NPR Story
4:41 am
Sun July 7, 2013

Civil War Surgeon Set The Standard For Battlefield Medicine

Originally published on Tue July 9, 2013 1:11 pm

July 1 marked 150 years since the beginning of the Battle of Gettysburg, a crucial victory for the Union and a turning point in the Civil War. But it came at an enormous cost to both sides — thousands of soldiers were killed and tens of thousands more were wounded.

However, it might have been even worse had it not been for a surgeon named Jonathan Letterman, who served as the chief medical officer of the Union's Army of the Potomac. He presided over some of the bloodiest battles in U.S. history and, over the course of a single year, revolutionized military medicine.

Scott McGaugh has just released his biography of Letterman, called Surgeon in Blue. He joins NPR's Rachel Martin to discuss the father of battlefield medicine, what conditions were like before he came along and the legacy he left behind.


Interview Highlights

On the state of medicine in the United States at the start of the Civil War

"In a word, horrific. Military doctors were poorly qualified from a medical standpoint. They didn't know what caused infections, bacteria, anything of that sort. There was no ambulance system, so the early battles, such as Bull Run, left thousands of men wounded on the battlefield for days, some of them dying of dehydration and thirst. They were weakened to begin the battle because [the] Army diet was horrible, in the sense of salt pork, weevil-filled biscuits and alcohol as the daily ration. And their odds of survival, if they were wounded, were not very good in the early battles."

On what happened to wounded soldiers at the battle of Bull Run

"They had very little place to go. They were dependent upon a few slackers, derelicts and Army band members who were typically assigned as ambulance crews. The ambulances were not nearly enough in number. No one expected to see the kinds of casualty numbers of Bull Run, which obviously became a harbinger of battles to come. If you were lucky enough to be ambulatory, you might have walked or hitched a ride back to Washington, and then walked the streets for several days looking for a hospital bed because there weren't nearly enough hospitals or hospital capacity in the early days of the Civil War."

On how Letterman improved Civil War medicine

"He stood in a remarkably fortuitous position in time. The commanding general, George McClellan, was something of a reformer; the surgeon general was a very deep-thinking reformer by the name of William Hammond, a young man. And that gave Letterman the opportunity to apply a very keen, analytical, holistic mind to health care, not just on the battlefield but before ever reaching the battlefield. And he was able to very quickly issue new regulations, make them mandatory with real authority, that defined and codified new standards in nutrition, camp hygiene, how and when latrines were dug and when they were covered, the disposal of lice-ridden uniforms. Because at the time when he took over, he was faced with a disease rate of nearly 40 percent."

On what it was like before Letterman developed the modern ambulance corps

"Prior to that, military officers routinely commandeered wagons intended as ambulances for their personal use and for their baggage with no repercussions. ... Luggage, personal belongings, even their servants in some cases. So one of the very first things Letterman did was acquire the authority from Gen. McClellan to hold military officers and medical officers accountable. [He] developed a corps of trained ambulance drivers and stretcher bearers, so he added a level, or created a level, of professionalism that had not been in existence."

On how keeping soldiers healthy wasn't just about compassion

"He believed that a healthier Army — wounded men who were kept with their units and treated in hospitals near the Army — were much more likely to return to battle [and] gave Gen. McClellan a stronger, more viable fighting force. And if that made him more effective, that might lead to a faster end to the war and the ability for everyone to go home."

On Letterman's legacy

"Letterman clearly demonstrated that speed to care, what was once called 'the golden hour,' was absolutely crucial to a soldier's chances of survival.

"A refined triage concept, beginning with those paramedics ... alongside the stretcher, to the aid station, to the field hospital, all the way to a specialized hospital in the United States today. All those concepts, those principles, that all began with Jonathan Letterman. And today it's a hallmark of battlefield medicine, to a point where in World War II, 30 percent of soldiers succumbed to their wounds. Today, it's less than 10 percent."

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

RACHEL MARTIN, HOST:

This past week marked 150 years since the Battle of Gettysburg. It was a crucial victory for the North, a turning point in the Civil War. But it came at an enormous cost to both sides. Thousands of soldiers were killed, tens of thousands more wounded. And it might have been even worse, had it not been for a surgeon named Jonathan Letterman. He served as the chief medical officer of the Army of the Potomac and over the course of a single year, he revolutionized military medicine.

Scott McGaugh is the author of the new biography "Surgeon in Blue: Jonathan Letterman, the Civil War Doctor Who Pioneered Battlefield Care." He joins us from the studios of KPBS in San Diego.

