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

Oliver Wendell Holmes

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

From the very beginning of human civilization armies have emerged to protect and uphold a nation's citizens' wealth and territory. And in consequence thereof came the uncivilizing hand of war. Combat, as well as the large concentrations of encamped soldiers inherent in military campaigns, resulted in wounds, injuries, and disease, all of which had to be dealt with for the physical and emotional well-being of the forces involved. Although some small advances had been made throughout the centuries, military medicine, hospitalization, and the evacuation of the sick and wounded had, for its worth, remained of little import within the overall scheme of an army's organization, duties, and responsibilities.

By 1860 the United States had itself, barely moved beyond the concept that "a collection of armed men constitutes an army," and similarly from the idea that civil practitioners were, if attached to that body, competent enough to act as the "medical department." So by 1861, and the outbreak of hostilities between Northern and Southern states, the prevailing medical philosophy basically remained a task of the individual, or, every man for himself. In the U.S. Army, unfortunately, there was regimental aid, and nothing more. But as the tiny rebellion escalated, and 36,000,000 people became involved, these old-fashioned ideas and methods were destined to be altered. That inevitable adaptation though, came slowly and in spurts. Awkward and haphazard at first, it was also forced to crawl over the self-righteous protests of narrow-minded civilian and military bureaucrats. Revision did come because of a natural necessity, and due to the uncounted and horrible experiences of the men-at-arms who endured the backwardness of the old system.

"The volunteer soldier offers his very dearest possession to his country, his blood his limbs, possibly his life. When the soldier is struck down shall his country leave him on the field suffering from cold, pain, thirst, even hunger; to die perhaps, without aid, unless he can drag himself away by his own painful exertions? Certainly when he gives his dearest possession the country should not be niggardly, when all it can give is dollars, but should supply an abundance of the best possible means for his succor." [2]

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

This preparedness did not exist in the U.S. Army and particularly in the Army of the Potomac in 1861 and much of 1862 for two major reasons. First, the enormous growth of the war and its resulting waterfall of casualties caught even the most ardent realists by surprise; and secondly, the normal organization of the medical machine did not lend itself to quick changes or to the adoption of new ideas, theories, or techniques. Therefore, it ensured the lack of a centralized and autonomous system for the evacuation of wounded, the establishment of field hospitals i.e., "movable hospitals", and the supplying of medicines, equipment, and provisions, which then became the main ingredients for disaster in the wake of Civil War battles, great and small. It took three years before the medical department was truly capable of satisfactory conduct in transporting and caring for its hurt and diseased personnel.

Excepting the usual minor and expected complications encountered in the early battles and skirmishes, it still required the frightful Peninsular Campaign and its aftermath in the spring and summer of 1862 to fully thrust into the limelight the helplessness and disarray of the U.S. Medical Department, as it coped with the casualties of a growing modern war. A dozen or more engagements, fought by two huge armies in a markedly unhealthy region of Virginia, complimented by numerous long and stifling marches and retreats, produced a never before convergence of sick and bleeding Americans. Added to these bleak conditions was the lack of fresh water, and the predominance in the ranks of green untested volunteers fresh from home. Well over 21,000 wounded alone in the Peninsula fighting, told some of the ghastly tale; the shock to the Northern populace can surely be imagined, especially when combined with the news of 8,500 additional injured at Shiloh, Tennessee, during the same period. [4] And since victims of disease far outranked the numbers of dead and wounded during that timeframe, one may clearly understand the sheer magnitude, unexpectedness and incredulity of these figures.

It was during this particular timeframe that several significant transitions occurred in the Eastern army. Although not always permanent features they foreshadowed some promise for the future. Soon after the Battle of Bull Run in late July 1861, Dr. Charles S. Tripler succeeded Surgeon William S. King as medical director of the Army of the Potomac. During King's term his position was frequently without instruction as to its duties, privileges and powers, and King, being attached to the commanding general's personal staff, had only such control as his personal influence might win for him. "He was the only possible coordinator of the battlefield relief work,yet was without authority to organize and direct the medical officers and stretchermen of the various regiments." [5] Consequently, each regimental surgeon took responsibility for only his men, leaving all who fell sick or injured away from his unit, "on their own hook."

Shortly before the onset of Tripler's appointment in August 1861, the winds of change had begun to blow. These winds had been assisted and even tactfully nurtured by the newly created United States Sanitary Commission (U.S.S.C.), the brainchild of Reverend Henry W. Bellows and Dr. Elisha Harris, both of New York. Concerned that the sanitation and supply efforts to the armies of the Union were wholly inadequate for the good of the troops, this private relief agency had been organized, and had quickly grown. Although the commission's central desire was quite modest, that of collecting and supplying articles useful to the sick and wounded, it shortly found itself beset with roadblocks. However modest as its aims were, initially the U.S.S.C. was seen by the army's medical officiary in Washington as not only impertinent and a nuisance, but plainly civilian interference. Fortunately for the men in the field, as Dr. Tripler commenced his duties, improvements launched by the Commission, (as its prominence grew) and more strict adherence to existing army regulations, begun to make a noticeable difference in the health and morale of the troops. [6]

Under General George B. McClellan, Tripler, who was not regarded as an innovator but merely a fine administrator, did seize the opportunity to institute some long overdue and much needed reforms. Although constantly stymied by Surgeon General Clement A. Finley, he still managed to improve evacuation methods, he outlined a clearer declaration of surgeons' duties, insured better training of hospital attendants, added more disease prevention, and established auxiliary general hospitals in Washington and elsewhere. Many of his other ideas were never implemented due to the indifferent disposition of the department, the large influx of new enlistments, and other factors beyond his control.

In April, 1862 a major blockage to progress was broken up in Washington which would in many ways forever transform the medical department of the U.S. Army. Surgeon General Finley, described by one detractor as a "self-satisfied, supercilious, bigoted blockhead... [who] knows nothing and does nothing..." was removed from office through the efforts of the Sanitary Commission, major newspapers, and other forward-looking thinkers. The Medical Corps under Finley, said the New York Tribune, "is not accused of misifeasance or malfeasance, but of non-feasance, [and has] done nothing since the war began." [7] As a result, the complicated and long campaign for his replacement eventually netted Dr. William A. Hammond, a distinguished surgeon and scientist, who was a friend of McClellan's, and even as an unknown entity was totally supported by the U.S. Sanitary Commission. But in choosing Hammond they passed over men with seniority, one in particular was Assistant Surgeon General R.C. Wood, who claimed he had been promised the position. In the end these "seniors" would have their revenge.

