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Memoir of Jonathan Letterman, M.D.

An Index to Medical Recollections

MEMOIR OF JONATHAN LETTERMAN, M.D., SURGEON UNITED STATES ARMY AND MEDICAL. DIRECTOR OF THE ARMY OP THE POTOMAC.

BY BREVET LIEUT.-COLONEL BENNETT A. CLEMENTS, SURGEON UNITED STATES ARMY. "- the iniquity of oblivion blindly scattereth her poppy, and deals with the memory of men without distinction to merit of perpetuity. * * * * Who knows whether the best of men be known, or whether there be not more remarkable men forgot, than any that stand remembered in the known account of time. "-SIR THOMAS BROWNE, 1686. IT is the purpose of this memoir to perpetuate the name and to honor the memory of an officer who effected an organization of the Medical Department of an army in the field, that not only contributed in a large degree to the discipline and efficiency of the foremost Army of the Republic, but also robbed war of many of its horrors; who left behind him for the use of those to come the record of the means by which these noble ends may be again achieved; and who, in rendering this great service to his country, added a brilliant page to the record of the humane character of his profession.[1]

[Letterman's Military Service: 1849-18 June 1862]
Dr. Jonathan Letterman was born in Canonsburg, Washington County, Pennsylvania, on December 11, 1824. His father was an eminent surgeon and practitioner of medicine in the western part of that State, and carefully educated his son for his own profession. His studies were directed by a private tutor until he entered Jefferson College in his native county in 1842, and he graduated thence in 1845. Pursuing his medical studies, he graduated at the Jefferson 2 Medical College, Philadelphia, in March, 1849. In the same year he passed a successful examination by the Army Medical Board in New York City, and was appointed an assistant surgeon in the Army, June 29, 1849. He served in Florida in the campaigns against the Seminole Indians from his appointment until March, 1853; he was then transferred to Fort Ripley, Minnesota, and in May, 1854, marched with troops from Fort Leavenworth, Kansas, to New Mexico. In that department he served at Fort Defiance in the country of the Navajo Indians, and was engaged in Colonel Loring's expedition against the Gila Apaches. He continued on duty in New Mexico until the autumn of 1858, when he was granted a leave of absence after his service of four years on the frontier. In 1859 he was on duty at Fort Monroe, Virginia, and in the office of the late General Satterlee, United States Army, who then was the Chief Medical Purveyor for the Army. 1860 found him in California, where he was engaged in Major Carleton's expedition against the Pah Ute Indians. In November, 1861, he accompanied troops from California to New York City, and was soon after on duty with the Army of the Potomac. In May, 1862, he was made Medical Director of the Department of West Virginia. He served in this position but a short time, for on June 19th of this year he was assigned to duty as Medical Director of the Army of the Potomac, succeeding Surgeon Charles Tripler, United States Army, who had been nominated by the President of the United States to the important position of Medical Inspector-General of the United States Army. On July 2d he received his promotion as surgeon, to date from April 16, 1862. Dr. Letterman, proceeding to the field of his new duties, arrived at the White House, on the Peninsula, on the 28th June, but, owing to the interruption of communications, was unable to report to General McClellan until July 1st, and was assigned to duty by him on July 4, 1862. The Army of the Potomac was then at Harrison's Landing, on the James River, whither it had retired after the exhausting Peninsula campaign. The service he had seen on the frontier and in Indian expeditions had inured him to the hardships of military life. It also gave him an intimate acquaintance with the personal needs and 3 requirements of the soldier, which was now to be made available on a larger scale than had ever before been necessary in our country. The Army, exhausted by its conflicts, and the malarious [sic] atmosphere of the Peninsula, was in great need of rest and recuperation. The great loss of material of every kind that it had sustained, and the impaired health of the troops, demanded the highest qualities for its reorganization and re-equipment. General McClellan, in his report, says of the condition of his Army at this time:[2] "The nature of the military operations had also unavoidably placed the Medical Department in a very unsatisfactory condition. Supplies had been almost exhausted or necessarily aban­doned; hospital tents abandoned or destroyed, and the medical officers deficient in numbers or broken down by fatigue." On his assignment to duty as Medical Director of the Army of the Potomac, he received from the Surgeon-General a letter of instructions which may be of interest at this day.


[Hammond's Letter to Letterman Appointing Him Medical Director of the Army of the Potomac] "SURGEON-GENERAL'S OFFICE, "June 19, 1862. "SIR: "You are detailed for duty with the Army of the Potomac as Medical Director. "In making this assignment, I have been governed by what I conceive to be the best interests of the service. Your energy, determination, and faithful discharge of duty in all the different situations in which you have been placed during your service of thirteen years, determined me to place you in the most arduous, responsible, and trying position you have yet occupied. "On the eve of your departure I desire to place before you some of the main points which should engage your attention. "1st. You should satisfy yourself that the medical supplies are in proper quantity and of good quality, and that each Regiment has its full allowance, and you will hold the senior medical officer to a strict accountability for any deficiency. The time has passed when the excuse of 'no supplies' will be accepted. "2d. You will lay before the officers of the Quartermaster's Department your necessities in regard to transportation, and communicate freely with the General commanding, relative to those things in which he is able to assist you. 4 "3d. You will require all medical officers to be attentive and faith­ful in the discharge of their duties, and you will report instantly to the General commanding, and to this office, all cases of dereliction. 4th. You will, in conjunction with Assistant Surgeon Dunster, U.S.A., Medical Director of Transportation, arrange for the safe, effectual, comfortable, and speedy transportation of such sick and wounded as in your opinion should be removed from the limits of the Army to which you are attached. You will bear in mind, however, the provision of General Orders No. 65, relative to the transportation of troops, and you will therefore, as far as possible, provide for those cases at such points in your vicinity as may seem best adapted to the purpose. "5th. You will hire such physicians, nurses, etc., as you may require, and as you can obtain on the spot, making known to me immediately your deficiencies in that respect at the earliest possible moment, so that I can supply you. "For the full performance of all these duties, you are authorized to call directly upon the Medical Purveyors in Washington, Baltimore, Philadelphia, and New York, who will be directed to furnish you with every thing you may ask for, regardless of supply-tables or forms. You will only be required to notify me by letter what you have ordered, and of whom, and you are directed to correspond frequently with me, and to make known such wants as can only be filled by my requisitions on the several bureaus here or through the orders of the Secretary of War. "And now, trusting to your possession of those qualities, without which I should never have assigned you to the duty, I commit to you the health, the comfort, and the lives of thousands of our fellow-soldiers who are fighting for the maintenance of their liberties. "I am, Sir, very respectfully, "Your obedient servant, (Signed) "W. A HAMMOND, "Ass't Surg., J. LETTERMAN, Surg.-Gen'l, U. S A. Medical Director.

