Report of Surg. Jonathan Letterman, U. S. A.,
Medical Director, Army of the Potomac,
of the operations of the medical department,
Sept. 2-Nov. 7.Operations in Northern Virginia, West Virginia, Maryland and Pennsylvania.--September 3-November 14, 1862.

O.R.-- SERIES I--VOLUME XIX/1 [S# 27]

CAMP NEAR FALMOUTH, VA., March 1, 1863.

Brig. Gen. S. WILLIAMS,
Assistant Adjutant-General, Army of the Potomac.

        GENERAL: In compliance with the directions contained in your communication of January 20, 1863, I have the honor to submit the following report of the operations of the medical department of this army from July 4 to November 7, 1862, viz:

* * * * * * * * * *

        From the date of the embarkation of the troops at Fortress Monroe up to the time when the general was placed in command of the defenses of Washington, I know personally but little of the medical department of the Army of the Potomac. It was not under my control. On the 2d of September, when the general was placed in command, it came once more under my direction, and I found it in a most deplorable condition. The officers were worn down by the labors they had in the mean time undergone; a large portion of their supplies, as I have stated, had been left at Fortress Monroe, and even much of that which they had brought with them was thrown on the roadside, I have been informed by commanding officers, whilst on their way to join General Pope. This state of things, taken in connection with the effects upon the medical department arising from the campaign of that officer, left it in a condition deeply to be deplored. The labor expended at Harrison's in rendering it efficient for active service seemed to have been expended in vain, and before it could be in a condition to render such service again it was necessary that it should be completely refitted. The circumstances under which the army was then placed made this simply impossible. There was not time to do it, for as soon as the troops reached the defenses of Washington they were marched into Maryland, and no time could be allowed for medical officers again to equip themselves with the medicines, instruments, dressings, and stores necessary for the campaign in that State.
        In a few instances the medical officers who returned with the first troops were able to obtain a few supplies, but these opportunities were few. Some corps which did not belong to the Army of the Potomac whilst it lay at Harrison's Landing were also marched rapidly into Maryland, of the condition of whose medical supplies I could know nothing except on the way to meet the enemy. The medical department had to be, as it were, reorganized and resupplied, and this had to be done while upon a rapid march over different roads, in different sections of the country, and almost in face of the enemy. Before leaving Washington I had ordered a number of hospital wagons from Alexandria, Va., which reached me at Rockville, in Maryland, whence they were distributed to the different corps. While at this place I directed the medical purveyor in Baltimore to put up certain supplies and have them ready to send to such a point as I should direct. Upon our arrival at Frederick on the 13th of September (having left Washington on the evening of the 7th), directions were given for the establishment of hospitals at that place for the reception of wounded in the anticipated battles, and additional supplies to a large amount ordered to be sent from Baltimore at once. The Confederate troops had been in this city but the day before our arrival. Almost all the medical supplies had been destroyed or had been taken by them. Just previous to our arrival in Frederick, 200 ambulances were received from Washington, which I distributed to the corps as rapidly as the movements of the troops would permit. The failure of the railroad company to forward the supplies caused serious annoyance. The railroad bridge over the Monocacy Creek between Frederick and Baltimore having been destroyed by the Confederate forces, made it necessary to have all the supplies of the quartermaster's and commissary as well as the medical departments removed from the cars at that point. A great deal of confusion and delay was the consequence, which seriously embarrassed the medical department, and not from this cause alone, but from the fact that cars loaded with supplies for its use were on some occasions switched off and left for some time upon the side of the road to make way for other stores.
        The battle of South Mountain took place on the 14th. The village of Middletown, about 4 miles in rear of the scene of action, was thoroughly examined before the battle began, to ascertain its adaptability for the care of the wounded. Churches and other buildings were taken as far as were considered necessary, and yet causing as little inconvenience as possible to the citizens residing there. Houses and barns, the latter large and commodious, were selected, in the most sheltered places on the right and left of the field, by the medical directors of the corps engaged, where the wounded were first received, whence they were removed to Middletown, the Confederate wounded as well as our own. The battle lasted until some time after dark, and as soon as the firing ceased I returned to Middletown and visited all the hospitals, and gave such directions as were necessary for the better care of the wounded. On the following morning Assistant Surgeon Thomson, U.S. Army, was directed to take charge of all the hospitals in the village, and three skillful surgeons were sent to consult together and with him, and perform such operations as the cases demanded. The object in sending these officers