Dr. Hammond, at 34, could not have been a better choice. With eleven years of frontier service, he was still open-minded with a keen inquiring intelligence. These were weighty attributes, but his eager willingness to tackle the serious problems within the army's medical system was his chief merit. Regrettably for the country, and especially its citizen soldiers, he was eventually forced out of office by the petty and vindictive Dr. Wood and Secretary of War Edwin Stanton. In the meantime, however, he formulated and implemented desperately needed priorities for the remodeling of his bureau. Some William Hammond of these immediate measures insured that expenditures for supplies went up, "red tape" was cut, supplemental nurses and physicians could be employed when needed, and a new ambulance organization was instituted. Further on, he drafted designs to add extra surgeons to regiments and staff, along with a new complement of medical inspectors for the field armies and general hospitals. He authored the concept of an Army Medical Museum and medical school, and sought pay increases and higher ranks for his dedicated officers. Three of his most beneficial advances involved: the removal of the transportation of medical supplies and patients away from the Quartermaster's Department and into the jurisdiction of the Medical Corps, the betterment and expansion of the general hospitals, and the replacement of medical directors with younger men who showed administrative ability, and were "not quite so thickly encrusted with the habits, forms and traditions of the service." [8]

One of the men chosen by Surgeon General Hammond to implement this transformation of the antiquated medical corps was Jonathan Letterman, MD, a 37-year-old Pennsylvanian and 1849 graduate of Jefferson Medical College in Philadelphia. Letterman had entered the army upon receipt of his diploma, and had served in Florida against the Seminoles, and subsequently spent almost five years on the frontier. In the two years prior to the Civil War he was stationed at Ft. Monroe, Virginia and participated in an expedition against Indians in California. Returning to the East in November 1861 he took up the position of Medical Director of the Department of West Virginia. On June 19, 1862 Dr. Letterman was ordered to duty as Medical Director of the Army of the Potomac, succeeding Charles Tripler. He reported to General McClellan at White House Landing on the Virginia Peninsula, July 1. Upon receipt of the news of Letterman's orders, a nurse at the Landing named Katharine Wormely wrote in a letter home: "A new Medical Director of the army has been appointed, for which we are deeply thankful. He...has just stood near me for a few moments,...so that I could observe him,... His [face] gave me a sad calmness. Such a worn face, - worn in the cause of suffering, full, it seemed to me, of a strong earnestness in his work. How much at this moment is freshly laid upon him!"

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

During their tenures as Surgeon General and Medical Director of the Army of the Potomac both Hammond and Letterman, respectively, worked diligently and in a partnership to bring about crucial modifications to a structure overloaded and burdened by every problem imaginable. In following Letterman's handiwork, in combination with Hammond's guidance during the twelve months prior to the Gettysburg Campaign, it is possible to observe his accomplishments and failures, and to understand whether basic lessons he taught and learned from the end of the Seven Days' Battles through Chancellorsville did or did not prepare that army's medical branch for its monumental crisis at Gettysburg.

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

While engaged in this mammoth endeavor, Letterman still found the spirit and energy to take up the long-standing ambulance problem and work for its solution. Although the final resolution did not evolve purely from him, Letterman did devise an innovative and workable evacuation process and put it quickly into practice. Whereas many medical officers had learned valuable lessons during the Peninsular Campaign, (where Letterman had not been present), it was obvious that he more than anyone had seriously considered the ambulance question and had already mapped out a simple yet viable formula long before joining McClellan in July. Letterman, explained the old methods thusly:

"[The ambulances] were under the control both of Medical Officers and Quartermasters, and, as natural consequence, little care was exercised over them by either. They could not be depended upon for efficient service in time of action or upon a march, and were too often used as if they had been made for the convenience of commanding officers."

Emphasizing his main point, it was clear that during a time of need, especially in battle, no officer, medical or otherwise should have control over the ambulances, as these men had their own duties and responsibilities to attend to. Logically, he saw other officers, "appointed for that especial purpose, should have direct charge of the horses, harness, ambulances, etc., and yet under such regulations as would enable Medical officers at all times to procure them with facility when needed for their legitimate purpose." [11]

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

Albeit all ambulance corps officers and men came from the line, they were under the sole control of the medical directors, and the total number of ambulances allotted depended on the size of the regiments in each division. For instance three ambulances were permitted for a regiment of 500 or more. The aggregate was about one vehicle per 150 men. As an illustration, in June 1863, the Fifth Corps contained 12,509 men and had 81 ambulances on hand. More importantly, though, everything boiled down to this major change: that all ambulances were taken away from the regiments and were thereafter kept together in a division train, which was sometimes combined in corps trains and sometimes not. [13]

Meanwhile away from the field, Surgeon General Hammond pressed forward his agenda in the nation's capital. He created a medical inspector general and eight inspectors for the overall management of military general hospitals and the improvement of sanitary conditions in army camps. A corps of staff surgeons was added, a total of 40 surgeons and 120 assistant surgeons to serve outside the regimental framework. He tightened up the contract surgeon business, and required strict exams for both entering military and temporary civilian physicians. Convalescent camps were founded to clear general hospitals of men caught between the front and the rear of an army, and where many malingerers had found safe havens from duty. Furthermore, Hammond made it easier for purveyors to do the job of supplying the department with medicines, instruments and equipment by expanding their depot locations and streamlining how requisitions were made, filled, and transported. All the while he supported his field personnel as they fought for front-line revisions. In one important move during the Battle of Second Bull Run (August 29-30), he appointed Surgeon Jeremiah Brinton to the new post of medical director of transportation, which freed Dr. Letterman from dealing with that battle's 8,000 casualties then being moved to the hospitals in Alexandria, and between numerous facilities in Washington. [14]

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

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

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

Hospital scene, Antietam, 1862

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

As for the new ambulance system, Antietam did not become the ground for a model experiment. Critics were vocal in any event, and bemoaned the evacuation service there as characterized by "gross mismanagement and inefficiency,...[and a] lack of system and control." In retrospect some of these faults may have been attributed to the incorporation of General Pope's untrained drivers and stretcher-bearers into the Army of the Potomac's better organized and more disciplined and motivated crews.

