the soldiers, being improperly used
by "gluttonous surgeons" and other "hangers-on," and the usual cowardly
riff-raff absent from the line units.
Like the several other corps, the Eleventh's
installations took in its share of artillerymen and cavalrymen, since
these combat arms did not regularly maintain totally separate field
By the second week after the battle, all of the Union
hospitals were fairly well supplied with volunteer nurses, and the 20
extra physicians sent by Surgeon General Hammond. Provisions provided by
the army's chief commissary, Colonel Henry F. Clarke, were arriving,
while miscellaneous items were offered by relief organizations, such as
the Sanitary Commission, and by a scattering of citizens in Adams County
and elsewhere.  Regretfully, there were great
criticisms directed at some local civilians, excluding many in
Gettysburg proper, for the lack of food and attention donated to the
thousands of helpless individuals in their midst. These condemnations
were usually heaped upon the heads of the German or "Dootch" farmers in
the countryside encircling the town, and were expressed vehemently by
scores of witnesses from general officers to the lowest private. 
In the days directly succeeding the three day
contest, both the Army of the Potomac and the Army of Northern Virginia
vacated south central Pennsylvania in a continuum of the campaign as
they marched southward into Maryland and Virginia. Dr. Letterman,
fearing a resumption of combat, assimilated most of his 650 medical
department physicians and hundreds of attending nurses and stewards,
plus 3,000 ambulance personnel back into the army which was then
pursuing Lee's scattered and retreating forces. With this untimely but
necessary decision, only 106 doctors were allowed to remain with nearly
22,000 injured Federal and Confederate soldiers, who lay in
approximately 50 makeshift field hospitals in and surrounding
Gettysburg. Fortunately, these few surgeons were supplemented by the
addition of Hammond's bequest and the crop of civilian and contract
physicians still in the vicinity.
Area of operations of the Army of the Potomac Medical Corps during the
Gettysburg Campaign. (click on image for a PDF version)
As the middle of July arrived, the heavy rains that
followed the battle began to roll away. With that clearing came a break
in the bleak prognosis given to the thousands of wounded still at
Gettysburg. Several changes improved the climate for these patients. The
first was that Letterman, upon his departure, placed Dr. Henry Janes in
charge of all of the field hospitals at Gettysburg. Janes was a U.S.
Volunteer surgeon formerly of the 3rd Vermont Infantry, a Sixth Corps
unit. He quickly moved to consolidate the entirety of medical facilities
both U.S. and C.S., whether in private dwellings, on farms, or in
divisional tent/field hospitals, into one general and more permanent
establishment east of the town.
The "general hospital on the field" concept had
always appealed to the director. It was soon ordered by General Meade
and approved by both Hammond and Letterman because it was easier to
supply and maintain. This approach also prevented the too hurried
removal and secondary injury of the more seriously hurt but convalescent
patients. By the waning days of July this large camp was in full
operation; however, Dr. Janes permitted three other clinics to remain
viable, 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 part
was the enormous effort maintained to evacuate every wounded soldier who
was able to travel on to major medical facilities in Annapolis and
Baltimore, York, Chester, Philadelphia, and New York, where over 12,000
beds were unoccupied and available. Normally the Army of the Potomac's
casualties went to Washington or Alexandria, but these city hospitals
were still heavily dominated by the battle residue from Chancellorsville
and Fredericksburg. Letterman was castigated by at least one of his
peers for leaving only four wagons and six ambulances with each corps
medical unit for this massive transportation effort, and for allowing
one doctor for every 150 patients. The press of duties lessened somewhat
when 50 additional ambulances were received from Washington along with
the aforementioned supplemental physicians.
On July 29, U.S. Medical Inspector E.P. Vollum, who
was sent to study the situation at Gettysburg by the Surgeon General on
July 7, reported to his superior Colonel John M. Cuyler these
"Including the 1,462 patients sent away from the
battlefield before his arrival, by the 23rd of July a total of 15,425
wounded had been removed to various general hospitals on the Eastern
Seaboard. These numbers included 3,817 Confederates, leaving at
Gettysburg on July 23, 1,925 Rebels (of the 6,802 in Yankee hands) and
2,922 Northerners.  Part of his report contained
this interesting comment: "For a correct number of rebel wounded, those
must be counted that were left at Chambersburg, Carlisle, Hagerstown,
Funkstown, Martinsburg, Winchester, and the various farm houses and
barns on the way, which will doubtless foot up to about 15,000 making
the probable number of wounded on both sides 35,000 in round
During the Gettysburg Campaign, General Herman Haupt
was in charge of transportation and construction on the U.S. Military
Railroad system. He supervised not only the funneling of supplies to the
army before the battle, but in consequence of the fighting he began
running five trains grouped together, making available 15 trains each
way daily from Baltimore to Westminster, Maryland until the ruined rail
branches to Littlestown, Hanover, and Gettysburg were repaired and
reopened between July 5 and 7. With these trains he was able to put
through, under the direction of Dr. J.D. Osborne, 4th New Jersey, 150
cars containing 2,000-3,000 injured and sick daily. With the base of
supplies and transportation in Baltimore, 55 miles away, cars began to
ply from Gettysburg on the 7th, habitually leaving several times a day
between 9 a.m. and 5 p.m. For instance on July 12 six trains departed
Gettysburg carrying 1,219 patients from both armies. For a time the
wounded were arriving at the terminus of the railroad faster then they
could be taken away, resulting in hundreds of "poor wretches [left]
to pass the night there without food, shelter or attendants." This
grim status was soon amended by the Sanitary Commission who erected two
"lodges," one about a mile eastward on the York Turnpike where the
destroyed railroad terminated, then later another next to the railroad
depot in Gettysburg itself.