was to have all necessary operations done as soon as possible, as it would be impossible for the surgeons in charge of the different hospitals to perform them all in season and at the same time attend to the other duties required of them. The work of these officers was very satisfactorily performed. The hospitals were soon put in good condition and the men well attended to. Supplies of medicines, &c., were in part obtained from the supplies in the army and in part from Frederick, from which place, owing to the causes already alluded to, it required no little exertion to obtain them. The difficulty was, however, overcome, and such as were needed were from time to time procured. The task of providing food for the wounded was one of still greater difficulty, but that was also accomplished by having it brought from Frederick and by purchasing from the people living in the village and in its vicinity. As was anticipated, the wounded, under the supervision of Dr. Thomson, who labored unceasingly, were attended to with great care and the hospitals placed in excellent condition. Great kindness was shown by the citizens, and especially the ladies, to our wounded, until the hospitals were broken up.
        The battle of Crampton's Gap took place also on the 14th, at the same time that of South Mountain was in progress. The hospitals for the wounded were located in Burkittsville, about a mile in the rear of our troops. As in the village of Middletown, churches and other buildings were here appropriated for hospital purposes. A sufficient number of surgeons were detailed by Surgeon White, U.S. Army, the medical director of the Sixth Corps (which was the only corps engaged), who had charge of the medical department in this action. There was but short time given to prepare hospitals in either of these villages, as the troops left Frederick and fought both battles the same day. By the exertions of the medical officers in charge, the hospitals in Burkittsville were in a short time put in good order, and every care taken of the men brought to them. The surgeon who was placed in charge, having been guilty of improper conduct, was displaced and afterward dropped from the rolls, and Assistant Surgeon Du Bois placed in charge, under whose administration everything went on well. The same difficulty existed here as in Middletown regarding supplies of medicines, &c., and food, and was overcome in like manner. The most reliable reports that can be obtained show 1,214 wounded in these two engagements. While these figures are not deemed entirely accurate, they are thought to approximate very nearly the actual number wounded, those of the Confederate forces not being included.
        Passing through the village of Boonsborough on the following day, it was examined to ascertain what accommodation it afforded for hospital purposes in the event they should be required there. Later in the evening we passed through the village of Keedysville, a few miles beyond, which was also subjected to a similar examination. Passing beyond this village, we came in sight, late in the evening, of' what afterward proved to be the battle-field of Antietam. As soon as the nature of the country and its resources for hospital purposes could be ascertained, and when an idea was given of the nature of the anticipated battle and the position to be occupied by our troops, directions were given to the medical directors of corps to form their hospitals as far 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; to select the houses and barns most easy of access, and such as were well supplied with hay or straw and water; when circumstances would permit, to designate barns as preferable in all cases to houses, as being at that season of the year well provided with straw, better ventilated, and enabling the medical officers with more facility to attend to a greater number of wounded, and to have all the hospital supplies taken to such points as were selected. These directions were generally carried into effect, and yet the hospitals were not always beyond the range of the enemy's guns. Very few hospital tents were to be obtained, owing to the haste in which the army was marched from Virginia into Maryland, but the weather was such as to enable the wounded to be taken care of without them. A reference to the map accompanying this report will exhibit better than any description the location of these hospitals, which, from the length of the line of battle and the obstinacy with which the engagement was contested, required to b,. numerous. The battle lasted until dark. During the day I received valuable aid from Assistant Surgeon Howard, U.S. Army, who was busily engaged while the battle was in progress in riding to different parts of the field and keeping me informed of the condition of medical affairs. After night I visited all the hospitals in Keedysville and gave such directions as were deemed necessary.
