Surgeon in Blue: Jonathan Letterman, the Civil War Doctor Who Pioneered Battlefield Care

by Scott McGaugh

Jonathan Letterman was an outpost medical officer serving in Indian country in the years before the Civil War, responsible for the care of just hundreds of men. But when he was appointed the chief medical officer for the Army of the Potomac, he revolutionized combat medicine over the course of four major battles—Antietam, Fredericksburg, Chancellorsville, and Gettysburg—that produced unprecedented numbers of casualties. He made battlefield survival possible by creating the first organized ambulance corps and a more effective field hospital system. He imposed medical professionalism on a chaotic battlefield. Where before 20 percent of the men were unfit to fight because of disease, squalid conditions, and poor nutrition, he improved health and combat readiness by pioneering hygiene and diet standards. Based on original research, and with stirring accounts of battle and the struggle to invent and supply adequate care during impossible conditions, this new biography recounts Letterman’s life from his small-town Pennsylvania beginnings to his trailblazing wartime years and his subsequent life as a wildcatter and the medical examiner of San Francisco. At last, here is the missing portrait of a key figure of Civil War history and military medicine. His principles of battlefield care continue to be taught to military commanders and first responders.

Genres: History, Civil War, Nonfiction, Biography, Medicine, War, Medical

369 pages, Kindle Edition

First published June 17, 2013

About the author

I'm proud to be a New York Times bestselling author of nonfiction military thrillers. My upcoming book, The Brotherhood of the Flying Coffin (March 2, 2023), is the untold combat aviation story of World War II volunteer glider pilots. A Civil War biography, Surgeon in Blue, was a bestseller. Honor Before Glory takes readers on a riveting rescue mission by Japanese American soldiers and is in film development. And I'm always looking for ideas for my next book...

Reviews

[Jay Schutt · Rating 3 out of 5]

At the outbreak of the American Civil War both sides were inadequately prepared for the large scale of fatalities, injuries and sickness that would follow. Although the Union Army of the Potomac had more resources, it still lacked in organization.
Jonathan Letterman instituted a new plan, fighting the red tape of bureaucracy, for improved medical care and supply. His overhaul of combat hygiene, diet, battlefield evacuation and hospital care helped keep more soldiers on the front lines of battle.
The bulk of the book covered just 18 months of some of the most ferocious fighting of the war. In that time Letterman instituted his changes. He was held in high esteem for his work restructuring army field medical treatment.
Although often repetitious, the book was very informative and educational.

[Betsy · Rating 4 out of 5]

This book presents a side of war that is frequently overlooked in the heat of battle. Jonathan Letterman served with the U.S. Army for ten years before the cataclysm, which started with the attack on Ft. Sumter, began. He learned the hard way what the army needed through the chaos of 1st and 2nd Manassas until finally he was in a position to do something about it at Antietam. As medical director for the Army of the Potomac, he worked closely with the Surgeon General, William Hammond and George B. McLellan. 'Little Mac' gets a bad rep in most books, but he defnitely understood the importance of a solid medical corps. Letterman also got along well with Burnside.

Unfortunately, Joseph Hooker frequently ignored Letterman's suggestions, while both Hammond and Letterman had a running feud with Secretary of War Stanton, and to a lesser degree with Henry Halleck. By the time of Gettysburg, Letterman had an efficient system worked out, which lessened the number of fatalities. In the space of a year, the number dropped from 37% to 20%. In recognition of his devotion to duty, one of the hospitals at Gettysburg was named for Letterman. (There is still a Camp Letterman Drive in that historic town.)

At the end of 1863, Letterman left the Army of the Potomac, partly due to ill health, and also because wanting to spend time with his new wife. The post-war years were not as successful as his efforts to bring in oil failed, his wife died and he returned to medicine as a coroner in San Francisco. His health continued to decline, and he died at the age of 47.

The last chapter of the book summarizes his achievements. Although not many people are familiar with his name now, but there were those who did remember him in the early 20th century. In fact, the Smithsonian Institution praised him with these words: "The name of Jonathan Letterman should always be remembered by military surgeons as the greatest sanitary organizer of modern times." Not a bad epitaph.

[Matthew Gurvich · Rating 5 out of 5]

New appreciation for role of medical doctors during Civil War

Many books are written about Civil War battles, leaders, and strategy. I have never truly took the time to consider medical needs before, during, and after battles. McGaugh does an outstanding job explaining the dire medical situation of the northern army leading up to and at the start of the war. He tells the story through Jonathan Letterman's perspective. His contributions to war medicine are still considered today. Although I believe the book falls short in actual anecdotes of Gettysburg and other battles, McGaugh gets to the point and helps the reader see the weaknesses in field injuries and presenting healthy soldiers for battle in the first place.
McGaugh also delves into the politics of war and Letterman's need to adapt to changes in leaders and their particular styles. He also tells of Letterman's life following his resignation from army medicine and the many trials and success that followed him to California. I highly recommend this book to those who want a clearer insight into how medicine and leadership played roles in the outcome of the Civil War.

[Sue · Rating 5 out of 5]

What an important person, I had no idea. It's amazing anything got done in this era of politics, ignorance, lack of supplies, and overwhelming odds against them.

