The Father of Battlefield Medicine

Jonathan Letterman was appointed to the position of  Medical Director of the Army of the Potomac in June of 1862. He was given Carte Blanche to enact such reforms and organization as he thought best and he engaged his duties with great vigor.

Prior to his appointment, virtually all medical services of the AoP were on the regimental level. Each regiment had a surgeon an assistant surgeon, a Hospital Steward, and 2-3 men detailed to act as orderlies. Each regiment usually had a motley collection of ambulances and wagons to support the medical staff, and the entire system was broken and inefficient. Letterman set about to rectify that.

One of his first actions was to  form separate Ambulance trains by stripping away the vehicles from the regiments, and  assigning them at the Division level. Each train consisted of 40 ambulances under the command of a Lieutenant. Men were permanently assigned to be drivers and litter bearers, and standard training was instituted.

Secondly, Letterman established Division-level field hospitals by removing the surgeons from the regimental level and assigning them to the new Division hospitals. Each one was tested and the surgeons assigned to duty that best reflected their skills. Some remained as “operators” performing surgical duties, while others were assigned to deal with the administrative side of things. Some few were left at lower levels to handle sick call, etc.

Next, Letterman set out to deal with battlefield casualties. He established a system of “Field Dressing Stations”. These were manned by an assistant surgeon and  an orderly with a knapsack containing palliatives, bandages and tourniquets.  Field Dressing Stations were set up directly behind the battle line, as close as was safely possible, and sheltered to whatever extent the ground, walls, trees, etc, could provide. The location was marked by a small red flag, and wounded men who could walk, and litter bearers carrying wounded were instructed to proceed to such stations first, where the wounded were stabilized prior to transport to the Division hospital, or treated and returned to the front.

Above all else, Letterman established, for the first time, the system of triage which is still in use today. Patients were divided into three categories: Those who would die from their wounds, those who would live, regardless of their wounds, and those who could go either way. Initial treatment was given to the latter category of wounded, and they were evacuated first. The remainder were given palliative care, their wounds dressed, and they were made as comfortable as the situation and resources allowed. They, too, were evacuated when conditions allowed.

Dr. Letterman established the basic organization and treatment protocols that exist to this very day. His ideas were revolutionary and their impact saved tens of thousands of lives during a terrible period of our history. They continue to do so today.

There are many myths about medicine and medical care during the civil war. I hope to dispose of some of them in future articles.