        The subject of supplies, always a source of serious consideration, was here peculiarly so. The condition of affairs at Monocacy Creek remained as heretofore described, and the action of the railroad was not commensurate with the demands made upon it. The propriety of obtaining the hospital wagons from Alexandria was evident, as these gave a supply for the emergency and enabled surgeons to attend to the wounded as soon as the battle opened. After the victory was won, supplies of medicines, stimulants, dressings, &c., were sent for and brought from Frederick, in ambulances, by officers sent for that purpose, and were distributed to the different hospitals as they were needed. The fear of the supplies becoming exhausted, for the difficulty in procuring them was well known, caused uneasiness on the part of some medical officers, who did not know the efforts that had been made before and were made during and after the battle to have enough furnished to supply their wants. I visited after the battle every hospital in the rear of our lines, although not always making myself known, and in no instance did I find any undue suffering for lack of medical supplies. Owing to the difficulty in having them brought from Monocacy Creek, for the first few days the supplies of some articles became scanty, and in some instances very much so; but they were soon renewed, and at the temporary depot established in Sharpsburg shortly after the battle a sufficient quantity of such articles as were necessary from time to time arrived, and when this temporary depot was afterward broken up, about the middle of October, a portion of the supplies remained on hand. Not only were the wounded of our own army supplied, but all the Confederate wounded which fell into our hands were furnished all the medicines, hospital stores, and dressings that were required for their use.
        The difficulty of supplying the hospitals with food was a much greater one than that of providing articles belonging to the medical department, and was a matter of very great concern. This, a matter in all battles of moment, was in this particularly so on account of the distance of the depot of supplies. An order was procured from Colonel Ingalls for a number of wagons (12), to be turned over by the quartermaster at Frederick to an officer that I should send there, for the purpose of bringing up supplies of medicines and food. These wagons could not be obtained at Frederick. Two were then procured from Colonel Ingalls at headquarters, and sent under an officer, who bought up supplies of coffee, sugar, and bread. The hospitals were afterward and in a short time abundantly supplied. The hospitals were thus provided with medical supplies, and for the first few days with food. They had all that was necessary for the wounded.
        I have already mentioned that the ambulances had been left at Fortress Monroe when the troops embarked, and that no system existed except in the corps which belonged to the Army of the Potomac while at Harrison's Landing. A portion of the ambulances of some of the corps arrived just prior to the battle. A large number had been distributed in other corps, but were yet unorganized. It was not, there-tore, expected that they would prove as efficient as could be desired. Notwithstanding these facts, the wounded were brought from the field on our right before 2 o'clock on the following day. The Second Corps was more fully equipped, and did most excellent service under the charge of Capt. J. M. Garland, who labored diligently and with great care until all his wounded were removed. The troops on our left were those among whom no ambulance system existed, but here, owing to the exertions of the medical officers, the wounded were removed by the evening of the day following the battle. When we consider the magnitude of the engagement, the length of time the battle lasted, and the obstinacy with which it was contested, causing this to be the greatest and bloodiest action that ever took place on this continent, it is a matter of congratulation to speak of the expeditious and careful manner in which the wounded were removed from the field.
        Compiled from the most reliable sources at my command, the number of wounded amounted to 8,350. This number is not entirely accurate, as many who were slightly wounded were attended to, of whose cases no record could, under the circumstances, be taken.
        The removal of so large a body of wounded was no small task. The journey to Frederick in ambulances was to wounded men tedious and tiresome, and often painful. It was necessary that they should halt at Middletown for food and to take rest; that food should always be provided at this place at the proper time and for the proper number; that the hospitals at Frederick should not be overcrowded; that the ambulances should not arrive too soon for the trains of cars at the depot at Frederick, and that the ambulance horses should not be broken down by the constant labor required of them. With rare exceptions this was accomplished, and all the wounded whose safety would not be jeopardized by the journey were sent carefully and comfortably away. The hospitals in Frederick were soon established and put in order by Surgeon Milhau, U.S. Army. In addition to the hospitals in the city, two large camps of hospital tents were formed on the outskirts of the city, capable of containing one thousand beds each. One hospital had been established in Frederick some months before our arrival there, but at that time it was filled, and chiefly with Confederate sick and wounded, who had been left there. All the available buildings in this city (six in number)were taken at once for hospitals for our own troops and those of the enemy who should fall into our hands. These were fitted up with great rapidity, particularly so when it is considered that the enemy was in possession of the city the day before we arrived there; that it had to be examined, the buildings selected and prepared, beds, bedding, dressings, stores, food, cooking arrangements made, surgeons, stewards, cooks, and nurses detailed and sent for. This was a great deal of labor, but it was done, and done promptly and well. On the 30th of September these hospitals contained 2,321 patients.