Major Letterman had always believed that after a severe engagement, such as that at Sharpsburg, the critically injured must not be moved right away, but instead kept immobile nearby until transportation would not endanger their lives. Therefore he set up two "large camp hospitals," (besides the main ones in Frederick), or mini-general hospitals if you will, near the battlefield. These were capable of maintaining about 1200 patients. He claimed that these institutions, "were the first of the kind attempted in this country, and were succesful,...and demonstrated the propriety of their establishment." [17]

A second prescription adhered to by the director was the unique concept that allowing relatives to remove seriously wounded men immediately to their homes was fraught with danger. He felt that not only was the physical movement bad for the disabled soldier, but then to be cooped up in stuffy, closed buildings was to compound an already grievous mistake. Letterman said that the "absolute necessity of a full and constantly renewal supply of fresh air..." is most relevant to the health and well-being of the patient. As a result of these beliefs, he was constantly appealing for the addition and maintenance of a large number of tents available to the medical wing of the army.

In examining all of Dr. Letterman's strategies and methods, it becomes apparent that throughout his tenure as medical director of the Army of the Potomac, one of his most important causes was the retainment of wounded men as close to the army as possible. This would ensure a quick return to their units enabling the successful prosecution of the war effort. This "directive" had a two-fold benefit, as it further allowed the men to be close to their own doctors and comrades which promoted better care and a morale boost in the process.

As an after-shock of Antietam another significant problem was attacked by Director Letterman. This was the inception of "field hospitals," or hospitals-on-wheels, the mobile medical facilities so common to past and present armies since his day. Up to September 1862, the field hospital concept had not yet been ordained. Regimental hospitals were the norm, with these enterprises sometimes combined into the advantage of brigade level cooperatives. Up to that time, the lack of tentage, and the separation of personnel, supplies and equipment had made divisional hospitals difficult to formulate and maintain. But after much study and acquisition of the necessary authority, all this changed. In a simple and clearly worded circular dated October 30, 1862, Letterman inaugurated this extraordinary reform. Its main feature was the direction of a field hospital for each division, and provision of the personnel and equipment for the same. In addition, a previously written circular had ordered that from that time on (October 4) supplies would be issued by brigade to the individual regiments as needed, eliminating much of the waste and abandonment of these valuable materials each time regiments moved. The new orders also guaranteed that every physician and all other attendants knew exactly where they belonged in the event of a battle, and that only the three most qualified doctors of a division could be classified as surgical "operators." [18] The value and superiority of these revolutionary directives was shortly demonstrated in December 1862 at the Battle of Fredericksburg, where, as Letterman explained, "they were first tried, and when from the nature of the action they were severely tested, they fulfilled in a great degree the expectations hoped for at the time of their adoption." [19]

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

After a long rest period following the Antietam Campaign, General McClellan began his slow probing maneuvers toward the Army of Northern Virginia then protecting Richmond in an advance position near Fredericksburg. So lentitudinous were his movements that he was relieved by the president, who placed Ambrose E. Burnside in command. General Burnside sensing Lincoln's mood, hastened the march over land to capture the Rebel capitol. In preparation of this upcoming conquest, he transferred the Army of the Potomac to the vicinity of Fredericksburg in middle November, ignoring the lateness of the season. His strategy, to take that city as a safe water base enabling a direct advance to Richmond, was thwarted by the Confederates, who forced Burnside to attack them across the Rappahannock River where they held superior, well prepared positions. The one-day battle fought on December 13, resulted in a Union defeat. With 9,600 injured stuck on the wrong side of a river the situation looked bleak. However in this instance, "for the first time in a great battle, the wounded of the United States Army had adequate care and treatment." [20]

Rappahannock River, near Fredericksburg, Virginia

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

Since removal of the wounded to the north side of the river was paramount to their safety from artillery fire, continued combat, or enemy attack, it was ordered almost immediately. Dr. Heard reported that his 1,500 cases were not only properly attended to in three divisional hospitals, but every man was driven or carried across before morning; and by December 16, all of the nearly 10,000 Union wounded were sheltered in tents on the northern bank of the river. Although Letterman protested, evacuation of these men to Washington began on the same day. As always, he was convinced that to leave soldiers with severe injuries immobile for awhile, as he had done after Antietam, was the best policy. But Burnside expected renewed hostilities, and the evacuation continued unabated. From existing reports it appears that this relocation of the wounded to the capital did not go as smoothly as it should have; the biggest problem being the lack of warm clothing, blankets, and ample rations. In this aspect the Sanitary Commission lent much aid, but even this organization was hard pressed to furnish every need. The usual criticisms surfaced and were directed toward Major Letterman, mainly his unwillingness to delegate authority and the aforementioned supply problems.

After this battle the Northern army went into winter encampments at Aquia and Belle Plain, Virginia. And except for Burnside's last effort to rescue his reputation in the infamous January four-day "Mud March campaign," all was quiet along the Potomac until the spring of 1863.

Meanwhile, within the crowded bivouacs the defeated and heavy hearted Army of the Potomac suffered on. Due to unsanitary conditions prevalent in the large camps, and the adverse weather, disease and sickness were by all accounts, rampant. "Letterman does not appear to quite such advantage as a sanitarian as he does as an organizer and manager in the field," said one modern historian. A few of his contemporaries would have agreed. [22] The loudest disapprovals as usual, seem to have emanated from his enemies in the government, those doctors who, with Secretary Stanton, were always busy trying to discredit both Surgeon General Hammond and even Director Letterman.

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

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

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

With the vast improvements in medical service beginning to become apparent, 1863 should have been a banner year for Medical Director Hammond and his emerging and efficient work force. But with the battling nations recruiting and conscripting thousands of new troops, and the armies brutally fighting each other with no end in sight, the strain on the medical department continued undeterred both in the Eastern and Western theaters of operation.