Army of the Potomac." Dr. Letterman's attention was first directed to the removal from the Peninsula of the great number of sick, wounded, and broken-down men that trammelled [sic] the Army, to the enforcement of sanitary measures for improving and preserving the health of the troops, and to providing medical supplies. His recommendations were brief, plain, and practical, and were enforced with 5 energy. General McClellan, in his report already quoted, says: "All the remarkable energy and ability of Surgeon Letterman were required to restore the efficiency of his department; but before we left Harrison's Landing he had succeeded in fitting it out thoroughly with the supplies it required, and the health of the Army was vastly improved by the sanitary measures which were enforced at his suggestion." In the history of our country there were no precedents for the organization for war of a Medical Department which could be adapted to such numbers as were then engaged in conflict, and no aid was to be had from the study of the medical service of foreign armies, except such as the example of their dire ill suc­cess afforded. The Medical Departments of the British and French armies had broken down utterly in the Crimean War in the sight of the world, and the few weeks' conflict between France and Austria, on the historic plains of Lombardy, in 1859, had been too short to admit of the development of any system of organization other than the defective one with which the campaign was begun. In 1861 the French army was considered the model army of the world. Legouest, an experienced French military surgeon, in his work, "Chirurgie de l' Armée," published a year after the Army of the Potomac left the Peninsula, writes of the objects desirable to be obtained in caring for the wounded; but nowhere does he indicate what special means are to be adopted for their accomplishment, and he refers to the works of Larrey and Des Gennettes-surgeons with the first Napoleon,-and even to the ancient Paré and Percy for information on those points. And after stating the fact that even the first succor to the wounded the battle-field is not so simple an affair as at first sight appears, continues (p. 984, 1st ed.): "The removal of the wounded from the battle-field and their transpor­tation to the hospital is the most defective part of the medical service. Even now, after the great wars of the end of the last century and the beginning of the present, after the bloody battles of our own times, this important service (in the French army) is delegated to no particular person, or rather no one has been given authority or placed in position to render it. Military surgeons who have been present in various engagements all know that when the wounded fall in the ranks, there are none, as a matter of fact, to carry them off except their own comrades, a service as painful to one as to the other; the soldier quits the ranks 6 often never to return or only after the fight is over; the number of men carrying off their comrades is rarely limited to the number really necessary, and one may sometimes see four, five, or even six soldiers conducting to a hospital a man slightly wounded and marching quite as well as his comrades." In the French army during the Italian war of 1859 an attempt was made to prevent these abuses by forming brigades of stretcher-bearers composed of the musicians of each corps, but it was found wholly unreliable and impracticable. In our own armies no comprehensive system of caring for the sick and wounded had yet been devised. In the Army of the Potomac itself, the measures to this end were derived from the existing army regulations of 1861; the Quartermaster's Department was responsible for the transportation of the wounded and for the establishment of the hospitals in an action.[3] Perhaps no one in the responsible position of Medical Director of an army had ever before encountered more serious difficulties than did Dr Letterman's predecessor, Surgeon Charles Tripler, of the United States Army. Experienced in the war with Mexico, of military instincts and soldierly training, Dr. Tripler brought to this high duty the most untiring zeal and devotion to the interest of the soldier and the service. Delay and disappointment met him at every turn, as indeed was inevitable, for the whole army were alike inexperienced, and its appointments new and untried, and, above all, but few of the medical officers had any military training or habits. They shared with all other departments the misfortunes of inexperience.[4] But the events of the Peninsular campaign had given to them all valuable experience and insight into the needs of the Medical Department. This experience made it apparent to this body of intelligent men, that a more comprehensive and practical system of caring for the sick and wounded than then existed, was still needed. The great need of an ambulance corps had long been felt. No thorough system for the management of ambulances had yet been devised, and without responsible organization, or a head to govern their use, they were inefficiently managed in time of battle, and often diverted to improper purposes. 7 It was at that time difficult to escape or break through the bonds which custom of service and military discipline had imposed even upon the most experienced officers of the Regular Army. But these restraints were being removed; the new head of the Medical Department of the United States Army, in disre­gard of precedent, gave extensive and independent authority to the officers of his corps, and especially to the Medical Director of the Army of the Potomac, for upon the condition of this Army at that time the attention of the whole country was directed. In Dr. Letterman were found the courage and the clear per­ception to devise and adapt a system for the organization of the Medical Department, which interfered in no manner whatever with the military authority of any commander, and which utilized in the most practical way the material at hand for this important service. Addressing himself at once to this serious task, amid the inces­sant labors of his new position, he, in a few weeks after joining the Army, drew up a plan for the organization of an Ambulance Corps, which was at once approved by General McClellan and published in General Orders dated August 2, 1862. The plan of organization devised by Dr. Letterman, placed in the Medical Director of the Army Corps under the General commanding it, the entire control of the ambulances. The Ambulance Corps was divided into three divisions corresponding to the divisions of troops in each army corps, and all officers of every grade were forbidden to use ambulances or to permit them to be used for other than the purposes designated. The order permitted their use for transporting medical supplies in urgent cases, and eventually they were habitually used for transporting supplies to the brigades and thence to regiments. The men were detailed especially for their fitness for this service, and were taken from the regiments of the respective divisions. In the many schemes suggested by others to organize an ambulance corps, it was always proposed to enlist men specially for the purpose, but Dr. Letterman's knowledge of the service taught him how much better it was to take men who had already been drilled and disciplined, and who were identified with the regiments whose wounded they were to care for; and as their duties in the Ambulance Corps would not exempt them from the dangers and exposure to which their regiments had to submit, the spirit of comradeship was thus kept up. 8 Further mention of the details of this organization it is need­less to give here. The provisions of the order were embodied in the Act of Congress, approved so late as March, 1864, with some few changes. Dr. Letterman himself believed that the act was defective in making the number of ambulances and its necessary complement of men dependent on the number of men in a regiment. The number in the latter constantly varied and especially after a battle, and incessant and harassing changes were thus entailed. If the policy so strenuously urged by officers in the field, of filling up old regiments to the standard strength with new men, instead of forming new regiments, were adopted, the organization of the Ambulance Corps would be less liable to be frequently changing, and more stability would be secured. This act of Congress is based on the order written by Dr. Letterman, devised by him and approved by General McClellan. It fortunately made a uniform system for every army in the field, but the student will miss from the act the precise details designat­ing specifically the practical work to be done by each and every one connected with it. It is most important that those details should be known to every member of the Ambulance Corps, and especially when a new army shall have to be formed.

The Military Committee of the Senate submitted their original draft of the bill to Dr. Letterman for suggestions and recommendations; he gave them in a brief and comprehensive way, suggesting a number of practical changes in the original bill, which he deemed of vital importance to the efficiency and discipline of the corps, all of which were adopted and incorporated in the bill, which finally became a law on March 11 1865. It must excite surprise that such a law was not passed until more than two years after final and absolute proof of the perfect adaptation of the system to the needs of the service had been given at the first battle of Fredericksburg, in December, 1862. No large opportunity, however, was given to test this plan during the transfer of the Army of the Potomac from the Peninsula to Alexandria, Virginia. Dr. Letterman shared with General McClellan the enforced inaction to which the head of the Army of the Potomac was for a while condemned at this critical period; but when the latter was again placed in command of that gallant but dispirited army on the night of September 2, 1862, Dr. Letterman resumed control of its Medical Department. He found that the supplies were woefully [sic] deficient. In the 9 rapid transfer of the army from the Peninsula, supplies and ambulances had been left behind or lost, and medical officers and the officers of the Ambulance Corps were worn down by fatigue from hard service. The deficiencies had to be made up while the army was actually on the march into Maryland. Under these disadvantages the battle of Antietam was fought, but even then the great value of the new system of managing the ambulances was shown, and warranted great hopes of its future excellence. Some changes relating to the responsibility for the care of the material of the Ambulance Corps, which were of great importance, as they rendered the Medical Department in a great measure independent in its transportation, were made with the co-operation of the Chief Quartermaster in the fall of 1863; and some alterations and additions in the details were embodied in a revised ambulance order, dated August 24, 1863, but beyond these no change in its working was ever made in that army.[5] Very soon after the battle of Antietam, Dr. Letterman made another change of great importance in the method of supplying the Army with medicines, dressings, and medical material. The quantity of these materials carried was often excessive, and in other instances insufficient; the mode of transporting them and if supplying them to the regiments was cumbrous and often unreliable in time of battle. With that sagacity and practical knowledge of adapting means to ends which he possessed in so marked a measure, he reduced careful selection the amounts of medicines and materials to be carried, lessened the number of wagons required to transport them to nearly one half the number previously in use, and gave simplicity, compactness, and efficiency to the whole service of supply. The details of this arrangement were published in a circular dated October 4, 1862,[6] and no material change in its requirements was ever found necessary, the completeness of the plan having been at once demonstrated. This circular was reused and republished September 3, 1863. Dr. Letterman now gave his attention to preparing a better method of providing for the care and treatment of the wounded in battle. It was not then known, nor is it now believed, that any precise system of Field Hospitals was then in use in any of 10 our armies; but it was of the greatest importance that a system should be devised and made compulsory, by which every person should, beforehand, know what his duties were, and which should hold each one to a proper responsibility, whilst the most skilful surgeons should be available for the performance of operations on the field. On the 30th of October, 1862, while the Army of the Potomac was still in Maryland, he issued the important circular establishing Field Hospitals and providing for all the details necessary for the prompt and efficient care of the wounded. It never required change or alteration, and was in use until the Army of the Potomac was disbanded. This circular completed his scheme of organization of the Medical Department. Its provisions were adopted by the Surgeon-General of the Army, who, on March 25, 1863, ordered its observance by all medical officers of the armies of the United States. It remained now to give practical effect to the working of this scheme of organization. The Ambulance Corps, the method of supply, and the Field-Hospital system were carefully designed to work as a whole. It is within the knowledge of the writer that the principal medical officers of the Army at once saw the sim­plicity of these measures, which also promised to increase the effectiveness of their own arduous labors in time of battle. The battle of Fredericksburg, in December, 1862, afforded the first opportunity to test whether they were to be successful. The actors in that dreadful conflict may themselves testify.

[Surgeon Charles O'Leary at Fredericksburg] Surgeon Charles O'Leary, then Medical Director of the Sixth Corps, now President of the State Medical Society of Rhode Island, said in his official report: "Being appointed Medical Director of the Sixth Corps a few days prior to the battle of Fredericksburg, December 13, 1862, I had the opportunity of putting in operation the Field-Hospital organization devised by the Medical Director of the Army, and witnessing its beneficial results. Within a very few hours after the positions were designated for the Field Hospitals on December 12th, all the necessary appliances were on hand, and the arrangements necessary for the proper care of the wounded were as thorough and complete as I have ever seen in a civil hospital. "During the engagements of the 13th, the ambulances being guided 11 and governed with perfect control and with a precision rare even in military organizations, the wounded were brought without any delay or confusion to the hospitals of their respective divisions. Not a single item provided for the organization of the Field Hospitals suffered the slightest derangement, and the celerity with which the wounded were treated, and the system pervading the whole Medical Department, from the stations in the field selected by the assistant-surgeons with the regiments, to the wards where the wounded were transferred from the hands of the surgeons to be attended by the nurses, afforded the most pleasing contrast to what we had hitherto seen during the war. * * * * * * "Both military commanders and medical officers agree that it would have been impossible for wounded to have received better care and treatment than they did in that battle." A similar state of things characterized the operations of the Medical Department in the rest of the Army.