        The camps to which I have just alluded were formed in October, in very eligible and pleasant locations on the outskirts of the city. In these hospitals and camps 62 surgeons, 15 medical cadets, 22 hospital stewards, 539 nurses, and 127 cooks were on duty during the mouth of October, when all were in operation. During this month 3,032 patients, chiefly wounded, were received into these hospitals, making, with those then under treatment, on the 30th of September, 5,353. Of this number 403 were returned to duty, 23 were discharged, 3 deserted, 4 were sent on furlough, 2,064 were sent to other hospitals, and 253 died, leaving on the 31st of October 2,603 remaining in the hospitals. A large number of wounded were sent from the hospitals on the battle-field, through Frederick, to other hospitals, of whom no record was kept, as they were not received into any of the hospitals in that city. No one seeing these hospitals after their establishment can form any conception of the labor required to put them in the good condition in which they were kept. The zeal and ability displayed by Dr. Milhau in their organization and management, and the hearty co-operation he at all times gave me, deserve especial mention. In addition to our own wounded, we had upon our hands from the battles of South Mountain, Crampton's Gap, and Antietam in all about 2,500 Confederate wounded. Those taken at South Mountain were taken to Middletown, and those at Crampton's Gap to Burkittsville.
        When the general assumed command of the defenses of Washington, the hospitals in Washington and in its vicinity were placed under my control. We left that city for Maryland on the 7th of September, and a few days thereafter those hospitals and the medical affairs of the troops in and around Washington were placed in the immediate charge of Surg. R. O. Abbott, U.S. Army, assistant medical director of the Army of the Potomac. It is perhaps not desirable to go much into details concerning them, and I only give the following statement in order to exhibit the number of hospitals and other points of interest connected with them, which are necessary, as they belonged to the medical department of this army:
        Number of hospitals, 38; medical officers, 224; remaining last report, 28,649; number of patients admitted, 23,298; total, 51,947. Returned to duty, 7,104; discharged, 2,100; deserted, 597; sent to other hospitals, 9,026; on furlough, 647; died, 1,498; remaining, 30,975.
        It may be gratifying for the general commanding to know that never had these hospitals been in better condition. The excellent system introduced in their management, the complete system of records adopted and carried out, and the care taken to have everything connected with them in fine condition, reflect the highest credit upon the officer in charge, for to him it is due. The very great assistance Surgeon Abbott so uniformly and so unreservedly gave me upon all occasions requires especial notice, and it affords me the greatest pleasure to ask the attention of the commanding general to the richly deserving merits of this officer.
        Immediately after the retreat of the enemy from the field of Antietam, measures were taken to have all the Confederate wounded gathered in from the field, over which they laid scattered in all directions, and from the houses and barns in the rear of their lines, and placed under such circumstances as would permit of their being properly attended to, and at such points as would enable their removal to be effected to Frederick and thence to Baltimore and Fortress Monroe to their own lines. They were removed as rapidly as their recovery would permit. The duty of attending to these men was assigned to Surgeon Ranch, U.S. Volunteers, to whom assistants were given from our own officers and all the medical officers who had been left by the enemy to look after their wounded. A sufficient number of ambulances having been placed at his disposal and supplies given him, these wounded were collected in the best and most convenient places, and everything done to alleviate their sufferings that was done for our own men. Humanity teaches us that a wounded and prostrate foe is not then our enemy.
        There were many cases both on our right and left whose wounds were so serious that their lives would be endangered by their removal, and to have every opportunity afforded them for recovery the Antietam hospital, consisting of hospital tents, and capable of comfortably accommodating nearly 600 cases, was established at a place called Smoketown, near Keedysville, for those who were wounded on our right, and a similar hospital, but not so capacious---the Locust Spring hospital--was established in the rear of the Fifth Corps for those cases which occurred on our left. To one or other of these hospitals all the wounded were carried whose wounds were of such a character as to forbid their removal to Frederick or elsewhere. The inspections made of these hospitals from time to time were a source of great gratification, as they made known to me the skillful treatment which these men received and the care with which they were watched over, and convinced me of the propriety of the adoption of this course in regard to them. Surgeon Vanderkieft, U.S. Volunteers, who was in charge of the Antietam hospital, was unceasing in his labors, and showed a degree of professional skill and executive ability much to be admired. Great care and attention were shown to the wounded at the Locust Spring hospital by Surgeon Squire, Eighty-ninth New York Volunteers, who had charge of it. Both hospitals were kept in excellent order.
