Civil War Saturday: The Father of Battlefield Medicine

Note from Murdoc: This is a new weekly feature we’re going to try out here at Murdoc Online. It’s going to be run and written by longtime MO commenter AW1 Tim. I’m sure that there a lot of other readers interested in the Civil War, and it would be great to get additional discussion in the comments section. Welcome, Tim!

Jonathan Letterman & staff, Warrenton, Virginia. Image from Library of Congress.

Jonathan Letterman & staff, Warrenton, Virginia. Image from Library of Congress.

Jonathan Letterman was appointed to the position of Medical Director of the Army of the Potomac in June of 1862. He was given Carte Blanche to enact such reforms and organization as he thought best and he engaged his duties with great vigor.

Prior to his appointment, virtually all medical services of the AoP were on the regimental level. Each regiment had a surgeon an assistant surgeon, a Hospital Steward, and 2-3 men detailed to act as orderlies. Each regiment usually had a motley collection of ambulances and wagons to support the medical staff, and the entire system was broken and inefficient. Letterman set about to rectify that.

One of his first actions was to form separate Ambulance trains by stripping away the vehicles from the regiments, and assigning them at the Division level. Each train consisted of 40 ambulances under the command of a Lieutenant. Men were permanently assigned to be drivers and litter bearers, and standard training was instituted.

Secondly, Letterman established Division-level field hospitals by removing the surgeons from the regimental level and assigning them to the new Division hospitals. Each one was tested and the surgeons assigned to duty that best reflected their skills. Some remained as “operators” performing surgical duties, while others were assigned to deal with the administrative side of things. Some few were left at lower levels to handle sick call, etc.

Next, Letterman set out to deal with battlefield casualties. He established a system of “Field Dressing Stations”. These were manned by an assistant surgeon and an orderly with a knapsack containing palliatives, bandages and tourniquets. Field Dressing Stations were set up directly behind the battle line, as close as was safely possible, and sheltered to whatever extent the ground, walls, trees, etc, could provide. The location was marked by a small red flag, and wounded men who could walk, and litter bearers carrying wounded were instructed to proceed to such stations first, where the wounded were stabilized prior to transport to the Division hospital, or treated and returned to the front.

Above all else, Letterman established, for the first time, the system of triage which is still in use today. Patients were divided into three categories: Those who would die from their wounds, those who would live, regardless of their wounds, and those who could go either way. Initial treatment was given to the latter category of wounded, and they were evacuated first. The remainder were given palliative care, their wounds dressed, and they were made as comfortable as the situation and resources allowed. They, too, were evacuated when conditions allowed.

Dr. Letterman established the basic organization and treatment protocols that exist to this very day. His ideas were revolutionary and their impact saved tens of thousands of lives during a terrible period of our history. They continue to do so today.

There are many myths about medicine and medical care during the civil war. I hope to dispose of some of them in future articles.


  1. AW1 Tim? I HATE AW1 Tim! He stole my wife and made my children hate me, after he ruined my practice with a silly malpractice suit. There’s no way I’m ever reading anything by that scuzzbucket AW1 Tim.

    Oh wait, I meant AW2 Tim. AW1 Tim’s probably pretty cool. Nevermind.

  2. I found your crediting of Letterman with introducing the concept of triage to casualty management very interesting. Previously, I had read that triage was something that came out of WWI. Was this something that carried over or was it another example of the lack of institutional memory forcing a reinvention of the wheel?

  3. John,

    No, it was Letterman who first introduced the practice into the Army of the Potomac. The problem(s) arrived shortly after the Civil War when many of his practices were scaled down, and as you mentioned, institutional memory lapsed and the lessons needed to be relearned.

    The Army-wide medical system was set up to treat large volumes of casualties but by 1870, there were few campaigns that used more than a Brigade-sized unit, and so many of the best and brightest had either been let go, or returned to civilian life after the war. Those left had to make do with a down-sizing of the force, with all that that entails, and it would not be until 1898 and the Span-Am war that large numbers of casualties would be seen again.

    Same with WWI. The Army had to once more dust off it’s planning for medical units when America mobilized and try and ramp up production on equipment, having sold off what remained after the last war through surplus channels or donations.

    An excellent treatment on CW period medicine (pardon the pun) may be found at the National Museum of Civil War Medicine in Frederick, Maryland. Their website is pretty good as well, and if you can ever visit, it is well worth your time to do so.

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