[Sixth Corps Medical Director at Fredericksburg] In the operations at the time of the battle of Chancellorsville in the following May, the Sixth Corps charged and took Marye's Heights behind the town of Fredericksburg. The Medical Director of the Corps, in his report (pp. cit, p. 138), says: "The charge was made at 1 P.M. the heights were taken, and in less than half an hour we had over 800 wounded. Two hours after the engagement, such was the celerity and system with which the ambu­lances worked, the whole number of wounded were within the hospitals under the care of nurses* * * "Our hospital organization was strictly on the plan prescribed in the circular of the Medical Director of the Army. Supplies of every thing necessary were never for a moment deficient." It was not always that the exigencies of a battle permitted the use of all the means for the speedy care of the wounded that had been prepared with such labor and forethought. Such in fact was the case at the battle of Chancellorsville, in the Wilderness, where, despite Dr. Letterman's most urgent representations, but few ambulances and medicine wagons were allowed to come on the field; and again for a time at the battle of Gettysburg, where for three days the issue hung in the balance. In the last named battle the orders of the Commanding General had not only reduced materially the number of supply wagons for the Medical Department, but the exigencies of the closely contested 12 conflict did not admit of those that were at hand being brought on the field. But the ambulance organization was intact, and such was the perfection of its administration, that on the early morning of 4th July, the day after the battle ended, not one wounded man of the great number who had fallen (over 14,000) was left on the ground.

[Inspector General of the Army at Gettysburg] The Inspector-General of the Army himself reported this interesting fact from personal examination. No better example of the efficiency of the ambulance system than this and that already mentioned at the capture of Marye's Heights could be given. In this mighty battle of Gettysburg it fell out that for some reason not now known, in one corps of the Army, the Twelfth, no reduction in the number of supply wagons had been made, nor had any been sent to the rear as was the case in the rest of the Army, and its surgical organization was therefore intact.

[Twelfth Corps Medical Director, Surgeon McNulty]Its Medical Director, Surgeon McNulty, United States Volunteers, in referring to the working of the hospital organization, reported: "It is with extreme satisfaction that I can assure you that it enabled me to remove the wounded from the field, shelter, feed them, and dress their wounds within six hours after the battle ended, and to have every capital operation performed within twenty-four hours after the injury was received." A few more illustrations and proofs of the efficiency of the organization of the Medical Department of the Army of the Potomac will be given, drawn from official reports. Surgeon (now Brevet Brigadier-General)

[Surgeon (now Brevet Brigadier-General) T. A. McParlin] T. A. McParlin, United States Army, who in 1864 succeeded Dr. Letterman in that Army, in reporting his preparations for the campaign to Richmond in 1864, referring to the ambulance law adopted by Congress in the spring of that year, says: "As its provisions corresponded in all essential particulars to the system already instituted in the Army by Surgeon Letterman, no difficulty or delay occurred in its adoption. * * * Tens of thousands of wounded men have been carefully, speedily, and safely transferred from the field of battle to the field hospitals, and from thence to the large depŏt hospitals, and this has been done without confusion, without hindering the movements of the Army, or conflicting with the operations of the other Staff Departments." 13 And of the Division Field Hospitals he says: "The Medical Staff of these hospitals was the same as established by Surgeon Letterman." And in beginning his report of his service in the Army as the successor of Dr. Letterman, he says: "The excellent condition of the Department at that period (January, 1864) evidenced the success of his labors."[7] It is unnecessary to multiply commendations and instances of the thorough working of Dr. Letterman's system.[8] Such was its practical "common-sense" character that the Medical Officers of the whole Army vied with each other in carrying out its require­ments, and their intelligence and devotion to their duty and to their profession engendered among them a spirit of enthusiasm. The writer well remembers with what earnestness a most distin­guished Surgeon of Volunteers and Surgeon-in-chief of a Division, Holman, once said to him: "You can't imagine how deeply we all are indebted to Letterman for telling us what to do, and showing us how to do it." No higher commendation could be bestowed on Letterman's work, nor on the speaker's own devo­tion to his profession and the service. It came soon to be known that the Medical Officers of the Army of the Potomac could care for their wounded without the uncertain aid of surgeons and nurses from civil life. Before the battle of Chancellorsville, Dr. Letterman telegraphed the Surgeon-General of the Army, at Washington, not to permit civilian surgeons to come to the field. He knew his corps could do the required work, and he desired to add to their self-reliance. For similar reasons he did not at this period, when his Department was in good working order, encourage the Sanitary Commission to apply their noble means of relief to the service of that Army. His confidence in his corps was well founded, for the wounded from that battle were treated, with the exception of a very small number, in the Field Hospitals of their respective divisions which were established on the north side of the river, and it was observed by all that the wounded never before did so well after any great battle of that Army. The different Army corps vied with each other in 14 seeing to the comfort of their wounded; the men were their comrades and treated by their own surgeons; their morale was maintained, and a great many speedily returned to the ranks who otherwise would not have rejoined in time for the impending campaign. The knowledge of the ability of the Army in the field now to take thoroughly good care of its wounded became eventually a source of great satisfaction to the country. A writer in a promi­nent Philadelphia newspaper, early in 1864, said, in drawing at­tention to the Medical Department of the Army of the Potomac: "The great and successful efforts which have been made by the Medical Department of the Army are known to but few outside of the Army. We have alluded to this subject in order that the friends and relatives of those who are now imperilling [sic] their lives in defence [sic] of their country may have some idea of what is doing by a humane and bountiful government for the relief of those who fall in its battles; and that they may rest easy in the confident assurance that there is a department of the government which looks after the wounded and sick with the utmost care, and provides for all their wants. This Department is silently, and unostentatiously, and successfully working to alleviate the sufferings that must ensue after a battle; and our people may rest assured that it will continue to take such care of the wounded and sick as has never before been done, either upon this continent or in the world." And at about the same time there appeared in a prominent medical journal in New York, the following remarks which aptly express the view then being taken of the results of Dr. Letterman's labors. After giving a clear outline of the organization, it is said:

[Extract from "Medical Times," New York on 30 April 1864] "Whatever may be the future of the Army of the Potomac, it has gained a reputation for perfection of organization which will secure it a commanding position among the armies of history. * * * * * * * "But the Medical Department has special claims upon the attention of the country. Without detracting from the merits of the other branches of the Army, we may say that the organization of the Medical Depart­ment has attained a degree of perfection which is found in no other army at home or abroad. It will be seen that the reforms were radical 15 and developed, under different heads, a system of operations which cov­ered the whole field of medical service. Its utility consisted in redu­cing to harmony and concert of action every branch of the medical service, and in placing the right man in the right place; unity and efficiency was the key-note of the reform proposed, and to this every other consideration had to yield. The entire medical staff of the Army became a unit, and moved with the deliberation and precision of a single person. Of the practical value of these improvements we are now able to speak in the most unqualified terms. They have been put to the most rigid test, and have been found in the highest degree practical and effective. The medical staff of no army ever worked in such perfect harmony and subordination on the battle-field as that of the Army of the Potomac. The battles of South Mountain, Crampton's Gap, Antietam, Fredericksburg, Chancellorsville, and Gettysburg, have placed the most violent strain upon every detail of this organization, whether taken as a whole or in its separate parts, and yet it has never been found wanting. The prompt care of the wounded in these sanguinary battles was never exceeded under similar circumstances. "The highest attestation of the value of the present organization of the ambulance service of the Army of the Potomac is found in the unanimity with which it has been pressed upon the attention of Congress, and the recent almost unanimous action of that body in extend­ing its provisions to all the armies of the United States. Its system of Field Hospitals has in the main also been adopted by the Surgeon-General for all our armies. "Too much praise cannot be awarded to Dr. Letterman for the patient and intelligent zeal with which he has labored to establish and perfect the present organization of the medical service of the Army of the Potomac. Its conception could only occur to a mind apt in method and organization, and while of comprehensive grasp, yet trained by experience to the study of details. * * * To Dr. Letterman is due the gratitude of the country for his perseverance in effecting these desired reforms." As time passed and officers and men became familiar with the workings of all its details, this system proved capable of improvement in the direction of simplicity Field Hospitals were organized for service even on the march; and in camp, and during periods of inactivity, it eventually became manifest that regimental hospitals were seldom necessary for the best interests of the sick-only the lighter and more trivial cases of disease and injury being treated in their regiments. 16 This organization, it will be seen, was devised by Dr. Letterman without aid from the experience of other armies; it bore he test of the gigantic struggles of the great armies in Virginia, and the writer has failed of his purpose if he has not shown that, solely to Dr. Letterman's ability and his practical mind are due he conception and efficient working of this scheme, which provided an Ambulance Corps for all our armies, added to the efficiency of the Army of the Potomac, and saved that Army from much of the inevitable suffering of war. It was not brought to its high state of efficiency without great and persistent labor, in which the Medical Directors of Corps and Divisions and the entire Medical Corps of that Army fully shared. Dr. Lettermann's [sic] admiration of his corps of surgeons was great, and his confidence in them unbounded. Nearly all had come recently from civil life, and had entered upon novel and exacting duties without previous training; but as soon as a plan was presented to them by which their sick and wounded could be cared for systematically, and their own great personal labors made to accomplish speedy and effective results, they eagerly grasped at the opportunity, and on every battle-field of that great Army displayed professional and administrative ability and a devotion to their duties that Dr. Letterman omitted no opportunity to recognize and commend. He well knew, and none knew better, how much of credit was due to the surgeons from civil life. He had the aid at different periods of his administration of some few able officers of the Regular Army of military training, To Alexander, Moore, Muhau, Wilson, of the Cavalry; Webster, Thompson, McMillan, and a few others of the Regular Medical Corps, he gave on all proper occasions the fullest meed of praise; but to those of the Volunteer Staff and to the Regimental Surgeons he knew the actual results attained were mainly due. In his work entitled "Medical Recollections of the Army of the Potomac," he writes in the highest terms of praise of the services of the able volunteers who shared with him the labors of his Department. He commended in brief and soldierly terms the services of O'Leary, Taylor, Dougherty, Heard, Pancoast, Janes, Holman, NcNulty, Oakley-and never omitted an opportunity to extol them. In a letter addressed to the Commanding General of the Army on the eve of the battle of Chancellorsville, he attributed the in the great improvement in the vigor and health of the troops "to the 17 zeal and energy displayed by the Medical Directors of Corps and the Medical Officers of this Army generally, in inculcating the absolute necessity of cleanliness, and attention to the precautions for preserving the health of the troops," etc., etc., and he adds: "My directions and suggestions have been carried out with an intelligence and zeal which it affords me great satisfaction to bring to the notice of the Commanding General." The President of the United States was then visiting the Army, and expressed gratification at the favorable exhibit of the health of the Army and at the just praise bestowed on the Medical Officers. But the management of the Medical Department did not al­ways escape unfavorable criticism. On every battle-field suffering is inevitable, and, amid the excitement and seeming confusion only the practised [sic] and experienced eye can see the harmonious opera­tion of an extensive system. Many inexperienced persons repre­sented that on many battle-fields the wounded were not well cared for, yet such complaints scarcely ever were heard from the wound­ed. Straw to lie on, food and water, and the skilful attention of his surgeons, are all that the tried soldier desires or the experi­enced medical officer would demand on the battle-field; yet there were at times even persons in authority, who, being ignorant of and inexperienced in the method of governing a vast establishment, were incapable of understanding the true meaning and significance of what appeared upon the surface of events on the battle-field. Some such at times would create misunderstanding and annoyance; but Utopian dreams of entire perfection have no place in the mind of the practised [sic] military man, and least of all did they find lodgement [sic] in the practical mind of Dr. Letterman. It seems probable that the changes which are being made in the method of conducting war in the future will involve altera­tions, in some degree, of the details of the plan of organization of the Medical Department of an army in the field that Dr. Letterman devised and perfected; but changes in its essential features are deemed unlikely to be required in this or the next generation, and any scheme radically different is not likely to be proposed. Its simplicity and tried adaptation to all emergencies of warfare must render its adoption inevitable. Whatever changes may be made in the future methods of warfare in this country, it may well be doubted if any Medical Corps will be willing to adopt the view expressed by a distin- 18

[Extract from "Journal of Military Service Institution," vol. ii, No. 5, p.8] guished officer of our Army,[9] that in future wars, "the sick and wounded will generally be sent to the rear, no longer to appear on the field during that war." No point was made more prominent, or considered more important in Dr. Letterman's administration of the Army of the Potomac, than the necessity of treating the curable sick and the wounded in their own field-hospitals, in order that they might the sooner rejoin the ranks. A war would be brief indeed if some of the sick and wounded could not rejoin their colors before its termination, and the just pride of a medical corps, apart from other equally weighty considerations, would not readily tolerate a system which regarded all sick and wounded as no longer to be counted on for active service. It is not intended in this sketch to treat at length of the details of his administration. He put an end to the depleting of the ranks of the Army which had been caused by injudicious and careless discharges from the service, and by the license of sending unfit men to General Hospitals; and he insisted upon having the sick and the wounded treated in the Division Hospitals of their own Army Corps whenever the conditions of the military opera­tions permitted; and by wise and practical sanitary measures, which were strenuously enforced, he kept that Army in a state of vigor and health altogether unparalleled in armies of its magnitude. Amid the labor required to accomplish these results, he did not lose sight of the opportunities which the experience of the Army would afford of enlarging the then existing knowledge of military medical science, if it were properly recorded. The blank forms which he devised for this purpose were clear and compre­hensive, and they were filled up and kept by the Medical Officers with a degree of accuracy and care which could have been secured only in a well-organized and thoroughly disciplined Medical Department. There is no reason to believe that the medical and surgical records of the Army of the Potomac, which were continued and perfected by his distinguished successor, Surgeon T. A. McParlin (now Brevet Brigadier-General), U. S. A., are full and complete to an extent never before deemed attainable. His orders and instructions, when the general plan of his 19 management had become familiar to his assistants, were few and brief, and marked by a spirit of directness and practicability, and an intimate knowledge of the character of the soldier and the influences which affect him, as well as by the clearest conception of the needs of the service, in which the maintenance of the effective strength of the Army and of the vigor and spirit of its individuals was never lost sight of. It is not too much to say that he succeeded in infusing into the officers of his Department much of the energy and directness of purpose which marked his own acts, and governed his conception of the duty of a Medical Officer of the Army. Dr. Letterman's claims to the grateful remembrance of his profession and of his countrymen, rest mainly upon the great services he rendered to his government in the Army of the Potomac, and the writer has therefore endeavored to present, in some detail, but as briefly as could be done, a plain account of the work he did and the results which were achieved by the Medical Department of that Army under the guidance of his practical and comprehensive mind. To him is justly due the praise of originating a system of medical administration which alleviated the sufferings and preserved the lives of thousands of his countrymen, added to the vigor and effective fighting strength of the principal Army of the Republic, and materially aided in perfecting and maintaining its discipline; and which has had no equal in the armies of modern times for simplicity and effectiveness. For having done these things he has a just claim to the grateful remembrance of his professional brethren, of his military associates, and of his countrymen. In October, 1863, Dr. Letterman obtained a short respite from duty with the Army and married Miss Mary Lee of Maryland, a highly accomplished lady, who was closely connected with some of the most prominent families of historic name in the adjacent States of Maryland and Virginia. On the occasion of his marriage he was presented, to his infinite surprise, with an elegant service of silver by the Medical Officers of the Army of the Potomac, with a note expressing feelings of great kindness to him. It was probably the first distinct intimation that he had ever received of the special regard entertained for him by that body of officers. In acknowledging its receipt he expressed the pride he felt at being an officer in that Army and his gratification at being so kindly regarded by its Medical Officers. 20 When the Army of the Potomac went into winter-quarters after the military operations at Mine Run, Dr Letterman, in December, 1863, requested the War Department to relieve him from duty with that Army with which he had so closely identi­fied himself. It was not known to even his intimate friends, and it can hardly concern those now living, why he took this step. He himself writes that it was evident no military movements could be made by either Army at that season; "The Medical Department had been fully organized in all its branches * * * * * and little more remained to be done beyond the ordinary routine of duty." The labor and responsibility he had endured well entitled him to a respite; he may have felt that other hands than his could now guide the instrument that he had so laboriously designed and perfected, and it may also be that some perception of failing health might have influenced his determination. But it caused the deepest regret to the Medical Officers when his intention to sever his connection with that gallant Army became known.

