Dr. Who?

     If there’s a little known hero of the Civil War, it has to be Dr. Jonathan Letterman.  I was reminded of that recently when the founder of the National Museum of Civil War Medicine, Dr. Gordon Dammann, gave a lecture on Dr. Letterman and his Letterman Plan.  Maybe you’ve never heard Dr. Letterman’s name before, but your life has probably been affected by his work.  The Letterman Plan, which is a system for treating and evacuating casualties from battlefields, is the basis for many aspects of our modern military medicine, emergency medicine, and even disaster relief.

Here is Dr. Dammann, talking about Dr. Letterman and his plan.  I think this is one of his favorite topics!

     At the start of the Civil War, there was no set procedure for removing wounded soldiers from the battlefields.  In some cases, the wounded were left on the battlefield for over a week, which meant that many of the men, who might have been saved, died from their wounds or from exposure.  While the army did have ambulances which could transport the wounded soldiers, the ambulances were under the control of the Quartermaster Department which procured and distributed most of the supplies for the army.  As you might imagine, the ambulances were not always the top priority in this system!  In fact, there were instances in which ambulances were appropriated to carry other supplies, or even personal items. 

     In 1862, just a few months prior to the Battle of Antietam, Major Jonathan Letterman was named the Medical Director of the Union Army of the Potomac.  His first step toward revamping the medical system was to establish a separate Ambulance Corps. He gave control of the army ambulances to the officers of the ambulance corps, he distributed ambulances to each regiment, he had enlisted men trained to serve as ambulance drivers and stretcher bearers, and he had the use of ambulance wagons for any non-medical uses forbidden.  

This Wheeling ambulance is one of the types of ambulance wagons used during the Civil War.  Illustration from “The Medical and Surgical History of the War of the Rebellion. (1861-65) Part III, Volume II.”

  

 

     Letterman also reorganized the system of medical treatment and field evacuation.  He applied a triage system in which the wounded were treated based on the severity of their wounds instead of the order they arrived.  He also established aid stations on the battlefields, where medical officers could stabilize the wounded soldiers and arrange for their transportation to a field hospital.  The field hospitals were located near the battlefields.  It was here that the soldiers received additional treatment, including emergency surgery if needed.  If more long-term treatment was required, the wounded were transported to the larger, more permanent hospitals which were usually located in the cities.

     The Battle of Antietam, the bloodiest single day in American history, was the first real test of Major Letterman’s new system.  It was a success.  Even when faced with over 23,000 casualties, his plan ensured that all of the wounded were removed from the battlefield within 48 hours, which undoubtedly saved many lives.  He continued to make changes and improvements, and in 1864 his plan was made official by an Act of Congress.

Though the equipment has changed, the Letterman Plan is still in use today.

     I’ll leave you with a quote from the NMCWM’s own website: Major General Paul Hawley, Chief Surgeon of the European Theater in the Second World War, said of Letterman, “I often wondered whether, had I been confronted with the primitive system which Letterman fell heir to at the beginning of the Civil War, I could have developed as good an organization as he did. I doubt it. There was not a day during World War II that I did not thank God for Jonathan Letterman.”

An 1862 photo of Major Letterman (first seated figure) and his staff in Warrenton, Virginia.  Library of Congress image.

Back at the Pry House

     The last time I wrote about the Pry House Field Hospital Museum it was to document the renovations which were being done to the house and barn.  Take a look at what was done here.  

     Though the artifacts are normally put back on display in the Pry House in April, I couldn’t put them in the house during the renovations.  Having the roof replaced meant that the temperature and relative humidity inside the house would fluctuate much more than usual.  If you’ve read much of my blog, you’ll know that I aim to keep artifacts in an environment with stable temperature and relative humidity!  There was also a higher risk of leaks and of pests gaining entry to the house, as well as an increase in dirt and dust in the house.  It was just not worth the risk to the artifacts.

Now the Pry House has a brand new roof!

     Once the roof was finished and the house was cleaned, I was finally able to take the artifacts for the displays back out to the Pry House.

No one likes seeing empty display cases!

     Since there had been some extra dirt and dust produced during renovations, I also decided to wash the cloth covers in the cases before the artifacts were put back inside them.  

This foam block was designed to safely support and display an open book.  There is a sheet of foam in the base of the case as well.  The foam helps to cushion and support the artifacts on display.

Unbleached muslin is used to cover both pieces of foam, since this kind of fabric does not contain any dyes or chemicals which can damage artifacts.

Since the Pry House was used as the headquarters for Dr. Jonathan Letterman during the Battle of Antietam, his book, "Medical Recollections of the Army of the Potomac" is displayed here, on the foam support pictured in the previous photo.  After the Civil War, Dr. Letterman wrote of his tenure as the Medical Director of the Army of the Potomac and of the role played by the Medical Department under his direction.

The rest of the artifacts are back in the display cases as well.  Some of the artifacts on display include amputation instruments, an ambulance water keg, a home pharmacy kit, Irish Brigade items recovered from the battlefield, Dr. Letterman’s desk, and many other relevant items.  If you’re in the area, come and take a look at them!

Photos courtesy of the National Museum of Civil War Medicine.

In the Light

     In the spring of 2012, all of us at the museum were excited about the addition of Major Jonathan Letterman’s desk to our exhibits out at the Pry House Field Hospital Museum.  (You can see my post about the desk’s arrival here. ) 

Here is Letterman’s desk on display.