In the East, in late January, Joseph Hooker relieved General Burnside. But unlike his predecessor, Hooker concentrated on bringing the health of the army up to acceptable standards, for he saw how diarrhea, scurvy, and various fevers were devastating his soldiery. Dr. Letterman had always believed that a good diet, (including ample vegetables) paired with enforced sanitation and better cooking methods would strengthen the army's stamina and morale. By April Letterman's policies, backed by General Hooker's authority and common sense, caused the rate of sickness to drop; and in turn the physical and mental spirit within the hundreds of old and new regiments rose accordingly.

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

Immediately before the army decamped, Letterman, in order to keep 8,000 sick soldiers near their commands, set up tent hospitals along the railroad from Fredericksburg to the Aquia and Potomac Creek depots. As expected, maneuvering soon began between Hooker's and Lee's armies and the resulting combat at the Battle of Chancellorsville, fought on May 1-4 threw 9,700 wounded Federals into Letterman's system. These casualties had to be funneled from the confused battlefield through Fredericksburg, then subsequently across the Rappahannock River. Once over that barrier the men were placed aboard trains and then run along a single track to the Potomac River and thence by boat to Washington. [24] The evacuation of these injured did not go as smoothly as it should have, and the army's medical service was not, in this case, a perfect model of efficiency. Due to the confused state of affairs during the fighting, and the general inept handling of the army by Hooker, many small things went wrong for Letterman's people. Field hospitals were frequently adjusted owing to artillery fire or an unexpected enemy breakthrough. One doctor in the Third Corps complained that his division facility had to be uprooted five times, and in the end, 1,200 badly injured Yankee soldiers eventually became captives of Lee's victorious forces. [25] Another embarrassment for Letterman was the admission that a few of his physicians had cowardly run off during combat leaving their charges, while others had become intoxicated on government issued stimulants stockpiled for the sick and wounded.

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

In his final assessment, Dr. Letterman professed that when looking at the entire operation, the frequent dislocations had been reasonably managed, and his staff had performed as well as could be expected under the circumstances. In acknowledging their valuable services, he was especially pleased to report that in almost all cases the 1862 field hospital directives of October 4 and 30 were carefully followed and adhered to. This resulted, even under the difficulties encountered, in generally excellent care and comfort provided to the majority of the wounded of that battle.

In the most serious cases, where patients were too hurt to be transported far, Letterman chose to keep them with the army instead of dispatching them to Washington. In accordance with this ideology, he set up large tent hospitals at Potomac Creek where the men could be tended by their own physicians. Of these encampments, he remarked:

"I have never seen better hospitals. This opinion was entertained by the professional and unprofessional men who visited them, and I regretted the necessity which compelled me to break them up about the middle of June in consequence of the march of the Army into Maryland and Pennsylvania."

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

Only speculation could infer what thoughts possessed the mind of Jonathan Letterman as the Army of the Potomac marched northward in hot pursuit of the resolute Confederate invaders. It had been barely a month since he and his colleagues were mired knee deep in thousands of casualties from a severe battle; now, they seemed to be headed for another and possibly even more terrible confrontation.

The Union march to intercept General Lee was well underway when it was announced that General George G. Meade, the Fifth Corps commander, had replaced General Hooker as head of the army. This came on June 28 when all of the corps except the Sixth, were within a day's hard walk or less of Gettysburg. The march from Falmouth, Virginia on June 12 to the very doorstep of Pennsylvania by the end of the month had been one of the hardest on record for Lincoln's grand force of approximately 100,000 men. Ruefully, not all of them made it to Gettysburg.

Thousands dropped out and straggling climbed to new heights, all in relation to the amount of dust and heat, or the number of miles covered during a particular day or night. Scores of veterans fell by the roadsides totally exhausted or dead, caused by the 25-30 mile per day treks. By the time the campaign ended in late July, many regiments could claim a travel agenda of between 500 and 600 miles covered on foot, while dining on hardtack, salt pork, and coffee, and with water taken where it could be found. The animals suffered too. Meade's force required in excess of 700 tons of supplies daily, therefore over 4,000 wagons accompanied it. If the needs of the cavalry and artillery are calculated, this amounted to over 50,000 horses and mules present for duty. Meshed into this huge coalition were Dr. Letterman's ambulances and two horse medical wagons, adding another 1,017 vehicles. [27]

When the army left the Fredericksburg area between June 12 and 14, Dr. Letterman commenced the removal of 9,025 wounded and sick with their supplies, from that city up Aquia Creek and on to Washington. This was successfully accomplished in short time. Meanwhile, as the Army of the Potomac skirted the capital on its northerly route, Letterman arranged for 25 wagon loads of battle supplies to be packed and sent to Frederick under the direction of Surgeon Jeremiah Brinton. By the day General Meade assumed command, Brinton had traveled even farther to Taneytown, Maryland, Jeremiah Brinton where headquarters were then located. There the wagons remained, under Meade's orders until after the Battle of Gettysburg. [28] Even more disturbing was a decree issued several days earlier, on June 19, before Meade's ascension. In it General Hooker directed that the "allowance of transportation" that Letterman had deemed necessary for the medical department in the fall of 1862, was to be reduced. This went against the director's opinion and argument, and it compelled him to send away a large portion of the "hospital tents, mess-chests, and other articles necessary upon the battlefield, and proved," said Letterman, "as I foresaw it would, a source of embarrassment and suffering, which might have been avoided." [29]

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

Thus the hundreds of medical officers and their associates assigned to the Army of the Potomac were once again in debt to the U.S. Sanitary Commission and other relief organizations who came to their immediate aid with foodstuffs and other assorted materials. Oddly, in contrast to six of Meade's corps, one, the Twelfth, did not receive or respond to this order, hence none of its normal compliment of hospital wagons was sent to the rear. Accordingly, this unit was able to evacuate, bathe, dress, and feed its wounded completely within six hours of the end of the battle. [31]

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

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

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

Throughout the day on July 1 as the First and Eleventh Corps clashed with Confederates north and west of Gettysburg, the aid or dressing stations, usually manned by a regimental assistant-surgeon and his attendants, followed their respective units back and forth as the battle raged and waned one way or the other. These aid stations were the first stops for the "walking wounded" or any seriously injured Federal who was fortunate enough to be reached by the stretcher-bearers. In recalling the earlier discussion of this subject, it should be remembered that as of October 1862, all medical personnel had particular assignments on the day of battle. Even before the opening shots, surgeons, assistant-surgeons, operators, recorders, hospital stewards, cooks, ambulance drivers, litter bearers, nurses, teamsters and other attendants, knew their posts and duties. So as the impassive missiles tore men from the regimental firing lines, these crippled and blood soaked individuals headed for safe zones, knowing that the medical department was ready and waiting. The initial stop was at the dressing stations where literally, "first aid" would be administered to all injured parties. No operations were performed at these primary sites. The doctor there would simply stabilize and bandage the wound then direct the ambulatory patient to his correct field hospital in the army's hinterland. Concurrently, other attendants gathered the more seriously injured to an ambulance collecting point for removal by wheeled conveyances to the divisional field hospitals.