[Memorial to the Senate Committee of Military Affairs] The principal Medical Officers of the Army, at once and wholly unknown to him, united in a "Memorial" to the Military Committee of the United States Senate urging, that he be honored with the rank and rewarded with the emoluments granted to the heads of other Staff Departments in the field, it being hoped that he might thereby be induced to rescind his resolution. This "Memorial" is in terms which constitute the highest commendation that his co-laborers in the Medical Department could confer, and it is here given entire. "To the Committee of the Senate on Military Affairs: "Actuated purely by an interest in the welfare of the public service, and believing that the honorable body we address are actuated by the selfsame motive, being composed of men selected as the Nation's representatives for their zeal, their patriotism, their knowledge, and integrity, to watch over the military affairs in which now lies the Nation's life or ruin, to correct their abuses, to remedy defects, to inaugurate and encourage improvement and efficiency in every department,-we beg to bring to their notice a subject, than which none other has, from its intrinsic importance, a stronger claim on their attention. "The Medical Department of this Army has, within the past year, approached to a degree of organization and perfection never attained even in the armies of those military powers where for centuries profess- 21 sional skill, aided by experience of many wars, and encouraged by the patronage and the rewards of military rulers, has labored for its improvement. We express not the sentiments of Medical Officers only; we give the opinion of Military Commanders, when we affirm that not only the remarkable state of health, but in great measure the tone, the vigor, and in part the discipline of this Army, is due to the efficient officer at the head of its Medical Department. "When we contrast this Army at present, with what it was when Surgeon Letterman assumed the charge of its Medical Department, when the tide of men flowing to the rear depleted its ranks, owing to a lax system of discharges, or no system at all, and owing to an un­checked license of granting passes to hospitals; when we compare the provisions now made for the wounded with what they were before his time, we cannot help congratulating the Army and the country upon the change, and cannot forbear bringing to your notice the merit of the officer to whom that change is due. "The Medical Department, without a head to guide it in the first campaign of this Army, between the complaints of the men, and the importuning solicitations of officers on every side, and without resources to provide for the sick, inclined universally to the only resource left, that of getting rid of every man who succumbed, or feigned to succumb, to the hardships of military life. "The Medical Officers saw and appreciated the evil, but were in their subordinate capacity helpless to remedy it. "The depletion of the Army by the great number sent to the rear has been stopped; ample means provided and skilfully [sic] applied afford the sick all comfort necessary for their recovery within the lines. Sickness, by wise sanitary regulations, inculcated and rigidly enforced by constant vigilance, has been prevented from making its customary inroads upon the strength of the Army. A system of ambulance has been devised, of the merits of which, and of its adaptation to all the vicissitudes of campaigns, we can adduce no stronger proof than that it has been embodied in a bill providing an Ambulance system for the Armies of the United States, by the Chairman of your Honorable Committee. We may search history in vain for campaigns of equal severity, for battles of equal magnitude, with those of this Army for the past eighteen months, and we challenge history to produce a battle wherein the hundreds of wounded have been so well and so rapidly provided for, as the thousands in the great battles of this Army. "For the man who has benefited so much by his ability, by his untiring zeal, our Department, and in benefiting one has benefited each department of the Army, we ask or claim no extraordinary tribute, we merely represent for the sake of the Armies of the United States that he 22 be honored with the rank and rewarded with the emoluments granted to the heads of other departments in the field, and that he be retained in his present position in order to complete successfully the organization he has devised, and to give the Government, the Country, and the Armies, the proof of its benefit in the practical success of its working. We make this appeal with feelings remote from personal considerations; we make it because we believe the interests of the Service will be promoted by the measure we recommend; we make it because we believe the Medical Department of the Armies of the United States will be thereby raised to the proud preeminence of being the most effective in any military organization of the world; we make it because we believe, and in this belief we are seconded by the voice of every man within and without this Army, acquainted with its history, that he alone who has organized the Medical Department is the most competent to guide its practical working." This memorial was drawn up entirely without Dr. Letterman's knowledge, and was presented in person to Senator Wilson, then Chairman of the Military Committee of the United States Senate, who enthusiastically expressed his gratification at this evidence of the high esteem in which Dr. Letterman's services were held by his own Department, and he promised to use his earnest efforts before Congress to have its purpose effected; but before any action could be taken Dr. Letterman had been relieved, and nothing further could therefore be done. When he was ordered to duty as Medical Director of the Army of the Potomac, he held the rank only of "Captain," though he soon after became, by regular promotion, a "Major." It will excite surprise that such a position should not entail a higher rank when the heads of all other Staff Departments in the field, in our own Army had much higher rank, and when in all other armies of modern times it is given only to officers of the highest grades.[10] But, in obeying the orders of the War Department, he accepted the great responsibilities of the high position as he would have done the lightest that could have been imposed on him. He had not sought the position, and he was not consulted as to his detail for it. In a private letter written some time later he says: "I knew nothing of it until it was done. It was a position I did not seek; it was one I could not decline." He accepted it as a soldier should do, and he retired from it when his work was done; but it 23 will ever be a great and lasting regret to his friends and comrades that he did not remain and inseparably link his name with his work, and with the glorious record of that grand Army until consummation of its mission at Appomattox.

[Letterman's Post-Military Career] On being relieved from duty with the Army of the Potomac Dr. Letterman was assigned as Medical Inspector of Hospitals in the Department of the Susquehanna, in which position he remained until December, 1864. Flattering offers of a position as superintendent of a commercial company in Southern California. which afforded a prospect of highly lucrative gains, had been made him by Mr. Thos. A. Scott, then President of the Pennsylvania Railroad Company, and he was induced to resign from the Army. His Army friends strenuously endeavored to prevent him from taking this step, and even entreaty was used; but be was not to be turned from his purpose, and his resignation from the Army was handed in and accepted by the President, to take effect December 22, 1864. He was twice recommended by General McClellan for brevets for his services, and also by the Surgeon-General, in March, 1863. The enterprise for which he had given up his commission an officer of the Army that he had held for over fifteen years, unfortunately did not fulfil [sic] the hopes of its originators, and Dr Letterman retired from its management and took up his residence in San Francisco, where he resumed the practice of his profession. In 1866, whilst engaged in Southern California, he prepared and published an account of his administration of the Medical Department of the Army of the Potomac. This work is entitled "Medical Recollections of the Army of the Potomac." At the time of its publication the country was resting under the reaction following the great and exhausting war, and interest in its events had not yet been revived, and in consequence this work has not attracted the attention that, in the opinion of the writer, it well deserves. It is replete with practical observations of the highest value, and in recounting the medical history of the different battles of that Army, he has made a valuable contribution to the science and art of military administration. In it he refers, often in ardent terms, to the services rendered by his medical colleagues. In his preface he says it was "prepared amidst press­ing engagements in the hope that the labors of the Medical Officers of that Army may be known to an intelligent people, with 24 whom to know is to appreciate, and as an affectionate tribute to many-long my zealous and efficient colleagues-who, in day of trial and danger which have passed, let us hope never to return, evinced their devotion to their country and to the cause of humanity, without hope of promotion or expectation of reward.[11] In the autumn of 1867, he was elected Coroner of the City and County of San Francisco, an office understood to be very lucrative; but before he entered upon its duties, a great and lasting affliction fell upon him in the sudden death of his de­voted wife on November 1, 1867. Under the weight of this great sorrow, he entered upon the duties of his new office, but with his usual energy and resolution, he performed them so satisfactorily that he was re-elected to the office for another term, on the expiration of which, on December 4, 1871, he retired to private life. He had been commissioned, in 1868, by Governor Haight, as Surgeon-General of the State of California. In 1870, the Regents of the University of California elected him a member of the Board of Medical Examiners of that university, and in 1877 he was made a member of the first class of the Military Order of Loyal Legion of the United States. But the dark shadow of his domestic affliction never passed away from his noble spirit; his health, already seriously impaired by long existing chronic disease of the intestines, became very precarious. On March 13, 1872,-but a few months after retiring from the office of Coroner,-he became very ill, and was visited by Dr. A. S. Ferris, of San Francisco, and by Dr. Wm. Hammond, an old friend and former colleague in the Army. As soon as it be­came known that he was seriously ill, troops of friends hastened to his side; his exhaustion rapidly increased, and, though he received every attention that skill and devoted friendship could bestow, he sank and died on March 13, 1872. His remains were removed to St. Mary's Cathedral, in the city of San Francisco, where the last rites of his church were celebrated, and thence were escorted by the members of the Loyal Legion and a body of distinguished officers of the Army and Navy, to Lone Mountain Cemetery, near that city, and laid 25 to rest. At his death he was forty-seven years and a few months old. Dr. Letterman's character was of such simplicity that no extended phrases are required to do it honor. His directness of speech and manner expressed the frankness and sincerity of his nature. Of a truly modest disposition, he possessed great kind­ness of heart and sensibility to the feelings of others, and he united to these endearing qualities the keen sense of humor that so often accompanies them. Unselfish himself, he was generous in according praise to his colleagues, and his guiding thought was to do his whole duty, whatever it might be, as thoroughly as he could do it. A true friend to all who gained his confidence, he was unswerving in his devotion to the right, and it may be truly said of him that he was an honest man in thought and in deed. An interesting reminiscence of his earliest service in the Army has recently been given by a distinguished officer. Military service on the frontier, in the days when railroads were not, brought men into intimate association; the common dangers and exposure, and the isolation from civilization, gave prominence to every trait of character, and brought into relief the virtues and the feelings of every one. Enduring friendships were formed in those days now passed, a pleasing illustration of which the writer is able to present, through the kindness of a friend, in the following graceful tribute to Dr. Letterman's