Now I know why the San Francisco Army hospital, over at the Presidio, is called "Letterman Army Hospital"; part of my childhood as an "Army brat." . . .

I must also add that I was the first to read this sweet library book. It's too expensive for me. I am very grateful to the library systems in this country.

[Rea Redd · Rating 5 out of 5]

Scott McGough’s Surgeon In Blue is the first full length biography of Letterman. The author’s narrative is accessible to a variety of readers. It is not a detailed account of military campaigns nor is it a densely written example of medical history. It offers minimal insight into Letterman’s character and motivation. Jonathan Letterman did not leave a trove of personal letters. A current edition of his Medical Recollections of the Army of the Potomac is 204 pages in a slim trade paperback edition. Letterman’s narrative is similar to an analytical treatise: clear, precise and dispassionate.McGough gives other medical reformers credit where credit is due. He notes that Letterman in early 1863 “could set aside the continuing refinement of battlefield care that he had organized. Fredericksburg validated the Letterman System. Though the system was Letterman’s achievement, it had been built in part on the work of Napoleon’s surgeons more than sixty years before and of Union army surgeons under Ulysses S. Grant earlier in 1862.”


McGough’s work accomplishes several tasks. It puts Letterman and his work in the context of the mid-19th century U.S. army. Surgeon in Blue offers a clear depiction of the personalities and political vendettas of the Army of the Potomac, the presidential cabinet, the U.S. Congress and the U.S. Sanitary Commission. McGough has researched the appropriate archival material and enhanced his efforts by consulting historians of the National Park Service and the U.S. Army, the Gettysburg Licensed Battlefield Guides, and the staff of the National Museum of Civil War Medicine. Surgeon in Blue offers the compelling story of American physician’s life lived during the sobering era of the American Civil War.

[Heather · Rating 2 out of 5]

This was very interesting. My only complaint is that it was somewhat repetative. It probably could have been 100 pages shorter.

[Karen · Rating 4 out of 5]

Recently, there has been a show on Public Television about a hospital during the Civil War. It's been interesting, because it demonstrates where military medicine was at that point. In Freedom, PA we have a beautiful home from that time period, the Vicary House, and oftentimes they have a demonstration there of Civil War materials including medical bags with all the saws and the few medicines they had available to them. You get a sense of how fearful it must have been to undergo medical care in this most horrific of wars.

This book about Jonathan Letterman really emphasized the importance of having a determined doctor whose organizational skills changed the face of military medicine. Even before the time when germ theory recognized that unseen bacteria and viruses were causing conditions such as septicemia and dysentery, Letterman was smart enough to recognize that well-fed men who were in cleaner environments did a lot better then men who were starving who were in filthy environments.

This book covers Letterman's entire life. We forget how short the length of life was for people at that time period, even when there wasn't a war. The Civil War took a huge toll on those men who survived the war itself, with many dying of exposure to disease later in life. Letterman had a short life, but at least during his life he was recognized for his great service to the Union.

This book was unnecessarily long. There was a lot of repetition. I got the feeling that McGaugh, the author, really wanted to emphasize what a great man Letterman was. He could have done this with better proofreading by the publishers, and a slightly shorter book. Otherwise it was a good book, and necessary addition to Civil War history.

[John Findlay · Rating 3 out of 5]

This book was full of information on how Jonathan Letterman revamped both preventive care and battlefield treatment of the wounded during his time as Medical Director of the Army of the Potomac during two years of the Civil War. His heroic efforts during the battles of Antietam and Gettysburg were marvelous, and revised how wartime medicine was practiced. He was a master of organization and planning, and managed to place field hospitals near the battle lines so that wounded soldiers could be quickly extracted, administered to, and then sent to more complete hospitals in larger cities. My major gripe with this book was that most of the rest of his life was unremarkable, and yet it comprised about two-thirds of the book. I greatly admire Letterman for his role in the Civil War, and learned a ton about how his organizational skills led to rethinking of how the wounded should be treated. But I would have been happy if the rest of the book were more condensed.

[Elana · Rating 4 out of 5]

An historical overview of how battlefield and emergency medicine were developed in the US as a result of catastrophically rudimentary military hospital at the beginning of the Civil war. Union heads definitely didn't consider medical care of wounded soldiers as an important task. Financial investment into the field ambulance and med equipment was thought to be a capricious luxury as much as selecting skilled doctors for the task. The book is full of detailed and grotesque descriptions of how wounded were treated that will make you cringe. Although repetitive at times and including unnecessary to the topic battlefield descriptions, it stills delivers the message of innovation during the wartime as one of the major driving forces of the modern society. How lucky we are to be born now and not then when it comes to trauma treatment and med field in general.

[J.R. Alcyone · Rating 3 out of 5]

This is a difficult book to rate.

On the one hand, it is extensively researched, to the point of almost repetition and dryness. On the other hand, this is a biography, and the author suffered extensively from the fact that his subject was a private man who apparently left no correspondence behind--nor, apparently, did much of his family. This means most of the biography is drawn from published sources; we learn little about Letterman the human being. This is unfortunate, as Letterman is a fascinating figure and someone fully deserving of a biography. But without letters or diaries to draw from, the author was severely hampered.