     Do you see any issues for the desk in this photo?  Note that the desk is positioned directly under a large window which is letting in a lot of sunlight.  Exposure to light can be very damaging to many materials, including the leather, cloth, and wood components of this desk.  The Pry House did have UV filtering films installed on the windows though, which were supposed to filter out 99% of the ultraviolet light coming through the glass.  

Imagine my surprise and dismay when I moved an inkwell and some papers on the desk one day and saw this.  Obviously the films in the window were not as effective as we’d thought!  This meant that ALL the artifacts in the house were probably being exposed to light levels which were much too high.

     So, I needed to find a quick and inexpensive method of protecting all the artifacts in the house from too much light.  I researched new window films, but the cost was over our budget.  Screwing brackets into the woodwork to install window blinds was also not an option in this historic house.  I started looking at curtains next.  I knew I could put them on spring tension rods which wouldn’t damage the windows, plus they were more affordable than window films or blinds.  I didn’t find much that seemed appropriate for our use in ready-made curtains though.  So, I took a trip to our local fabric store and found an insulated drapery fabric which suited the museum’s purposes.  I thought I would have to take the time to make the curtains, but Susan Yano, a staff member at the Pry House, very graciously volunteered to make them.  Thank you Susan!  The curtains seem to be functioning well, though I am looking into obtaining some blue wool standards to better monitor the displays. 

Blue wool standards, or blue wool scales are used to monitor light exposure in display areas.  Usually one side of the scale is covered so that the light cannot affect it, then when the card is checked later any fading on the uncovered side is apparent.  If there is noticeable fading on the card, I’ll know I need to take stronger measures to block the light from the artifacts.

You can see here that the curtains block a lot of the sunlight from the artifacts, but still let in enough light for visitors to view the displays.  For now, I'm declaring the curtains a success!    

Photos courtesy of the National Museum of Civil War Medicine.

    

Amputation Instruments

     There’s a story the Director of our museum (George) likes to tell about overhearing two people on the street debating over whether or not to visit the museum.  The wife was looking in the front window and commenting that she’d like to take the tour.  Her husband replied, “Civil War medicine?  It’s just a saw!”  At that point, George stepped up and offered to show them the museum, as well as how much more there was to Civil War medicine than an amputation saw.

 

 

Here is what most people associate with Civil War medicine - an amputation kit. This is a nice example of an amputation kit with a rosewood case and the basic instruments (including the saw!) needed to perform an amputation.  

 

 

       Sadly, this has been the image of Civil War medicine for quite some time.  Even during the war, the surgeons were judged to be “butchers” for performing so many amputations.  The image has persisted through the years, and many people still have the idea that Civil War surgeons were heartless and incompetent.  The simple truth is that these surgeons were saving lives in the best way that the knowledge and technology of the time allowed.

     There is no doubt that amputations were a big part of Civil War medicine though. So, let’s take a look at some of the instruments that were used.

 

 

This is the culprit responsible for the necessity of so many amputations - the Minié ball. These bullets caused tremendous damage to soft tissue and to bones. One medical textbook of the time describes the damage as
“….truly terrible; bones are ground almost to powder, muscles, ligaments, and tendons torn away, and parts otherwise so mutilated, that loss of life, certainly of limb, is almost an inevitable consequence.”

 

One of our volunteers is a present-day surgeon, even though he dresses as a Civil War surgeon at the museum! He took our Director, George, through the amputation process, using a pig leg. 
Don’t worry; even though those instruments look old, they are actually reproductions of Civil War instruments. I wouldn’t let them use the real ones! 

 

 

Normally the first step in an amputation was to anesthetize the patient, but obviously that was unnecessary for this“patient.” The next step would be to apply a tourniquet to the limb above the wound, to stop or slow the bleeding.

Here is an example of a Petit’s screw tourniquet, which would have been used in the Civil War.

 

     There were two main methods of amputation used in the Civil War.  The flap method left flaps of skin and muscle which would be used to cover the stump at the completion of the operation.  A V-shaped cut would be made, and then the bone would cut away a few inches above the flaps.  In a circular amputation, the surgeon basically cut in a circle around the limb, would draw back the skin slightly and then cut straight across the bone. 

 

George uses an amputation knife to make the first incision through the skin and muscle. Afterwards, the skin and muscle will be pulled back slightly from the bone. 
 I will point out here that Civil War surgeons did not wear gloves.

 

This amputation knife is similar to the one being used in the photo above. Single-edged amputation knives were used for circular amputations.

 

This double-edged amputation knife is called a catlin. It was more commonly used in flap amputations.

 

The amputation saw was used just to cut through the bone.

   

This is a typical amputation saw with a “fishtail” handle. The checkered texture on the handle gave the user a better grip. Operating quickly was important. There was less chance of shock to the patient, and it allowed the surgeon to move on to the next patient quickly. Most amputations were done in less than ten minutes!

 

 

With the amputation completed, the surgeon would use a hooked instrument called a tenaculum to pull out the large blood vessels to be tied off.

 

 

Here is a closer view of a tenaculum.

 

 

This instrument, called a rongeur, would be used to remove any sharp edges from the bone before closing the wound. A bone file could be used to help smooth the bone too.

 

 

And finally, the flaps of skin would be sutured together. Often, an opening would be left to allow the wound to drain. Bandages would be applied to the stump.

Surgical needles haven’t changed much since the Civil War!

 

     To learn more about Civil War amputations click here.

      

     I’ll leave you with a quote from the medical director of the Army of the Potomac, Dr. Jonathan Letterman, who wrote in his report after the battle of Antietam,

“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.”

 

 

Photos courtesy of the National Museum of Civil War Medicine.