        Immediately after the battle a great many citizens came within our lines in order to remove their relatives or friends who had been injured, and in a great many instances when the life of the man depended upon his remaining at rest. It was impossible to make them understand that they were better where they were, and that a removal would probably be done only with the sacrifice of life. Their minds seemed bent on having them in a house. If that could be accomplished, all would, in their opinion, be well. No greater mistake could exist, and the results of that battle only added additional evidence of the absolute necessity of a full supply of pure air, constantly renewed---a supply which cannot be obtained in the most perfectly constructed building. Within a few yards a marked contrast could be seen between the wounded in houses and barns and in the open air. Those in houses progressed less favorably than those in the barns, those in barns less favorably than those in the open air, although all were in other respects treated alike.
        The capacious barns, abundantly provided with hay and straw, the delightful weather with which we were favored, and the kindness exhibited by the people, afforded increased facilities to the medical department for taking care of the wounded thrown upon it by that battle. From the frequent inspections which I made from time to time, and from the reports of inspections made of the hospitals, and the manner in which the duties required in them were performed by medical officers, it gives me no little pleasure to say that the wounded had every care that could be bestowed upon them--that they were promptly, willingly, and efficiently attended to. And although I have more than once spoken to the general commanding concerning the conduct of medical officers on that battle-field, I cannot refrain from alluding here to the untiring devotion shown by them to the wounded of that day Until all the wounded were finally disposed of, no pains were spared, no labor abstained from, by day or by night, by the medical officers of this army, to alleviate the sufferings of the thousands of wounded who looked to them for relief. The medical directors of corps, especially Surgeons Dougherty and McNulty, were untiring in their exertions and unceasing in their labors, and were ably assisted by the staff under their commands. Very few delinquencies occurred, and these were swallowed up by the devotion exhibited by the rest of the medical staff during and long after the battle.
        The surgery of these battle-fields has been pronounced butchery. Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon. It is not to be supposed that there were no incompetent surgeons in the army. It is certainly true that there were; but these sweeping denunciations against a class of men who will favorably compare with the military surgeons of any country, because of the incompetency and short-comings of a few, are wrong, and do injustice to a body of men who have labored faithfully and well. It is easy to magnify an existing evil until it is beyond the bounds of truth. It is equally easy to pass by the good that has been done on the other side. Some medical officers lost their lives in their devotion to duty in the battle of Antietam, and others sickened from excessive labor which they conscientiously and skillfully performed. If any objection could be urged against the surgery of those fields, it would be the efforts on the part of surgeons to practice "conservative surgery" to too great an extent.
        I had better opportunities, perhaps, than any one else to form an opinion, and from my observations I am convinced that if any fault was committed it was that the knife was not used enough. So much has been said on this matter that, familiar as I am with the conduct o? the medical officers on those battle-fields, I cannot, as the medical director of this army, see them misrepresented and be silent.
        After these battles the army remained some time in Maryland, preparing for the coming campaign in Virginia. During this time I was occupied in having the wounded well cared for and properly sent away, in making suitable provision for those whose safety required that they should not be removed, and in making such changes as experience and observation during those battles and the short time that I had occupied the position of medical director convinced me were necessary to render the medical department more efficient. Hitherto large amounts of medical supplies had been lost and in various ways wasted, and not unfrequently all the supplies for a regiment had been thrown away for want of transportation, and, of course were not on hand when wanted. It was necessary that this should be remedied, and in order to do so it was necessary to diminish the amount that was furnished a regiment at one time, which would affect the whole existing system and make the change a radical one. The objects which it was considered as desirable to attain were to reduce the waste which took place when large supplies were at one time issued to regiments, to have a supply given them, small, but sufficient for all immediate wants, and to have these supplies easily obtainable and replenished without difficulty when required, and without a multiplicity of papers and accounts. It was necessary also that they should be transported with facility, and that no trouble should be experienced in having them in abundance at the field hospitals in time of action and yet at the same time to preserve a proper degree of accountability.
        To accomplish this, a system of supplying by brigades was adopted on the 4th of October, 1862. The following extract from a circular issued to the medical department of this army at that date, from the medical director's office, will show the main features of the system which since that time has been in existence in this army:

        Hereafter in the Army of the Potomac the following supplies will be allowed to a brigade for one month for active field service, viz: One hospital wagon, filled; one medicine chest for each regiment, filled; one hospital knapsack for each regimental medical officer, filled. The supplies in the list marked A to be transported in a four-horse wagon.
        The surgeon in charge of each brigade will require and receipt for all these supplies, including those in the hospital wagons, and will issue to the senior surgeons of each regiment the medicine chests and knapsacks, taking receipts therefor. The hospital wagon, with its horses, harness, &c., will be receipted for by the ambulance quartermaster.
        The surgeon in charge of the brigade will issue to the medical officers of the regiments such of these supplies as may be required for their commands informally, taking no receipts, demanding no requisitions, but accounting for the issues as expended.
        The surgeons in charge of brigades will at once make out requisitions in accordance with these instructions, and transmit them, approved by the medical director of the corps, to the medical purveyor of this army. These supplies being deemed sufficient for one month only, or for an emergency, medical directors of corps will see that they are always on hand, timely requisitions being made for that purpose.

        Before the adoption of this system, one and sometimes two wagons were required to transport the medical supplies of a regiment, and, in addition, another wagon was required to transport cooking utensils, hospital tents, baggage of medical officers, &c. With this system one wagon suffices for the medical department of a regiment; one wagon is added to a brigade and at least one taken from each regiment, and, besides, should it become necessary to take away this one wagon from a regiment, the supplies are in such shape as will permit them to be carried on a horse, and not necessarily lost, as heretofore. The regimental surgeons have no trouble in replenishing their supplies, and the amounts expended in a regiment are always known to the surgeon-in-chief of a brigade, whose duty it is always to check any undue waste or improper expenditure. These supplies are easily transported, and are without difficulty made available on the field of battle, as events which have since transpired have demonstrated.
        These instructions having been issued, my attention was given to the manner in which the wounded were attended to upon the field of battle. No system of field hospitals that I was aware of existed, and, convinced of the necessity of adopting some measures by which the wounded could receive the best surgical aid which the army afforded, and with the least delay, my thoughts were naturally turned to this most important subject. On the field of battle confusion is, above all other places, most prone to ensue, and unless some method is observed by which certain surgeons have specific duties to perform, and every officer has his place pointed out beforehand, and his duties defined, and held to a strict responsibility for their proper performance, the wounded must of course suffer. To remedy the want which existed, the following circular was issued:

CIRCULAR. ] HEADQUARTERS ARMY OF THE POTOMAC,
Medical Director's Office, October 30, 1862.

        SIR: In order that the wounded may receive the most prompt and efficient attention during and after an engagement, and that the necessary operations may be performed by the most skillful and responsible surgeons at the earliest moment, the following instructions are issued for the guidance of the medical staff of this army, and medical directors of corps will see that they are promptly carried into effect:
        Previous to an engagement there will be established in each corps a hospital for each division, the position of which will he selected by the medical director of the corps.

        The organization of the hospital will be as follows:

1st. A surgeon in charge; one assistant surgeon to provide food and shelter, &c.; one assistant surgeon to keep the records.

2d. Three medical officers to perform operations; three medical officers as assistants to each of these officers.

3d. Additional medical officers, hospital stewards, nurses of the division.

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

Very respectfully, your obedient servant,
JONA. LETTERMAN,
Medical Director.

        As both of these circulars met the approval of the commanding general and were issued under his auspices, it may not be amiss to say that at the battle of Fredericksburg, on the 13th of December, 1862, when 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.
        I have alluded to the loss of medical officers in battle. Two of them fell upon the battle-field of Antietam, whose devotion to duty I cannot pass over. Surg. W. J. H. White, U.S. Army, medical director of the Sixth Corps, under General Franklin, was killed on that field by a shot from the enemy. He, was a skillful surgeon, a gallant officer, and a gentleman whose deportment was kind and courteous to all who had intercourse with him. These admirable traits, together with his familiarity with the medical affairs of that corps, made his loss, and especially on that day, deeply to be deplored. Assistant Surgeon Revere, of the Twentieth Massachusetts Volunteers, accompanying his regiment into the midst of the fight, fell by the hands of the enemy, nobly and fearlessly discharging his duty to the wounded.
        I cannot act justly without mentioning the faithful services of Hospital Steward Robert Koldeway, U.S. Army, who has been constantly with me. His attention to duty has been invariably most marked. Shrinking from no labor by day or by night, in everything he has acquitted himself to my entire satisfaction, and it gives me no little pleasure to bring to the notice of the general commanding a non-com-missioned officer who has acted so well.
        I may have gone more fully into the details of the operations of the medical department of the Army of the Potomac than will be considered necessary, but upon my first interview with the commanding general at Harrison's Landing, I perceived the deep interest taken by him in everything connected with it. Time only strengthened my convictions and continued to assure me of his constant solicitude for the welfare of the sick and wounded, and I feel the most grateful remembrance of the unvarying confidence and support he gave me in everything which I considered conducive to that end.
        The efficiency of the medical department of this army owes much to the Surgeon-General. His advice and authority upon all occasions were freely given, and enabled me to act without restraint. I beg to assure the commanding general that the administration of this department, which he has more than once approved, has depended to a great extent upon the chief of the Medical Bureau in Washington.
        We crossed the Potomac and entered Virginia early in November, in anticipation of another battle soon taking place. Nothing of especial interest occurred in the medical department during our very rapid march through that portion of the State which was traversed by the army. My arrangements had been made, and the necessary instructions given to the medical directors of corps, and with the hearty cooperation they were affording me I felt that should the anticipated battle occur shortly after our arrival at Warrenton, the medical department would be more able than it had been hitherto to discharge the duties devolving upon it. The general was relieved; the battle did not take place.

Very respectfully, your obedient servant,
JONA. LETTERMAN,
Surgeon, U.S. A., and Medical Director Army of the Potomac.

Source: "Official Records of the War of the Rebellion"

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