Scott, thanks for being with us.

SCOTT MCGAUGH: Thank you, Rachel. It's good to be here.

MARTIN: So, before we get to Jonathan Letterman and his specific story, could you help us understand the state of medicine in the United States around the time of the Civil War?

MCGAUGH: In a word, horrific. Military doctors were poorly qualified from a medical standpoint. They didn't know what caused infections - bacteria, anything of that sort. There was no ambulance system, so the early battles such as Bull Run left thousands of men wounded on the battlefield for days; some of them dying of dehydration and thirst.

They were weakened to begin the battle because Army diet was horrible in the sense of salt pork, weevil-filled biscuits and alcohol as the daily ration. And their odds of survival, if they were wounded, were not very good in the early battles.

MARTIN: You mentioned the Battle of Bull Run. Can you tell us more about that story, what happened to the wounded from that battle? Did they have anywhere to go for care?

MCGAUGH: They had very little place to go. They were depended upon a few slackers, derelicts and Army band members who are typically assigned as ambulance crews. The ambulances were not nearly enough in number. No one expected to see the kinds of casualty numbers of Bull Run, which obviously became a harbinger of battles to come.

If you were lucky enough to be ambulatory, you might have walked or hitched a ride back to Washington, and then walked the streets for several days looking for a hospital bed because there weren't nearly enough hospitals or hospital capacity in the early days of the Civil War.

MARTIN: So let's talk about Letterman. He is named the chief medical officer of the Army of the Potomac. Huge percentages of the fighting force are sick, unable to fight. How did he tackle this problem?

MCGAUGH: Well, he stood in a remarkably fortuitous position in time. The commanding general, George McClellan, was something of a reformer. The surgeon general was a very deep-thinking reformer by the name of William Hammond, a young man. And that gave Letterman the opportunity to apply a very keen, analytical, holistic mind to health care, not just on the battlefield but before ever reaching the battlefield.

And he was able to very quickly issue new regulations, make the mandatory with real authority that defined and codified new standards in nutrition, camp hygiene, how and when latrines were dug and when they were covered, the disposal of lice-ridden uniforms. Because at the time when he took over, he was faced with a disease rate of nearly 40 percent.

MARTIN: Jonathan Letterman is credited with building up the first modern ambulance corps. Can you describe what that looked like in those early days and why it was such a radical improvement?

MCGAUGH: Prior to that military officers routinely commandeered wagons, intended as ambulances, for their personal use and for their baggage. There was no repercussions...

MARTIN: For their baggage...

MCGAUGH: Yes.

MARTIN: ...not carrying the people, carrying equipment.

MCGAUGH: Luggage, personal belongings, even their servants in some cases. So one of the very first things Letterman did was acquire the authority from General McClellan to hold military officers and medical officers accountable; developed the corps of trained ambulance drivers and stretcher bearers. So he added a level or created a level of professionalism that had not been in existence.

MARTIN: And it's interesting. You write that keeping soldiers healthy, this wasn't just about compassion. It was pragmatic, to a certain degree. They wanted to keep people in the fight.

MCGAUGH: You're absolutely right. He believed that a healthier army - wounded men who were kept with their units and treated in hospitals near the Army - were much more likely to return to battle, gave General McClellan a stronger, more viable fighting force. And if that made him more effective that might lead to a faster end to the war and the ability for everyone to go home.

MARTIN: I wonder where we can see Letterman's legacy. You argue that these principles became the model for battlefield medical care. Can you point to any examples in modern warfare of how Letterman's innovations changed the way people practice medicine in war zones?

MCGAUGH: Letterman clearly demonstrated that speed to care - what was once called the golden hour - was absolutely crucial to a soldier's chances of survival. A refined triage concept, beginning with those paramedics, if you will, back in those days alongside the stretcher to the aid station, to the field hospital, all the way to a specialized hospital in the United States today. All those concepts, those principles, that all began with Jonathan Letterman.

And today it's a hallmark of battlefield medicine, to a point where in World War II, 30 percent of soldiers succumbed to their wounds. Today, it's less than 10 percent.

MARTIN: Scott McGaugh is the author of "Surgeon in Blue: Jonathan Letterman, The Civil War Doctor Who Pioneered Battlefield Care." He joined us from member station KPBS in San Diego.

Mr. McGaugh, thanks so much.

MCGAUGH: My pleasure. Thank you.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.