Scott McGaugh, Author of Surgeon in Blue
Related Story: San Diego Author Profiles Forgotten Civil War Hero
CAVANAUGH: In his work promoting USS Midway Museum, Scott McGaugh can tell you just about anything you'd like to know about that famous aircraft carrier. But it seems McGaugh's penchant for history does not stop at the 20th century. He's written a book about one of the unsung heroes of the American civil war, credited with inventing modern battlefield medical treatment. Dr. Letterman's greatest triumphs came at the battle of Gettysburg. The book is called "Surgeon in Blue" and I'd like to welcome author, Scott McGaugh. Welcome.
MCGAUGH: It's good to be back.
CAVANAUGH: What led you to this story?
MCGAUGH: Well, it started with my involvement with Midway. As I got to learn about some of the amazing unsung heroism of some of the service members, I discovered Jonathan Letterman, who suddenly was in charge of a 100,000-man army two months after the bloodiest battle of the war in Antietam. And I learned about what he was able to accomplish in ten months, accomplishments that inspire battlefield medical treatment today. And it just inspired me.
CAVANAUGH: There apparently was a surgeon in World War II who said every day, he thanked God for Jonathan Letterman.
MCGAUGH: That's right. His is a legacy that those medical historians certainly appreciate, but it normally isn't part of the Gettysburg culture.
CAVANAUGH: We hear the number of dead and wounded in civil war battles, and they are unbelievable. For instance, more than 50,000 soldiers were killed or injured at Gettysburg. What were the reasons that the casualties were so high?
MCGAUGH: There were a number of reasons. One was simply the size of the two armies. When you have 160,000 men between the two armies colliding in a very small area, we're talking about a square mile or two, and the reality that in every war, weaponry becomes far more lethal, and military medicine has to catch up to that, oftentimes during the war it's a sad truth that our medical departments in the military are unprepared at the outset of each war. And it's something that has to be resolved throughout the course of the war. With Gettysburg, it was the sheer numbers of men, artillery, and small arms fire.
CAVANAUGH: In the early battles of the Civil War, were there any provisions made to get injured men off the battled field?
MCGAUGH: No. Military medicine had always been an afterthought in our military in the first 100 years of our country. They had almost no authority. It was Jonathanletter man who recognized that could not continue. When hundreds of men were left on Bull Run for days, dying of starvation. When hundreds more were walking the streets of Washington in search of a hospital. Letterman realized that. So he created the first professional organized, trained appliance core that exists still today.
CAVANAUGH: What was his background before he served in the Civil War?
MCGAUGH: Remarkably, not a whole lot! He graduated from medical school in 1849, joined the army, and like many surgeons in those days was assigned to a series of remote military outposts in the swamps of Florida, eastern Arizona, New Mexico. He would be responsible for the total healthcare of about 100 men. At most, he had treated perhaps a dozen arrow wounds before he was handed medical command of a 100,000-man army.
CAVANAUGH: Why was he handed that command?
MCGAUGH: He had demonstrated even in his short time, a remarkable ability be to grasp the large picture. He was an organizer, extremely compassionate. Early in the war, he began developing a more compassionate ambulance. Hospitals with better ventilation to reduce infection. So he was a rising star. It was clear that the army of the Potomac needed somebody to overhaul everything from camp hygiene to diet to battlefield evacuation to triage to hospitalization. Jonathan did all that.
CAVANAUGH: So Dr. Letterman established the first ambulance system?
MCGAUGH: Yes. It was not organized in those days. Line officers could take wagons that were nominally assigned to the medical department for their personal baggage. The doctors had no authority to commandeer or retain their own ambulances. They had to scrounge as best they could. And in the early days of the war with the massive number of casualties coming to light and realizing that was a harbinger of things to come, Letterman was the first person to organize, acquire the authority to make sure when our men were wounded they would be taken care of.
CAVANAUGH: When we look at the overall numbers of casualties in the civil war, and that is huge, hundreds of thousands of soldiers, hygiene in the soldiers' camps was also a big point of those illnesses and deaths. And it was a big point for Letterman. There were a lot of non-battlefield deaths because of bad hygiene and bad food; is that right?
MCGAUGH: Absolutely, leading to disease. A lot of people are surprised that twice as many soldiers died from disease in the civil war as enemy gun fire. Wasn't until World War II that the enemy killed more American soldiers than disease did. Letterman recognized this early in the civil war. He realized that a diet of salt pork, biscuits and alcohol did not make for a healthy army. He realized that open latrines next to company kitchens were not acceptable. He realized that lice-infected uniforms worn by men lying in the mud in a Virginia winter wasn't acceptable. He obtained the authority and the ability to change all that and post new regulations, dietary standard, and produced a far healthier, stronger army for his generals than any other man before him.
CAVANAUGH: Did he face any bureaucratic resistance?
MCGAUGH: Oh, absolutely. There were some military officers, even generals who felt that they knew the medical needs of their soldiers than Letterman did. They were in the minority, fortunately. And finally when Letterman's system was proven to be so effective, especially at Gettysburg, within a year, Congress passed a federal lawmaking the Letterman healthcare system, the battlefield system mandatory in all union armies.