[Confederate General William Wing Loring] memory, from General W. W. Loring, under whom he served when the latter was Colonel of the Regiment of Mounted Rifles of our Army when Dr. Letterman entered the service, and who later held high rank in the Egyptian Army of the Khedive. "No. 9 WAVERLEY PLACE, NEW YORK. " Nov. 27, 1882. "Dr. I. COOPER M'KEE, "U. S. Army. "DEAR DOCTOR :-I recollect our old friend Dr. Letterman with great affection. * * * For several years we served together at Fort Union, New Mexico, where there was stationed the larger portion of my old regiment, and I always had reason to be thankful that we were favored by a gentleman of such equable temperament and such skill in his profes­sion. I never knew an officer who was all the time more ready to act at the call of duty; full of manly sympathy, he was ever ready to render 26 timely aid to the suffering, whether at the summons of an officer or the call of the private soldier. "These and his many virtues endeared him to the entire command. Socially, he was modest and retiring, gentle, almost childlike in his character. No one who had the pleasure of knowing him but formed & very high estimate of his ability, and (though comparatively young at that time) of his varied experience. "From my close intimacy with him, I became aware that he was an ardent student, and no man in his corps sought more earnestly to attain the highest knowledge in the scientific advancement of his profession. "I have hastened to send you this short note, and to add, though slight, my respectful homage in remembrance of a generous and true-hearted gentleman; and though our fortunes were in opposite directions, I have never ceased to look back to our early acquaintance on that distant frontier service, as one of the pleasant episodes in my life, and, as you may conceive, I recall the many incidents connected with it to make green in my memory one of those who was without guile, and who never did an intentional wrong to any man. "With kindly regard, truly, (Signed) "W W. LORING." The friends and comrades of Dr. Letterman in the Army of the Potomac will read with special gratification the following

[Major General George B. McClellan]note from his old and beloved commander, General McClellan, which expresses in generous terms his appreciation of Dr. Letterman's services and character.[12] "WASHINGTON, Febr'y 26, 1883. "Gen'l CHAS. H. CRANE "Surgeon-General U. S. A. "MY DEAR GENERAL:-I have read with the greatest interest Dr. Clements' memoir of our old friend Letterman. "It recalled in all its freshness the memory of those trying days during which it was my good fortune to have him at my side as the Chief Medical Officer of the Army of the Potomac. He joined me in the midst of the cares inseparable from the close of a week of contin­uous battle. "Thousands of sick and wounded were to be cared for with insufficient means. 27 "I saw immediately that Letterman was the man for the occasion, and at once gave him my unbounded confidence. In our long and frequent interviews upon the subject of his duties, I was most strongly im­pressed by his accurate knowledge of his work-the clear and perfectly practical nature of his views and the thorough unselfishness of his character. He had but one thing in view-the best possible organization of his Department-and that, not that he might gain credit and promotion by the results of his work, but that he might do all in his power to diminish the inevitable sufferings of the soldiers and increase the efficiency of the Army. "I never met with his superior in power of organization and execu­tive ability. "It is a great satisfaction to me to be able once more to bear testi­mony to my intense gratitude for the services he rendered to the Army under my command, and my admiration for his high qualities as an officer and man. "Very sincerely, your friend, "GEO. B. McCLELLAN." The writer of this paper, though honored with the friendship of Dr. Letterman, and intimately associated with him in his administration of the Medical Department of the Army of the Potomac, would gladly have left to abler hands the grateful task of endeavoring to rescue from oblivion the record of his able, faithful, and useful services. But there seemed to be no other one to render to his memory this last office of justice and of friendship; and he presents this memoir, however inadequate it may be, to the Army, to the Medical Profession, and especially to the surviving Medical Officers of the Army of the Potomac, as a tribute due to the memory of a most faithful officer, who devoted his great talents and all his energy to the welfare of the men of that Army, and to the honor of his profession and of his corps. 28 APPENDIX. I.