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

In the late afternoon of July 1, after hours of some of the most severe combat of the battle, units of the Union's First and Eleventh Corps retreated to reserve positions on Cemetery Hill and Cemetery Ridge just south of Gettysburg. In consequence of the rapid redeployment of these corps, the ambulance teams were unable to recover all of the wounded individuals from the 1st and 3rd Divisions of the Eleventh, nor from all three divisions of the First Corps. During the long and eventful day medical directors and surgeons of the two corps set up sheltered division hospitals near to and in the borough itself. They seized the Lutheran Theological Seminary and college buildings, the railroad depot and express office, several large warehouses, the Washington House Hotel, the Union School, the county courthouse and almshouse, and several churches. But even this was not enough, and an overflow of perhaps 400-450 men ended up as patients in private dwellings. When the troops at the front begun their withdrawal about 5 p.m. the ambulance drivers and attendants went right along, thus ending the evacuation of U.S. casualties on the day's field by Union personnel until July 4. If not found and taken up by Southern squads, which many were, the abandoned wounded remained on the contested ground until after the Confederate retreat. By dusk of that day the village was in sole possession of the Rebel army, as were the Federal hospitals, and several thousand prisoners, both hurt and not. When it was clear that Gettysburg would be given up to the Confederates, some of the nearly 4,000 Northern casualties were hurried out of town to safer locales. A handful of doctors chose to stay with their men, usually one or two in each facility; the balance joined the retreat and were directed to new field hospitals then being formed south and southeast of Cemetery Hill.

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

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

By midnight, any of the first day's casualties that had been fortuitously rescued before or during the collapse of the Union forces, were deposited in makeshift temporary hospitals at farmsteads along the Baltimore Pike and the Taneytown Road. Obviously the director of the First Corps, Dr. T.J. Heard had learned his lesson, for he placed his new facilities well out of range of enemy missiles. The biggest concentration of this Corps' casualties were, by July 2, clustered around the "White Church," three miles out on the turnpike to Westminster and Baltimore, and on farms contiguous. The three Eleventh Corps divisions were congregated on the Elizabeth and George Spangler place, (not out of artillery range) east of that pike and just south of Power's Hill, where they remained until early August. It is surprising that inasmuch as the Eleventh Corps met with disaster, confusion, and some demoralization on July 1, its medical staff managed to regroup and rebound quickly; they set up and maintained a cohesive, well regulated field hospital very near the battleground, although not completely out of harm's way. [36]

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

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

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

Heavy fighting broke out near 3 p.m. on July 2 and continued almost unabated until nearly midnight. Casualties were high. By day's end the Union army suffered over 8,500 wounded and 1,825 killed. Dedicated ambulance work was needed well into the evening, but as some ground was lost to the Rebels, it was impossible to collect each and every downed soldier. The ambulance corps was by most accounts, skilled and efficient in its work, having enough practical experience and drill since late 1862 to be able to handle any ordinary situation. On the average at Gettysburg each infantry corps mustered between 80 and 100 ambulances, plus medical wagons, etc. The Eleventh for one, counted 100 ambulances, nine wagons, 270 men and 260 horses. [37]

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

"About eleven o 'clock at night the ambulances were busy collecting and carrying to the rear great loads of mangled and dying humanity. The wagon-train, with tents and supplies, had not yet arrived, and the wounded were deposited on the ground....As they were removed from the ambulances they were placed in long rows, with no reference to the nature or gravity of their injuries nor condition or rank. Friend and foe alike, as they had been promiscuously picked where they had fallen, were there laid side by side in these prostrate ranks.... Soon the ambulances ceased their visits...[to await] as dawn should appear to furnish light for the painful work. Opiates were administered to alleviate pain, and water supplied to appease their thirst.... Sounds of pain and anguish, invocation and supplication, singing, and even cursing by some in their delirium or sleep,... At last morning dawned, and at the same time orders were received to remove the wounded farther to the rear and out of range of the enemy's batteries,... [38]

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

"As soon as the division was placed in position all my stretcher men, under their lieutenants and sergeants, were sent to the front to follow their respective regiments; leaving one lieutenant and three sergeants in charge of the train. I conducted the train to a point two hundred yards in rear of the second and third brigades, where it was rapidly loaded with severely wounded. Owing to some misunderstanding there was a delay in locating the division hospital and the wounded men remained in the ambulances about an hour, when the hospital was established and the wounded unloaded. The ambulances then commenced regular trips to the battlefield and were constantly at work during the night."

Lieutenant Ayer further relates that shortly afterward he too was called on to relocate the injured to a more secure region. [39]

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

"The ambulance corps consisted of three trains, one for each division of the army corps. Each train consisted of forty-two horse ambulances, [about three to a regiment] with a few for the artillery, several wagons with four horses to carry forage and rations in, and a forge wagon for repairs and horseshoeing, with several old-style four-horse ambulances. The men were selected proportionately from the regiments, and consisted of a driver for each ambulance and wagon, two stretcher-carriers for each wagon, and several blacksmiths and supernumeraries.... The total force of the ambulance corps [Second Corps] was, in round numbers, 13 officers, 350-400 men, and 300 or more horses, with a little over 100 ambulances and 10 or 12 forage and forge wagons;... Each two-horse ambulance was a stout spring wagon,...with sides a little higher than theirs along each side. Inside this wagon were two seats the whole length,...stuffed and covered with leather. Hinged to the inner edges of each of these seats was another leathercovered seat, which could be let down perpendicularly so as to allow the wounded to sit on the first seats facing each other, or could be raised and supported horizontally on a level with the first seats, and, as they filled all the space between the first seats, thus made a couch on which three men could lie lengthwise of the ambulance....