CAVANAUGH: Now, the crowning achievement as we've been talking about of his time as chief medical officer for the union came during Gettysburg.
CAVANAUGH: A lot of these things he'd been working on came into play during that battle. Can you remind us a little bit about that battle? This is the 150th anniversary. It took place over a number of days.
MCGAUGH: Yes, July 1 through July 3. It was the epic battle of the civil war that many historians believe turned the tide of the civil war, forever put the south on the defensive. It was General Robert E. Lee's last attempt to take the fight to the north and thereby avoid a war of attrition in the South which he knew he couldn't possibly win. So it was a gamble on Lee's part. George Mead was responsible for the union army. They collided outside of Gettysburg. Three days of fighting, horrific charges and counter attacks. Letterman's army suffered a wounded soldier every six seconds for three days.
CAVANAUGH: What was his system able to accomplish?
MCGAUGH: His system of battlefield evacuation and hospitals and tiered triage care enabled him to get 15,000 wounded men off the battlefield by the close of each day's fighting. Within literally, 6-8 hours, every man was in a hospital. That may have been just a collection of tents in a farm field, but it was far better than lying out on the field for a week waiting for someone to find you. Within a day or two, he was evacuating the most seriously wounded to hospitals, larger hospitals farther east and north. So he was able to get people to care very quickly. He really almost pioneered what came known as the golden hour, which became recognized later as that key time of healthcare or treatment after you've been wounded. So he really set military medicine on a pace that today disability has replaced death as a signature of war because of the survival rates we enjoy today.
CAVANAUGH: Now, he's were -- just to remind everyone, these were the days when after a huge battle like that, are there weren't just hospitals. Wounded soldiers were brought into people's homes.
MCGAUGH: Oh, yes. When you've got 20,000 casualties you're responsible for, there are no hospitals. It's a collection of tents. It's barns, it's homes, it's churches. He would designate and scour the area, organize his ambulances, aid stations, stretcher-bearers to get these men into the areas as soon as possible.
CAVANAUGH: And there was no concept of the white flag back then for hospitals or medical units. They were attacked.
MCGAUGH: Oh, yes, snipers, sharpshooters. There are many chilling accounts of ambulance crews working into the night extinguishing the lamps on their &%C1ses because they provided targets for the enemy.
CAVANAUGH: What do you think about this man what you spent so much time writing about?
MCGAUGH: That's a great question. I have a great deal of empathy for him. He was only in his '30s, unmarried, placed in an impossible situation based on his experience or the nation's experience. What he accomplished in three of the nation's bloodiest battles of the civil war in ten months is inspiring. He was burned out within a couple years, resigned from the army. Struggled as a failed wildcater, became the coroner in San Francisco, and tragically died at the age of 47 after losing his wife a few years earlier. His is a largely unrecognized story. It's one that I think is very inspirational. It has a far-reaching legacy into this century, and I think it's one that needs to be told and preserved.
CAVANAUGH: And one of the most curious things about Letterman was that he asked to be relieved of command.
CAVANAUGH: Before the war ended. Why do you think he did that?
MCGAUGH: He never shared personal reasons. Most of his papers have been lost to history, but secondhand accounts from some of the senior officers under his command indicate that he was simply burned out. No one had endured ten, 12 months of the kinds of battles at Gettysburg that he had. Following Gettysburg, he decided he wanted to marry a woman that he had met between those battles. I'm sure they had something to do with it. A year later he resigned and moved to California.
CAVANAUGH: You talk about him as being an unsung hero, an almost forgotten hero. Other medical heroes of the civil war, like Clara Barton, went on to great fame she founded the Red Cross. Why do you think Letterman's career did not follow that path?
MCGAUGH: Well, a lot of times that happens, quite honestly. Battlefield medicine often validates or pioneers new standards in medicine. And oftentimes those lessons are lost from one war to the next. There wasn't another conflict or another war for almost half a century. He was such an unassuming man who did not leave a lot of personal written materials behind. He just got lost in the shuffle, I think.
CAVANAUGH: As you look at the present day, is there a line that you can trace from Dr. Jonathan Letterman and the kinds of changes he brought to military medicine to what we do today?
MCGAUGH: Absolutely. As I say, he really validated the concept that you could treat a wounded man to far better his chances of survival would be. He institutionalized the concept of triage. You treat, you stabilize, and you progressively move on from there. That has with technology progressed exponentially in this century. He was proud to get somebody off the battlefield in a week. In Vietnam, it could take six weeks. Today from Afghanistan, a severely wounded soldier could be home in four days. That fundamental principle of speed to care, specialized care, triage, multi-tier care all was forged and proven by Jonathan Letterman in the Civil War.
CAVANAUGH: Has his name been honored?
MCGAUGH: It has. For a long time, there was a Letterman hospital in San Francisco that was built at the turn of the century. There are other hospitals and wings in military hospitals that bear his name. Those who are in the business certainly know his legacy and cherish his legacy. But for the rest of us in the classroom, we learn a lot about Robert E. Lee and the battle, but this is an aspect of the Civil War that largely goes unnoticed.
CAVANAUGH: Fascinating story. Thanks so much for coming in and speak with us.
MCGAUGH: My pleasure, thank you.