Major Jonathan Letterman: The Father of Battlefield Medicine

When the Springfield Musket arrived on the scene in 1861 it had become the weapon that effectively changed warfare, Accurate to more than 500 yards, the Springfield would get its first real outing during the American Civil War with devastating consequences. Whilst the technology had advanced, the tactics operated in the battlefield had yet to catch up. 

Lining up in traditional formations, the armies of the Union and the Confederacy would charge each other head-on in the same manner as armies had fought for years prior. It provided the Springfield Musket with plenty of targets and it duly delivered resulting in massive casualties as the 0.58 calibre bullets, weighing nine pounds, penetrated the enemy.  More than a third of any unit would fall victim once the whistle was blown. Back in 1861, the Springfield was a weapon of mass destruction. 

Yet, the advance in technological warfare was not the only thing to be concerned about. Those who had survived the onslaught of the Springfield would be transferred from the field to the camps. Here, thousands of men would suffer as dysentery, scurvy, typhoid fever, pneumonia, smallpox, tuberculosis, measles, and malaria took hold. It is believed that 60% of Union soldiers would die from non battle injury disease.

For those who depended on medical care from either battle wounds or disease, there was another concern. In 1860, the U.S Army had 100 doctors for every 16,000 soldiers. With the country now divided and the escalation of war it was virtually impossible to maintain that ratio. At its peak, the Union had 2 million soldiers with only 10,000 surgeons operating.

Jonathan Letterman was one of those surgeons. His army career was already well established before the first shots were fired at Fort Sumter. 11 months later, he was promoted to the rank of Major and named medical director of the entire Union Army. The soldiers may not have known it yet but Letterman was about to change their lives. 

Using his experience from his pre Civil War service, Letterman started to make sweeping changes. He began with the soldiers themselves and in particular, their diet. From the preparation of food and the handling of waste, soldiers were given larger and more nutritious rations prepared in more hygienic conditions. The camps became cleaner with the men well fed and rested. In improvement in morale was clear but more importantly for Letterman there was a reduction in the disease rate by nearly one third.

Jonathan Letterman (second left) with staff. Credit: Wikimedia Commons

The conditions and wellbeing of the soldiers were only the first part of his plan. Letterman saw the devastation on the battlefield at first hand witnessing the deaths of thousands of men. Many would die on the battlefield from wounds and thrust as there was little that could be done to remove them to safety. The wounded were often left to their own devices depending on comrades to remove them. In some cases it could take up to one week to remove the wounded from the battlefield as was the case at the Second Manassas. For this reason, Letterman established the first Ambulance Corps. ​

American Civil War veteran, with an amputated leg at the hip. Credit: Wellcome Collection. CC BY 4.0

Men were trained to act as stretcher bearers and to operate wagons to pick up the wounded quickly and efficiently. If necessary, the Ambulance Corps were trained to use triage on the battlefield. The success of Letterman’s Ambulance Corps was witnessed at the Battle of Antietam in September 1862. With over 23,000 casualties, the newly established Corp was able to remove the wounded within 24 hours and in doing so, saved hundreds of lives in the process. 

The immediate treatment on the battlefield was a game changer but Letterman had also instigated further changes for the care of the soldiers after the battle. His evacuation system comprised of three core areas. A Field Dressing Station located on the battlefield for triage, dressings and tourniquets. Then those who required surgery would be moved to the Field Hospital before a lager Hospital away from the battlefield for longer term treatment and recuperation. Having an orgainsed system from battlefield to recovery not only save the lives of the men within his own care but also later, the Union Army as in March 1864 the system was adopted by the whole Union Army. 

Since the Civil War, almost 4 million Ameicans have served their country. Of these, more than 600,000 have died with over 1.3 million returning home injured, Many would have experienced the services that Major Letterman and his team had pioneered in the 19th Century. Technology may have advanced even further but the concept of Letterman introduced is still used to this day. It is for this reason that he is still referred to as “The father of Battlefield Medicine.”

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