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

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

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

(click on image for a PDF version)

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

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

This hospital changed its locality to higher ground about July 22 and into a clover field across Rock Creek and nearer to the farm buildings of Jacob Schwartz. Altogether this facility cared for 3,260 Union and 952 Confederates, making it the largest field hospital extant after the battle. Dwinell had between 17 and 30 doctors available to him at various times between July 4 and August 8 when the hospital closed. He emphatically voiced his distrust of the skill and dedication of civilian volunteer and contract surgeons, citing them as too "unreliable." Dr. Dwinell complained too of the hundreds of able-bodied skulkers that invaded these safe areas, and who "consume the food and occupy the shelter provided for the wounded." In that hospital there were 437 deaths, of which 192 were Southerners. In conclusion, Dwinell felt the medical department of the Second Corps was made up of practical men of large experience and observation. "It is thoroughly organized," said he. "Every Surgeon knows beforehand whether he is to remain on the field or return to the Hospital in the time of Battle. In either case he knows the part he is to perform. They have become familiar with their duties....they were indefatigable in the performance of their labors,...and did all in their power to alleviate the sufferings of the wounded." Ending his manuscript, he made this observation: "[P]robably at no other place on this continent was there ever congregated such a vast amount of human suffering. [41]

Justin Dwinell's last quote is correct. From one single calamity the United States had never been exposed to as many casualties caused by any natural or human incited event. It is also likely that his statement still holds true today. The literally hundreds of eyewitness versions that describe the horror of Gettysburg would alone fill a large volume. Everyone who saw the catastrophe was singularly impressed and often aghast at the hideous sea of misery which surrounded the community. Within seventy-two short hours, over 7,100 people had been sent to eternity, while 33,300 more remained alive weltering in their own blood and waste, anxiously awaiting and even begging for medical treatment. Of these, several additional thousands shortly perished.

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

"The scenes of suffering among the many thousands of wounded of both the Union and Confederate armies which came under my observation in the few days I spend in and about Gettysburg on that memorable occasion, are altogether indescribable. Human language is inadequate to do it justice. The horrors of war were revealed in a way that was sickening to the heart. The ghastly wounds, the moans and cries and screams of anguish, the ravings of those whose reason had been dethroned, and the appeals for water to allay thirst and morphine to ease pain, were such as to move the stoutest hearts. One of the streams had overflowed its banks, and a number of wounded confederates were drowned and their bodies swept away by the raging waters. Great piles of amputated limbs lay around. Experienced surgeons and medical students fresh from the schools were at work like so many bloody butchers. The putrid and swollen remains of slaughtered men and horses filled the air with malaria, which soon brought disease and death to visitor from all parts of the country, as well as to the inmates of the crowded hospitals. Suffering and death were everywhere, and the efforts put forth for alleviating the latter, though rendered by hundreds of willing hands, seemed as but drops to a bucketfull when compared to the vast aggregate all about us." [42]

Preacher Cort saw the field on July 8 after almost a week of aid had been administered to the 22,000 wounded left behind by the two armies. An active imagination might attempt to view the problems encountered even earlier when the medical directors and surgeons were, in the constant shifting of hospitals, doing their utmost to render comfort to their wretched patients under more extreme and adverse conditions.

At the end of the third day not only had the First, Eleventh and Second Army Corps field hospitals been safely reestablished as previously encountered, so had the Third, Fifth, Sixth, and Twelfth Corps. The Third and Fifth, after fierce fighting on the Union left during July 2 had also mishandled the positioning of their hospitals on the day of battle. This tactical error required realignment from spots carelessly selected on farmsteads, in woods, and in meadows along the Taneytown Road and out toward the Baltimore Pike, to protected and more permanent camps south and southeast of Gettysburg. The Third Corps' two divisions were lastly settled south of and along White Run 300 yards from its junction with Rock Creek, a place southwest of the farm buildings of Jacob Schwartz and east of those of Martha and Michael Fiscel. The site was reportedly high, dry and "airy," with plenty of water nearby. However, Surgeon J.W. Lyman, 57th Pennsylvania, described part of it as "finely wooded and [on a] shady slope."

The Third's medical director Thomas Sim was not present; he was ordered to accompany Corps commander Daniel Sickles, who had lost a leg in the fray, to Washington. Under Surgeon Thaddeus Hildreth this camp handled about 2600 U.S. wounded, and 259 of the enemy, and closed its operation on August 8. One division there reported 813 casualties - of these there were 97 operations performed, 53 being amputations. [43] Immediately after the battle, an army physician stationed at this site declared that most of his patients were "lying on the wet ground without any shelter whatever. The people in this district have done nothing for them."

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

The U.S. Fifth Corps, like its July 2 companion fighting force, the Third Corps, grouped all three divisions much too near the battle lines, mainly around the Jacob Weikert farm and fields adjacent along the Taneytown Road, just in rear of the Round Tops. One location was about a half mile from the base of Big Round Top and contained 250-300 casualties from the 1st Division. The 2nd Division under Assistant Surgeon John S. Billings commandeered the Weikert place, and with three Autenreith medicine wagons, and the farmer's food on hand, he "performed a large number of operations, [and] received and fed 750 wounded." He too acknowledged assistance from the Sanitary Commission.

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

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

The most fortunate body of Federal troops in service at Gettysburg was the Sixth Corps. Its medical director, Charles O'Leary, assigned Dr. C.N. Chamberlain to manage the hospitals which superintended about 315 wounded. Many of the Corps' infantrymen were thoroughly worn down by a rapid forced march of 32 miles prior to reaching Gettysburg. Previously it had covered 100 miles in four days, yet percentage-wise, few men had fallen out of the columns. Since it was not heavily engaged the Corps suffered only 27 killed and 185 wounded. [46] Yet the field hospital on the 165 acre farm of John and Suzannah Trostle along Rock Creek, cared for an assortment of maimed Southerners and an overflow of men from the Fifth, Third, and Second Corps. The injured here received especially good treatment and attention, and had quarters in tents and in Trostle's house, barn, and outbuildings, although one soldier complained of the lack of enough food. In early August, as was usual, this facility was closed, and the remaining patients transferred to Camp Letterman east of Gettysburg or to the railroad for shipment to other governmental general hospitals miles away. [47]

George Bushman House, Twelfth Corps Hospital

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

Returning to the first day's casualties that were sheltered on the premises of the First and Eleventh Corps hospitals, we find that by the end of the first week of July these stations were in stable condition, especially as they sat near the Baltimore Pike, the main supply route into Gettysburg, and were close to the depots established by the Sanitary and Christian Commissions, and by Dr. Brinton for the army itself. They were also fortunately in proximity to hard roads leading to the railroad depot and eventually Camp Letterman.