[General Orders No. 85 Published on 24 August 1863]AMBULANCE CORPS. HEAD-QUARTERS, ARMY OF THE POTOMAC, August 24, 1863. GENERAL ORDERS, No. 85. The following revised regulations for the organization of the Ambulance Corps, and the management of the Ambulance Trains, are published for the government of all concerned, and will be strictly observed: 1. The Army Corps is the unit of organization for the ambulance corps, and the latter will be organized upon the basis of the Captain as the commandant of the corps, one 1st Lieutenant for each division, one 2d Lieutenant for each brigade, one Sergeant for each regiment. 2. The Privates of this corps will consist of two men and one driver to each ambulance, and one driver to each medicine wagon. The two-horse ambulances only will be used, and the allowance, until further orders, to each corps, will be upon the basis of three to each regiment of infantry, two to each regiment of cavalry, one to each battery of artillery, to which it will be per­manently attached, and two to the head-quarters of each army corps, and two army wagons to each division. Each ambulance will be provided with two stretchers. 4. The captain is the commander of all the ambulances, medicine and other wagons in the corps, under the immediate direction of the Medical Director of the Army Corps to which the ambulance corps belongs. He will pay special attention to the condition of the ambulances, wagons, horses, harness, etc., and see that they are at all times in readiness for service; that the officers and men are properly instructed in their duties, and that these duties are performed, and that the regulations for the corps are strictly adhered to by those under his command. He will institute a drill in his corps, instructing his men in the most easy and expeditious method of putting men in and taking them out of the ambulances, lifting them from the ground and placing and carrying them on stretchers, in the latter case observing that the front man steps off with the left foot and the rear man with the right, etc.; that in all cases his men treat the sick and wounded with gentleness and care; that the ambulances and wagons are at all times provided with attendants, drivers, horses, etc.; that the vessels for carrying water are constantly kept clean and filled with fresh water; that the ambulances are, not used for any other purpose than that for which they are designed and ordered. Previous to a march he will receive from the Medical Director of the Army Corps his 29 orders for the distribution of the ambulances for gathering up the sick and wounded previous to, and in time of, action; he will receive orders from the same officer where to send his ambulances, and to what point the wounded are to be carried. He will give his personal attention to the removal of the sick and wounded from the field in time of action, going from place to place to ascertain what may be wanted; to see that his subordinates (for whose conduct he will be responsible) attend faithfully to their duties in taking care of the wounded, and removing them as quickly as may be found consistent with their safety to the field hospital, and see that the ambulances reach their destination. After every battle he will make a report, in detail, of the operations of his corps to the Medical Director of the Army Corps to which he belongs, who will transmit a copy, with such remarks as he may deem proper, to the Medical Director of this Army. He will give his personal attention to the re­moval of sick when they are required to be sent to general hospitals, or to such other points as may be ordered. He will make a personal inspection, at least once a month, of every thing pertaining to the ambulance corps, a report of which will be made to the Medical Director of the Corps, who will transmit a copy to the Medical Director of this Army. This inspection will be minute and made with care, and will not super­sede the constant supervision which he must at all times exercise over his corps. He will also make a weekly report, according to the prescribed form, to the same officer, who will forward a copy to the Medical Director of this Army. 5. The 1st Lieutenant assigned to the ambulance corps for a division, will have complete control, under the captain of his corps and the Medical Director of the Army Corps, of all the ambulances, medicine and other wagons, horses, etc., and men in that portion of the ambulance corps. He will be the Acting Assistant Quartermaster for that portion of the corps, and will receipt and be responsible for all the property belonging to it, and be held responsible for any deficiency in any thing appertaining thereto. He will have a travelling [sic] cavalry forge, a blacksmith, and a saddler, who will be under his orders to enable him to keep his train in order. His supplies will be drawn from the depot Quartermaster, upon requisitions approved by the captain of his corps, and the Commander of the Army Corps to which he is attached. He will exercise a constant supervision over his train in every particular, and keep it at all times ready for service. Especially before a battle will he be careful that every thing be in order. The responsible duties devolving upon him in time of action, render it neces­sary that he be active and vigilant and spare no labor in their execution. He will make reports to the captain of the corps, upon the forms prescribed, every Saturday morning. 6. The 2d Lieutenant will have command of the portion of the ambulance corps for a brigade, and will be under the immediate orders of the commander of the ambu­lances for a division, and the injunctions in regard to care and attention and supervision prescribed for the commander of the division he will exercise in that portion under his command. 7. The Sergeant will conduct the drills, inspections, etc., under the orders and supervision of the commander of the ambulances for a brigade, be particular in enforcing all orders he may receive from his superior officer, and that the men are attentive to their duties. The officers and non-commissioned officers will be mounted, The non-commis­sioned officers will be armed with revolvers. 8. Two Medical Officers, and two Hospital Stewards will be detailed, daily, by roster, by the Surgeon-in-Chief of Division, to accompany the ambulances for the Division, when on the march. whose duties will be to attend to the sick and wounded with the ambulances, and see that they are properly cared for. No man will be per- 30 mitted, by any line officer, to fall to the rear to ride in the ambulances, unless he has written permission, from the senior Medical Officer of his regiment, to do so. These passes will be carefully preserved, and at the close of the march be transmitted, by the senior Medical Officer with the train, with such remarks as he may deem proper, to the Surgeon-in-Chief of his Division. A man who is sick or wounded, who requires to be carried in an ambulance, will not be rejected, should he not have the permission required; the surgeon of the regiment who has neglected to give it, will be reported at the close of the march, by the senior surgeon with the train, to the Surgeon-in-Chief of his Division. When on the march, one half of the privates on the ambulance corps, will accompany, on foot, the ambulances to which they belong, to render such assistance as may be required, The remainder will march in the rear of their respect­ive commands, to conduct, under the order of the Medical Officer, such men as may be unable to proceed to the ambulances, or who may be incapable of taking proper care of themselves until the ambulances come up. When the case is of so serious a nature as to require it, the surgeon of the regiment, or his assistant, will remain and deliver the man to one of the Medical Officers with the ambulances. At all other times the privates will be with their respective trains. The medicine wagons will, on the march, be in their proper places, in the rear of the ambulances for each brigade. Upon ordinary marches, the ambulances and wagons belonging to the train will follow immediately in the rear of the division to which it is attached. Officers connected with the corps must be with the train when on the march, observing that no one rides in any of the ambulances except by the authority of the Medical Officers: Every necessary facility for taking care of the sick and wounded upon the march will be afforded the Medical Officers by the officers of the ambulance corps. 9. When in camp, the ambulances will be parked by divisions. The regular roll-calls, reveille, retreat, and tattoo, will be held, at which at least one commissioned officer will be present and receive the reports. Stable duty will be at hours fixed by the captain of the corps, and at this time, while the drivers are in attendance upon their animals, the privates will be employed in keeping the ambulances to which they belong in order, keeping the vessels for carrying water filled with fresh water, and in general police duties. Should it become necessary for a regimental Medical Officer to use one or more ambulances for transporting sick and wounded, he will make a requi­sition upon the commander of the ambulances for a division, who will comply with the requisition. In all cases when the ambulances are used, the officers, non-commissioned officers, and men belonging to them, will accompany them; should one ambu­lance only be required, a noncommissioned officer as well as the men belonging to it, will accompany it. The officers of the ambulance corps will see that ambulances are not used for any other purposes than that for which they are designed, viz. : the transportation of sick and wounded, and in urgent cases only, for medical supplies. All officers are expressly forbidden to use them, or require for them to be used, for any other purpose. When ambulances are required, for the transportation of sick or wounded at Division or Brigade Head-quarters, they will be obtained, as they are needed for this purpose, from the Division train, but no ambulances belonging to this corps will be retained at such Head-quarters. 10. Good, serviceable horses will be used for the ambulances and medicine wagons, and will not be taken for any other purpose except by orders from these Head-quarters. 11. This corps will be designated for Sergeants, by a green band one and one quarter inches broad around the cap, and chevrons of the same material, with the point toward the shoulder, on each arm above the elbow. For Privates, by a band 31 12. No person except the proper Medical Officers, or the officers, non-commis­sioned officers, and privates of this corps, will be permitted to take or accompany sick or wounded to the rear, either on the march or upon the field of battle. 13. No officer or man will be selected for this service except those who are active and efficient, and they will be detailed and relieved by Corps Commanders only. 14. Corps Commanders will see that the foregoing regulations are carried into effect. By command of Major-General MEADE S. WILLIAMS, Assistant Adjutant General. SUPPLY TABLE FOR THE MEDICAL DEPARTMENT OF THE ARMY OF THE POTOMAC. HEAD-QUARTERS ARMY OF THE POTOMAC, MEDICAL DIRECTOR'S OFFICE, September 3, 1863 [CIRCULAR.] The following table of supplies for the Medical Department of this Army is published, instead of the one contained in the Circular from this office of October 4, 1862. Experience has more fully shown the expediency of the manner of supplying this Department, as ordered by the Circular referred to, and it will be kept up. There will be allowed, in the Army of the Potomac, the following supplies to a Brigade for one month, for active field service, viz. One Medicine Wagon, filled. One Medicine Chest for each Regiment, filled. One Hospital Knapsack for each Regimental Medical Officer, filled. Supplies in the list marked "A," which will be carried in an ordinary Army wagon. The Surgeon-in-Chief of each Brigade will require and receipt to the Medical Purveyor for all these supplies, and will issue to the senior Medical Officer of each Regiment in his Brigade the Medicine Chest and Knapsacks, taking his receipt there for. The Wagons, both Medicine and Army, will be receipted for by the Ambulance Quartermaster. The Surgeons-in-Chief of Brigades will issue to Regimental Medical Officers such of the supplies from the Medicine or Army Wagon as may from time to time be required. These issues will be informal, the Surgeons-in-Chief giving no invoices, demanding no receipts, but accounting for them as expended. At the same time they will be particular that no improper expenditure or wastage is permitted.; These officers are especially directed, when they shall have drawn the monthly supply, not to divide it out among the Regiments, but only to issue the articles at such times and in such quantities as they are needed for use, or to keep the Medicine Chests and Knapsacks supplied. Requisitions will be made in duplicate, and in strict conformity with this table; and in all cases the articles will be enumerated in the order in which they occur in it. 32 Supplies will only be issued by the Medical Purveyor upon requisitions approved by Medical Directors of Corps, and these officers are particularly enjoined to revise all requisitions with care, that sufficient supplies may be on hand, and yet that no unnecessary expenditure be permitted. As far as possible, requisitions will be made but once a month, and special requisitions avoided as far as practicable. The supply allowed will be kept up, and Medical Directors will see, especially before a march or a battle, that timely requisitions are made, and the supplies obtained. In all ordinary cases, the amount on hand at the time the requisition is made, will be given, as well as the amount required, and requisitions will be made only for such articles, and in such amounts, as may be necessary to fill up the Brigade Supply to the amount ordered to be kept on hand. Should the welfare of the sick demand a greater amount than is given by this table, or for articles which are not allowed by it, the reasons therefor [sic] must be fully and clearly stated, and the requsitions [sic] approved at this office. The Medical Purveyor will keep on hand only such articles as are contained in this table. Instruments, except such as are enumerated in this table, will be issued only upon requisitions approved at this office. When articles, such as Instruments, Medicine Chests, are from any cause unser­viceable, they will not be turned in to the Medical Purveyor, unless inspected and ordered to be disposed of in accordance with the instructions contained in General Order No. 37, Head-quarters of Army of the Potomac, April 2, 1863. Whenever it becomes necessary, from any other cause, to turn in supplies to the Medical Purveyor, application, with the reasons therefor [sic], will be made to this office. One Knapsack will be carried, in each Regiment, when on the march, by a Hospital Nurse. 32 Supplies will only be issued by the Medical Purveyor upon requisitions approved by Medical Directors of Corps, and these officers are particularly enjoined to revise all requisitions with care, that sufficient supplies may be on hand, and yet that no unnecessary expenditure be permitted. As far as possible, requisitions will be made but once a month, and special requisitions avoided as far as practicable. The supply allowed will be kept up, and Medical Directors will see, especially before a march or a battle, that timely requisitions are made, and the supplies obtained. In all ordinary cases, the amount on hand at the time the requisition is made, will be given, as well as the amount required, and requisitions will be made only for such articles, and in such amounts, as may be necessary to fill up the Brigade Supply to the amount ordered to be kept on hand. Should the welfare of the sick demand a greater amount than is given by this table, or for articles which are not allowed by it, the reasons therefor [sic] must be fully and clearly stated, and the requsitions [sic] approved at this office. The Medical Purveyor will keep on hand only such articles as are contained in this table. Instruments, except such as are enumerated in this table, will be issued only upon requisitions approved at this office. When articles, such as Instruments, Medicine Chests, are from any cause unser­viceable, they will not be turned in to the Medical Purveyor, unless inspected and ordered to be disposed of in accordance with the instructions contained in General Order No. 37, Head-quarters of Army of the Potomac, April 2, 1863. Whenever it becomes necessary, from any other cause, to turn in supplies to the Medical Purveyor, application, with the reasons therefor [sic], will be made to this office. One Knapsack will be carried, in each Regiment, when on the march, by a Hospital Nurse.