I'd recommend this to people with a particular interest in Civil War medicine, or those looking for an overview of what a Civil War army-level medical director did.

[Nick · Rating 4 out of 5]

McGaugh has created an interesting biography of a man whose contributions to wartime medicine are too much overlooked. During the difficult times faced by the Union Army during the Civil War, Jonathan Letterman reinvented and structured medicine. Combining his experience in frontier forts with a keen eye for organization, his work saved thousands of lives, and his principles were studied by generations of army physicians, leading to everything from improved ambulance corps to the MASH units of the Korean War.
If you're not interested in the Civil War or in medical history, some of the story will be a bit dry, but overall it's well told.

[Gary]

Interesting Read

Overall I thought it was a pretty interesting read, but it's a biography about someone I would guess the average reader, including myself, has never heard of. And why have I never heard of this man. His accomplishments during the Civil War were stellar! So I now question what is it about the famous vs the not so famous. Are the famous really living more interesting lives, or are the better authors just picking and choosing who they write about?

Either way, I believe that History is created by those who research it.

[Deborah · Rating 4 out of 5]

Great story about someone I had never heard about before..J Letterman. What a talented doctor who really changed the way medical services were given to soldiers in the Civil War. I was especially intrigued with his relationship to the numerous generals who commanded the Army of the Potomac. The only reason I did not give it a full 5 stars was not due to the story or the writing but was based on some repetitive comments about his medical service processes. Otherwise this would have been 5 stars.

[Carol · Rating 4 out of 5]

An up close and personal look at the real support heroes behind the Civil War troops; raw and gritty ...

Terrific read for those interested in behind the scenes happenings of horrific battles... a closer look at the pros/cons of Union leaders, examinating Lincoln and his chosen commanding staff's decisions. Most revealing is the tireless and underappreciated battlefield medical corps, struggling to save lives in inhumane conditions.

[Gmaharriet · Rating 4 out of 5]

I enjoyed all but the last two chapters which were basically a repeat of information included in the earlier chapters of the book, and I think those last two chapters could safely be skipped over. Most of the book was about Jonathan Letterman's life and his effect on medical treatment and organization in the field during the Civil War. It covers aspects of that war which are often omitted from the history books.

Highly recommended!

[Dave Koch · Rating 4 out of 5]

Very interesting historical biography of Jonathan Letterman, a surgeon of the Civil War who instituted practices the change how wounded soldiers were cared for. His innovations were adopted during that war and persist to the present day.

[Linda Nelson · Rating 4 out of 5]

Very interesting book that enlightened me about the Civil-War era approach to battlefield medical care. Dr. Letterman deserves this recognition. There was a little more description of the actual battles than I would have preferred, but it certainly made the situation very realistic.

[Troy Sehlinger · Rating 3 out of 5]

Good read about the Civil War, with insight about the way the Army of the Potomac functioned. Letterman changed the way the battlefield was managed and the book tells his story well. Somewhat repetitive at times, but one seeking knowledge of the Civil War will enjoy.

[Ben Bartlett · Rating 4 out of 5]

Solid bio

Good little bio of special interest to operational leaders, for its focus on prices and organization. It is valuable to see the civil war from a different angle, that of the doctors behind the scenes. Not the most exciting bio ever but a solid read.

[Kevin McGrath · Rating 3 out of 5]

I had difficulty choking through this to be honest but the content is very interesting. Very specific topic for Civil War enthusiasts. Mr. Letterman made important advances in combat medicine and is somewhat unknown relative to his accomplishments.

[Patricia Tennant · Rating 3 out of 5]

Not my normal genre but I enjoyed this book along with a family trip to Gettysburg. I found some of it repetitious though I’m guessing he meant it as a review or summary. The fact that he went for the oil industry was not something expected and fascinating.

[Shannon · Rating 4 out of 5]

Fascinating!

[Steven Barclift · Rating 3 out of 5]

Well worth reading, to learn about Dr. Letterman's invaluable legacy in reducing lives lost and suffering during the civil war and it's impact in wars that followed.

[Tom · Rating 3 out of 5]

Interesting account of the Civil War doctor who developed the standards for battlefield medical care.

[Margee · Rating 4 out of 5]

Lengthy.

Interesting and factual. Dr. Letterman greatly improved medical treatment at the battlefield and saved many lives. This was a good read.

[Ron Vick · Rating 4 out of 5]

It was pretty good. In some spots, it was a bit redundant and tedious. All in all it was well worth it.

[Joel Lantz · Rating 3 out of 5]

Interesting biography, but could have been shorter. A surprising portion of the book simply reviews previously covered information.

[Scott McGaugh · Rating 4 out of 5]

Amazingly, the first biography on the Civil War surgeon who created a battlefield ambulance system and refined triage; milestones we all benefit from today.

[Casey · Rating 3 out of 5]

Interesting, but it was a little long winded. And I admit I cheated and read the epilog when I got close to the end.

[Kathleen Sherman · Rating 3 out of 5]

Too much strategy and not enough about the characters.