These sanitary lodges provided the essentials
patients needed while awaiting transportation, such as a kitchen to
prepare food, tents, beds, and nurses. The commission later claimed to
have fed every man of the 16,125 that left Gettysburg in the early
stages, and "to have sheltered 1,200, and to have furnished very many
A woman who worked with this agency explained how the
"Twice a day the trains left for Baltimore or
Harrisburg, and twice a day we fed all the wounded who arrived for them.
Things were systematized now, and the men came down in long ambulance
trains to the cars; baggage-cars they were, filled with straw for the
wounded to lie on, and broken open at either end to let in the air. A
Government surgeon was always present to attend to the careful lifting
of the soldiers from ambulance to car....
"When the surgeons had the wounded all
placed,...on board the train, our detail of men would go from car to car
with soup,..fresh bread and coffee,...[or] ale, milk-punch or
Rebels and Yankees were always kept together, she
said, and for the ones who had to remain over night, clean bandages were
applied, along with donated basins of water, soap, and towels; last came
new socks, slippers, shirts, drawers, and the most coveted of all,
"wrappers" which were multi-colored dressing-gowns. 
For the men too ill or hurt to stand evacuation
immediately a general hospital had been authorized and was laid out one
mile east of Gettysburg on the south side of the York pike. Construction
began on July 16 and the facility opened on July 22 in charge of a 10th
Massachusetts doctor, C.N. Chamberlain. In total it held up to several
thousand inhabitants, where, upon an elevated and attractive site, were
erected as many as 400 tents, most situated in six double rows, ten feet
apart, 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 good
spring of water, and stood just a few hundred yards north of the
railroad where it began to parallel the pike, and opposite the site of
the first sanitary lodge.
During the four months of its operation, on average
the camp weekly fostered between 1,200-1,700 of the most critical cases,
several hundred of which were Confederates. The medical staff counted no
fewer than 400 doctors and attendants, and at various times outnumbered
the patients themselves. Each surgeon, including a score or so of
Southern physicians who remained with their wounded, supervised from 40
to 70 recuperating soldiers. Since the injuries were so severe, many men
died at Camp Letterman, a majority being Confederate, and all 350-400
dead were buried in a cemetery south of the main compound. In one sample
it was shown that of the 345 individuals there with gunshot fractures of
the femur, amputations were performed on 158 cases, and of these 101
As quickly as a patient could be transported, he was
carried to the railroad for removal, so the number of convalescents
fluctuated from over 1,000 in mid July to 1,600 on August 30 then to 326
on October 18. The last man left about the third week in November.
Officially, Letterman Hospital closed at the end of that month, but a
skeleton staff remained under Surgeon Janes to break up the camp, and
send off all government supplies and material. With the shutdown of Camp
Letterman, the Army of the Potomac's medical role in the Battle of
Gettysburg came to an end. 
In evaluating the medical department's handling of
the enormous calamity which they inherited during and after this, the
largest battle of the Civil War, the first question asked could be: how
well did Medical Director Jonathan Letterman believe his organization
functioned during the emergency? Reporting to General Meade in October,
1863 he summed up the mistakes made during the campaign, and described
the problems encountered and whether or not they had been eliminated. He
also complimented his officers and men where they deserved credit.
Overall, Letterman was most unhappy with the number of medical supply
wagons that accompanied the army, and with the absurd practice of
abandoning them to the rear when the troops went into battle. Supplies,
such as tents, were usually abundant he made clear, but getting them to
the wounded was the greatest challenge. Making note of Surgeon McNulty's
satisfaction of having the Twelfth Corps' trains remain with their
troops, Letterman admonished:
"I can, I think, safely say that such would have
been the result in other corps had the same facilities been allowed - a
result not to have been surpassed, if equaled, in any battle of
magnitude that has ever taken place."