Table, Part I 33 Table, Part II 34 Table, Part III 35 Table, Part IV 36 The following articles, in addition to those given in the foregoing table, will be carried in the box of each Ambulance, under the driver's seat, and will be kept there at all times, excepting the hard bread, which will only be placed in the box when there is a probability of an engagement. These boxes will be locked, and the keys kept by the Surgeon-in-Chief of Brigade, who will, by weekly inspections, ascertain that each Ambulance has the articles required, and that they are used for no other purpose than that for which they are intended, viz.: in the Field Hospitals, upon the field of battle, except in cases of emergency, and then only upon the order of the Medical Director of the Corps.
Table, Part V

[Establishment of Divisional Field Hospitals Published on 3 October 1862]
FIELD HOSPITALS.

HEAD-QUARTERS ARMY OF THE POTOMAC, MEDICAL DIRECTOR'S OFFICE, October 30, 1862.

CIRCULAR. SIR: In order that the wounded may receive the most prompt and efficient attention during and after an engagement, and that the necessary operations may be performed by the most skilful and responsible Surgeons at the earliest moment, the following instructions are issued for the guidance of the Medical Staff of this Army, and Medical Directors of Corps will see that they are promptly carried into effect: Previous to an engagement, there will be established in each Corps a hospital for each Division, the position of which will be selected by the Medical Director of the Corps.

The organization of the hospital will be as follows 1st.A Surgeon, in charge; one Assistant Surgeon, to provide food and shelter, etc. ; one Assistant Surgeon, to keep the records. 2d.Three Medical Officers, to perform operations ; three Medical Officers, as assistants to each of these officers. 3d. Additional Medical Officers, Hospital Stewards, and Nurses of the Division. The Surgeon in charge will have general superintendence, and be responsible to the Surgeon-in-chief of the Division for the proper administration of the hospital. The Surgeon-in-chief of Division will detail one Assistant Surgeon who will report to, 37 and be under the immediate orders of, the Surgeon incharge, whose duties shall be to pitch the hospital tents and provide straw, fuel, water, blankets, etc. ; and when houses are used, put them in proper order for the reception of wounded. This Assistant Surgeon will, when the foregoing shall have been accomplished, at once organize a kitchen, using for this purpose the hospital mess chests and the kettles, tins, etc., in the ambulances. The supplies of beef stock and bread in the ambulances, and of arrow-root, tea, etc., in the hospital wagon, will enable him to prepare quickly a sufficient quantity of palatable and nourishing food. All the cooks, and such of the Hospital Stewards and Nurses as may be necessary, will be placed under his orders for these purposes. He will detail another Assistant Surgeon, whose duty it shall be to keep a complete record of every case brought to the hospital, giving the name, rank, company, and regiment; the seat and character of injury; the treatment; the operation, if any be performed; and the result; which will be transmitted to the Medical Director of the Corps, and by him sent to this office. This officer will also see to the proper interment of those who die, and that the grave is marked with a head-board, with the name, rank, company, and regiment legibly inscribed upon it. He will make out two " Tabular statements of wounded," which the Surgeon-in-chief of Division will transmit within thirty-six hours after a battle, one to this office by a special messenger, if necessary) and the other to the Medical Director of the Corps to which the hospital belongs. There will be selected from the Division, by the Surgeon-in-chief, under the direction of the Medical Director of the Corps, three Medical Officers, who will be the operating staff of the hospital, upon whom will rest the immediate responsibility of the performance of all important operations. In all doubtful cases, they will consult together, and a majority of them shall decide upon the expediency and character of the operation. These officers will be selected from the Division without regard to rank, but solely on account of their known prudence, judgment, and skill. The Surgeon-in-chief of the Division is enjoined to be especially careful in the selection of these officers, choosing only those who have distinguished themselves for surgical skill, sound judgment, and conscientious regard for the highest interests of the wounded. There will be detailed three Medical Officers to act as assistants to each one of these officers, who will report to him and act entirely under his direction. It is suggested that one of these assistants be selected to administer the anaæesthetic [sic] . Each operating surgeon will be provided with an excellent table from the hospital wagon, and, with the present organization for field hospitals, it is hoped that the confusion and the delay in performing the necessary operations so often existing after a battle will be avoided, and all operations hereafter be primary. The remaining Medical Officers of the Division, except one to each Regiment, will be ordered to the hospitals to act as dressers and assistants generally, Those who follow the Regiments to the field will establish themselves, each one at a temporary depot, at such a distance or situation in the rear of his Regiment as will insure safety to the wounded, where they will give such aid as is immediately required; and they are here reminded that, whilst no personal consideration should interfere with their duty to the wounded, the grave responsibilities resting upon them render any unnecessary exposure improper. The Surgeon-in-chief of the Division will exercise general supervision, under the Medical Director of the Corps, over the medical affairs in his division. He will see that the officers are faithful in the performance of their duties in the hospital and upon 38 the field, and that, by the ambulance corps, which has heretofore been so efficient, the wounded are removed from the field carefully and with dispatch [sic]. Whenever his duties permit, he will give his professional services at the hospital--will order to the hospital as soon as located all the hospital wagons of the brigades, the hospital tents and furniture, and all the hospital stewards and nurses. He will notify the Captain commanding the ambulance corps, or, if this be impracticable, the First Lieutenant commanding the Division ambulances, of the location of the hospital. No Medical Officer will leave the position to which he shall have been assigned without permission, and any officer so doing will be reported to the Medical Director of the Corps, who will report the facts to this office. The Medical Directors of Corps will apply to their Commanders on the eve of a battle for the necessary guard and men for fatigue duty. This guard will be particu­larly careful that no stragglers be allowed about the hospital, using the food and comforts prepared for the wounded. No wounded will be sent away from any of these hospitals without authority from this office. Previous to an engagement, a detail will be made by Medical Directors of Corps of a proper number of Medical Officers, who will, should a retreat be found necessary, remain and take care of the wounded. This detail Medical Directors will request the Corps Commanders to announce in orders. The skilful attention shown by the Medical Officers of this Army to the wounded upon the battle-fields of South Mountain, Crampton's Gap, and the Antietam, under trying circumstances, gives the assurance that, with this organization, the Medical Staff of the Army of the Potomac can with confidence be relied upon under all emergencies, to take charge of the wounded entrusted to its care. Very respectfully, your obedient servant, JONA. LETTERMAN,
Medical Director.

[Circular Ambulances, Etc. Published on 30 September 1862]
HEAD-QUARTERS, ARMY OF THE POTOMAC CAMP, NEAR CULPEPPER COURT-HOUSE, VA., September 30, 1863. CIRCULAR, AMBULANCES, ETC. I. Ambulances are issued by the Quartermaster's Department for the sole purpose of transporting sick and wounded, upon requisitions approved by the Medical Director and Corps Commander. II. Officers of the Ambulance Corps will receipt for ambulances, wagons, harness, horses, mules, hospital, and other tents, and all other articles of Quartermaster's property which may come under their charge. They will be held accountable, and will make their returns for the same as required by existing regulations. III. For all purposes connected with the transportation of sick or wounded, or medical supplies, these officers are subject to the direct control of the Medical Department; but in drawing forage, horses, accountability of property, they are subject to the orders of the Chief Quartermasters of Corps, the same as other officers doing duty in the Quartermaster's Department. [Signed] RUFUS INGALLS, Brigr.-General, Chief Quartermaster. I concur in the above. [Signed] JONATHAN LETTERMAN, Medical Director, A. P.


[1] The writer is indebted to General C. H. Crane, Surgeon-General United States Army, and to Dr. Charles O'Leary, President of the 5tate Medical Society of Rhode Islands for valuable aid in the preparation of this paper. Reprinted from the JOURNAL OF THE MILITARY SERVICE INSTITUTION, Vol. iv, No. 15, 1883. [2] Ex. Doc. No. 15, 38th Congress, 1st session. [3] 'See Circular, Head-quarters Army of the Potomac, Washington, March 7, 1862. > [4] 'See War of the Rebellion, Official Records of Union and Confederate Armies." Series 1. [5] This order will be given in an appendix to this " memoir," and will repay the careful attention of the student. See Appendix I and IV. [6] Vide Appendix II. [7] Op. cit. p. 148. [8] For illustration in more detail of the practical working of this organization the reader may consult the following-named works, it is not intended here to do more than show its results. "Medical and Surgical History of the War of the Rebellion," Part I, Medical Volume and Appendix. Same. Part III, Surgical Volume, chap. xv: "Medical Recollections of the Army of the Potomac." D. Appleton & Co. New York. [9] JOURNAL OF THE MILITARY SERVICE INSTITUTION, vol ii, No. 5, p. 8. [10] In February 1865, Congress passed an Act giving higher rank and pay to Medical Directors [11] "Medical Recollections of the Army of the Potomac," by Jonathan Letterman, M.D. D. Appleton & Co. New York. [12] The manuscript of this paper, through the kindness of the Surgeon-General of the Army, was submitted to General McClellan, who returned it with the note given in the text.