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

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

Like the several other corps, the Eleventh's installations took in its share of artillerymen and cavalrymen, since these combat arms did not regularly maintain totally separate field hospitals.

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

In the days directly succeeding the three day contest, both the Army of the Potomac and the Army of Northern Virginia vacated south central Pennsylvania in a continuum of the campaign as they marched southward into Maryland and Virginia. Dr. Letterman, fearing a resumption of combat, assimilated most of his 650 medical department physicians and hundreds of attending nurses and stewards, plus 3,000 ambulance personnel back into the army which was then pursuing Lee's scattered and retreating forces. With this untimely but necessary decision, only 106 doctors were allowed to remain with nearly 22,000 injured Federal and Confederate soldiers, who lay in approximately 50 makeshift field hospitals in and surrounding Gettysburg. Fortunately, these few surgeons were supplemented by the addition of Hammond's bequest and the crop of civilian and contract physicians still in the vicinity.

Area of operations of the Army of the Potomac Medical Corps during the Gettysburg Campaign. (click on image for a PDF version)

As the middle of July arrived, the heavy rains that followed the battle began to roll away. With that clearing came a break in the bleak prognosis given to the thousands of wounded still at Gettysburg. Several changes improved the climate for these patients. The first was that Letterman, upon his departure, placed Dr. Henry Janes in charge of all of the field hospitals at Gettysburg. Janes was a U.S. Volunteer surgeon formerly of the 3rd Vermont Infantry, a Sixth Corps unit. He quickly moved to consolidate the entirety of medical facilities both U.S. and C.S., whether in private dwellings, on farms, or in divisional tent/field hospitals, into one general and more permanent establishment east of the town.

The "general hospital on the field" concept had always appealed to the director. It was soon ordered by General Meade and approved by both Hammond and Letterman because it was easier to supply and maintain. This approach also prevented the too hurried removal and secondary injury of the more seriously hurt but convalescent patients. By the waning days of July this large camp was in full operation; however, Dr. Janes permitted three other clinics to remain viable, one each in the Lutheran Theological Seminary, express office, and the Public School building on High Street in Gettysburg.

The second stroke of efficiency on Letterman's part was the enormous effort maintained to evacuate every wounded soldier who was able to travel on to major medical facilities in Annapolis and Baltimore, York, Chester, Philadelphia, and New York, where over 12,000 beds were unoccupied and available. Normally the Army of the Potomac's casualties went to Washington or Alexandria, but these city hospitals were still heavily dominated by the battle residue from Chancellorsville and Fredericksburg. Letterman was castigated by at least one of his peers for leaving only four wagons and six ambulances with each corps medical unit for this massive transportation effort, and for allowing one doctor for every 150 patients. The press of duties lessened somewhat when 50 additional ambulances were received from Washington along with the aforementioned supplemental physicians.

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

"Including the 1,462 patients sent away from the battlefield before his arrival, by the 23rd of July a total of 15,425 wounded had been removed to various general hospitals on the Eastern Seaboard. These numbers included 3,817 Confederates, leaving at Gettysburg on July 23, 1,925 Rebels (of the 6,802 in Yankee hands) and 2,922 Northerners. [54] Part of his report contained this interesting comment: "For a correct number of rebel wounded, those must be counted that were left at Chambersburg, Carlisle, Hagerstown, Funkstown, Martinsburg, Winchester, and the various farm houses and barns on the way, which will doubtless foot up to about 15,000 making the probable number of wounded on both sides 35,000 in round numbers." [55]

During the Gettysburg Campaign, General Herman Haupt was in charge of transportation and construction on the U.S. Military Railroad system. He supervised not only the funneling of supplies to the army before the battle, but in consequence of the fighting he began running five trains grouped together, making available 15 trains each way daily from Baltimore to Westminster, Maryland until the ruined rail branches to Littlestown, Hanover, and Gettysburg were repaired and reopened between July 5 and 7. With these trains he was able to put through, under the direction of Dr. J.D. Osborne, 4th New Jersey, 150 cars containing 2,000-3,000 injured and sick daily. With the base of supplies and transportation in Baltimore, 55 miles away, cars began to ply from Gettysburg on the 7th, habitually leaving several times a day between 9 a.m. and 5 p.m. For instance on July 12 six trains departed Gettysburg carrying 1,219 patients from both armies. For a time the wounded were arriving at the terminus of the railroad faster then they could be taken away, resulting in hundreds of "poor wretches [left] to pass the night there without food, shelter or attendants." This grim status was soon amended by the Sanitary Commission who erected two "lodges," one about a mile eastward on the York Turnpike where the destroyed railroad terminated, then later another next to the railroad depot in Gettysburg itself.

These sanitary lodges provided the essentials patients needed while awaiting transportation, such as a kitchen to prepare food, tents, beds, and nurses. The commission later claimed to have fed every man of the 16,125 that left Gettysburg in the early stages, and "to have sheltered 1,200, and to have furnished very many with clothing."

A woman who worked with this agency explained how the lodges operated:

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

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

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

For the men too ill or hurt to stand evacuation immediately a general hospital had been authorized and was laid out one mile east of Gettysburg on the south side of the York pike. Construction began on July 16 and the facility opened on July 22 in charge of a 10th Massachusetts doctor, C.N. Chamberlain. In total it held up to several thousand inhabitants, where, upon an elevated and attractive site, were erected as many as 400 tents, most situated in six double rows, ten feet apart, with each tent capable of holding 8-12 patients. The entire camp, named after the medical director, was on a plot of 80 acres, with a good spring of water, and stood just a few hundred yards north of the railroad where it began to parallel the pike, and opposite the site of the first sanitary lodge.