He, like Surgeon Dwinell, also placed no reliance on
doctors from civil life, saying that they "cannot or will not submit to
the privations and discomforts which are necessary" during or after a
battle. Of his own 650 staff and regimental physicians he reminded the
commanding general that they "were engaged assiduously, day and
night, with little rest, until the 6th, and in the Second Corps until
July 7, in attendance upon the wounded. The labor performed by these
officers was immense. Some of them fainted from exhaustion, induced by
over-exertion, and others became ill from the same cause. The skill and
devotion shown by the medical officers...were worthy of all
commendation; they could not be surpassed."
So too was his admiration for the ambulance corps. In
describing their actions throughout the battle and afterward, he claimed
it "acted in the most commendable manner during those days of severe
labor," and of the army's [14,529] combat injured, "not one
wounded man of all that number was left on the field within our lines
early on the morning of July 4." In accomplishing this feat, five
men were killed and 17 wounded from this corps. And in the end,
considering that 21,331 Union and Confederate patients were thrown by
fate onto his department's resources, which "conspired to render the
management [of it] one of exceeding difficulty," Letterman could
still say that "the wounded were well taken care of...especially so
when we consider the circumstances under which the battle was fought and
the length and severity of the engagement."
Although Major Letterman naturally placed his
department in the very best possible light, he and his subordinates had
faced some formidable tasks. Most were overcome, but not without causing
undue pain, suffering and death to many of their charges. Medical
supplies were insufficient at Gettysburg, due to the holding back of the
trains. 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 in
excess of 21,000, coupled with the absence of supplies, these factors
piled up a mass of difficulties that transcended the departments best
capacity. Other areas of concern which went beyond Letterman's
abilities, or control, were the unusually severe wounds encountered at
Gettysburg inducing a very high death rate. There was also the condition
of the infantrymen themselves; the inordinately long and difficult
marches preceding the battle wore down the men and generated a climate
of sickness, which made them less able to counter the adverse effects of
even a slight injury. Then too, following the fighting, the area's
railroad system was in complete turmoil, and near total breakdown, with
destroyed roadbeds and bridges, and numerous damaged engines and cars,
all tied to a civilian work force which were not motivated to quickly
clean up the mess.
According to General Haupt, even as late as July 9 he
found "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 without
unloading, wounded lying for hours, without the ability to carry them
off..." He was also highly distressed to find an "utter
indifference manifested by the railroad companies toward the sufferings
and wants of our wounded at Gettysburg,....The period of ten days
following the battle...was the occasion of the greatest amount of human
suffering known to this nation since its birth, [and] the railroad
companies, who got the only profit of the battle, and who had the
greatest opportunities of ameliorating the sufferings of the wounded,
alone stood aloof and rendered no aid."
Along with these areas of concern stood Letterman's
weak managerial style and organizational abilities and in his lack of
planned evacuation facilities. One historian noted that, "there were
no supporting medical services between the division and the general
hospitals in the rear. He [Letterman] could handle an engagement and
take good care of the wounded but this tied up his division hospitals
and ambulances, and required considerable time after an engagement to
reorganize and again be ready to handle a considerable number of
wounded." This imperfection would have been most apparent, had it
not been somewhat corrected by his successor during 1864, when Meade and
Grant chose to hammer Lee's army for several months without letup. In
these campaigns, the need for "an elaboration of Letterman's
organization was shown. This elaboration, however, was not thoroughly
developed until the [First] World War."
Jonathan Letterman's systems of evacuating the
wounded, supplying the department, and establishing field hospitals and
work directives for his staff, were models of simplicity and excellence
and were sorely tested throughout his one year and five months with the
Army of the Potomac (he resigned in December 1863). Although not
perfected, these devices did allow the army to cross many hurdles and
pass through rigorous trials, and as improvements came over time they
set up some of the best military and civilian standards for medical
service available even well into the Twentieth Century. 
Today at Gettysburg, hundreds of granite, marble and
bronze memorials cover the fields, woods, and hillsides where two great
armies clashed in the summer of 1863. The ground is a shrine, a mecca,
for thousands of Americans who come to the battlefield out of curiosity
or remembrance, or to pay tribute to the men and deeds of that fierce
contest. But of all the monuments, less than a dozen speak for the
valiant services of the medical departments of both armies. And worse,
the military hospital sites themselves, due to their remoteness from the
field of battle, rarely see visitors, and are slowly being encroached
upon and destroyed by the polluting hand of humankind. The grounds, the
farms, the old structures, with no agency to protect them, and no
benevolent patriarch to support and care for them, fall prey to the
relentless march of progress and soon most will become shopping centers,
parking lots, golf courses, and housing developments.
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