During the four months of its operation, on average the camp weekly fostered between 1,200-1,700 of the most critical cases, several hundred of which were Confederates. The medical staff counted no fewer than 400 doctors and attendants, and at various times outnumbered the patients themselves. Each surgeon, including a score or so of Southern physicians who remained with their wounded, supervised from 40 to 70 recuperating soldiers. Since the injuries were so severe, many men died at Camp Letterman, a majority being Confederate, and all 350-400 dead were buried in a cemetery south of the main compound. In one sample it was shown that of the 345 individuals there with gunshot fractures of the femur, amputations were performed on 158 cases, and of these 101 deaths occurred.

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

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

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

He, like Surgeon Dwinell, also placed no reliance on doctors from civil life, saying that they "cannot or will not submit to the privations and discomforts which are necessary" during or after a battle. Of his own 650 staff and regimental physicians he reminded the commanding general that they "were engaged assiduously, day and night, with little rest, until the 6th, and in the Second Corps until July 7, in attendance upon the wounded. The labor performed by these officers was immense. Some of them fainted from exhaustion, induced by over-exertion, and others became ill from the same cause. The skill and devotion shown by the medical officers...were worthy of all commendation; they could not be surpassed."

So too was his admiration for the ambulance corps. In describing their actions throughout the battle and afterward, he claimed it "acted in the most commendable manner during those days of severe labor," and of the army's [14,529] combat injured, "not one wounded man of all that number was left on the field within our lines early on the morning of July 4." In accomplishing this feat, five men were killed and 17 wounded from this corps. And in the end, considering that 21,331 Union and Confederate patients were thrown by fate onto his department's resources, which "conspired to render the management [of it] one of exceeding difficulty," Letterman could still say that "the wounded were well taken care of...especially so when we consider the circumstances under which the battle was fought and the length and severity of the engagement."

Although Major Letterman naturally placed his department in the very best possible light, he and his subordinates had faced some formidable tasks. Most were overcome, but not without causing undue pain, suffering and death to many of their charges. Medical supplies were insufficient at Gettysburg, due to the holding back of the trains. But the main cause was the abnormally high number of wounded. Ten thousand could have been handled conveniently, and the 14,000 U.S. line casualties could have been at least well managed, but with in excess of 21,000, coupled with the absence of supplies, these factors piled up a mass of difficulties that transcended the departments best capacity. Other areas of concern which went beyond Letterman's abilities, or control, were the unusually severe wounds encountered at Gettysburg inducing a very high death rate. There was also the condition of the infantrymen themselves; the inordinately long and difficult marches preceding the battle wore down the men and generated a climate of sickness, which made them less able to counter the adverse effects of even a slight injury. Then too, following the fighting, the area's railroad system was in complete turmoil, and near total breakdown, with destroyed roadbeds and bridges, and numerous damaged engines and cars, all tied to a civilian work force which were not motivated to quickly clean up the mess.

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

Along with these areas of concern stood Letterman's weak managerial style and organizational abilities and in his lack of planned evacuation facilities. One historian noted that, "there were no supporting medical services between the division and the general hospitals in the rear. He [Letterman] could handle an engagement and take good care of the wounded but this tied up his division hospitals and ambulances, and required considerable time after an engagement to reorganize and again be ready to handle a considerable number of wounded." This imperfection would have been most apparent, had it not been somewhat corrected by his successor during 1864, when Meade and Grant chose to hammer Lee's army for several months without letup. In these campaigns, the need for "an elaboration of Letterman's organization was shown. This elaboration, however, was not thoroughly developed until the [First] World War."

Jonathan Letterman's systems of evacuating the wounded, supplying the department, and establishing field hospitals and work directives for his staff, were models of simplicity and excellence and were sorely tested throughout his one year and five months with the Army of the Potomac (he resigned in December 1863). Although not perfected, these devices did allow the army to cross many hurdles and pass through rigorous trials, and as improvements came over time they set up some of the best military and civilian standards for medical service available even well into the Twentieth Century. [58]

Epilogue

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

NOTES

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

2. Duncan, 25.

3. Duncan, 27.

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

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

6. Adams, 5 & 22.

7. Adams, 27 & 29.

8. Adams, 31-35.

Gillett, Mary C. The Army Medical Department 1818-1865. Washington, DC (1987): 177-80.

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

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

10. Duncan, 96.

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

12. Letterman, 23-25.

13. Duncan, 98-99.

14. Gillett, 179-191.

15. Letterman, 38-39, 41.

16. Gillett, 192.

17. Letterman, 46-47.

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

18. Duncan, 103.

Gillett, 193.

Letterman, 58-63.

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

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

20. Duncan, 172.

21. Duncan, 191.

22. Duncan, 202.

Gillett, 194.

23. Duncan, 203.

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

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

Gillett, 210.

26. Gillett, 209-210.

27. Letterman, 142-144.

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

Duncan, 214.

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

28. Letterman, 153.

29. Letterman, 153.

30. Letterman, 154-155.

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

Gillett, 211.

Letterman, 157.

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

33. McCreary, Robert G. United States Christian Commission for the Army and Navy. First Annual Report, Philadelphia, PA (1863): 59-60.

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

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

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

35. Ebersole, 329.

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

Duncan, 235-247.

37. Weist, J.R., MD, "The Medical Department in the War," an article in the papers of the MOLLUS-Ohio Commandry, vol. II, 92-93.

Duncan, 225.

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

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

40. Livermore, Thomas L. Days and Events, 1860-1866. Boston, MA (1920): 237-240, 243, 258. Dwinell, no page number.

41. Dwinell, no page number.

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

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

Duncan, 239-240.

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

44. Fatout, 70-73.

45. Duncan, 245-240.

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

Duncan, 246.

46. Duncan, 246-247.

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

47. Duncan, 249-230.

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

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

49. Duncan, 235.

50. Duncan, 248-249.

Coco, 208-209.

NPS, "Hospital Markers," 3.

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

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

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

52. Coco, 248-254.

53. Letterman, 158-159.

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

54. Letterman, 158. Gillett, 213.

Duncan, 21.

55. Medical and Surgical History.... Appendix, vol. I, 143-145.

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

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

56. Medical and Surgical Hi story.... Appendix, vol. I, 144.

Duncan, 214, 258-260.

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

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

57. Duncan, 260-261.

Coco, 226-237.

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

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

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

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

U.S. Army, 23.