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Appendix to Part I

Containing Reports of Medical Directors, and Other Documents

Edited, under the direction of Surgeon General Joseph K. Barnes, United States Army

Assistant Surgeon J. J. Woodward, United States< Army

and

Assistant Surgeon George A. Otis, United States Army

Washington, D.C.

LXXXII. Extracts from a Report of the Operations of the Medical Department of the Army of the Potomac from July 4th to December 31st, 1862. By JONATHAN LETTERMAN, Surgeon, U. S. Army, Medical Director of the Army of the Potomac.

* * * In obedience to orders from the War Department, dated June 23d, 1862, I reported, on the 1st day of July, to General McClellan, at Haxhall’s Landing, on the James River, for duty as medical director of the Army of the Potomac, and, after the arrival of the army at Harrison’s Landing, I was placed on duty as such, on July 4th. I attempted, on the 28th of June, to report to the Commanding General from the White House, on the Pamunkey River, but was prevented from so doing by the movements of the army, and was compelled to proceed, by way of the James River, to the headquarters. The change which was taking place in the position of the army, when I left the White House, rendered it necessary that the medical supplies and the transports for the wounded and sick should also be sent up the James River, to meet the wants of the army. Upon inquiry, not ascertaining that any orders had been issued in the matter, I assumed the authority, and directed Assistant Surgeon R. H. Alexander, U. S. A., medical purveyor, and Assistant Surgeon E. S. Dunster, U. S. A., medical director for transportation, to proceed up that river with their supplies and vessels with all possible despatch. They reached Harrison’s Landing in time to be of the greatest service. The army, when it reached Harrison’s Landing, was greatly exhausted. The malaria from the borders of the Chickahominy and the swamps throughout the Peninsula, to which it had been so freely exposed, now manifested its baneful effects upon the health of the men. In addition to this, the troops had been marching and fighting, for seven days and nights, in a country abounding in pestilential swamps, and traversed by streams greatly swollen by the heavy rains, which made that region almost a serbonian bog. The labors of the troops had been excessive; the excitement, intense. They were called upon to subsist upon a scanty supply of food, and but little time was afforded to prepare even this meagre allowance. They had little time for sleep, and even when the chance presented itself, it was to lie in the rain and mud, with the expectation of being called to arms at any moment. The marching and fighting in such a country, with such weather, with lack of food, want of rest, great excitement, and the depression necessarily consequent upon it, could not have other than the effect of greatly increasing the numbers of sick in the army after it reached Harrison’s Landing. Scurvy had made its appearance before the arrival of the army there. The seeds of this disease had doubtless been planted some months previously, and were due not merely to the want of vegetables, but also to exposure to cold and wet, working and sleeping in the mud and

rain, and, also, to the inexperience of the troops in taking proper care of themselves under difficult circumstances. This disease is not to be dreaded merely because of the numbers it sends upon the reports of sick. Its influence goes much further, and the causes which give rise to it undermine the strength, depress the spirits, take away the energy, courage, and elasticity of those who do not report themselves sick, and who yet are not well. They do not feel sick, and yet their energy, their powers of endurance, and their willingness to undergo hardship are, in a great degree, gone, and they know not why. In this way, it had affected the fighting powers of the array much more than was indicated by the numbers it had sent upon the reports of sick. All these influences were not without their effect upon the medical officers, as well as upon the rest of the army. A number of these became sick from the exposure and privation to which they had been subjected, and those who did not succumb entirely to these influences were worn out by the excessive labor required of them during the campaign upon the Peninsula, and especially upon the labor incident to the battles immediately preceding the arrival of the army at Harrison’s Landing. The nature of the military operations unavoidably placed the medical department, when the army reached this point, in a condition far from being satisfactory. The supplies had been exhausted almost entirely, or bad, from necessity, been abandoned. The hospital tents had been almost universally abandoned or destroyed; the arrangement of the ambulances was not in such a state as to render very effective service, and the circumstances under which the army was placed required a much larger number of medical officers to perform the duties which were thrown upon that portion of the staff. It was impossible to obtain proper reports of the number of sick in the army at Harrison’s Landing. Nor had the causes just referred to yet produced their full effects. After about six thousand sick had been sent away on the transports, twelve thousand seven hundred and ninety-five remained. The data on which to base the precise percentage of sick and wounded could not be obtained at this date; but, from the most careful estimate which I could make, in the absence of positive data, the sickness amounted to at least twenty per centum. On the 1st of July, I directed the Harrison House to be taken and used as a hospital, as it was the only available building for the purpose in that vicinity, although entirely inadequate to meet the wants of the army. Only a few wall tents could be obtained at that time, with which to enlarge the capacity of the hospital. No regulation hospital tents could be procured. The rain began to fall heavily early on the morning of July 2d, and continued, with little interruption, until the evening of the 3d. A few wounded came to the hospital on the let; on the 2d, and, thereafter, for several days, they came in great numbers. Details of medical officers were required to work day and night, and continued to work faithfully until all the wounded who desired assistance had received it. The absence of tents prevented shelter being provided, and the great majority, being slightly wounded, were obliged to find protection from the rain as best they could, the more serious cases being kept in the building known as the Harrison House. The labors of the medical officers were excessive, but no relaxation was given until all who required attention had received it. The greatest difficulty experienced at this time was providing proper food, which very many needed much more than medical or surgical aid. Very soon large cauldrons and supplies of beef stock were obtained from the medical purveyor, and hard bread from the commissary department. Excellent soup was prepared and freely issued, relays of cooks being, at first, employed night and day. This hospital was afterward sufficiently enlarged, by hospital tents, to contain twelve hundred patients, and, when the army left Harrison’s Landing, the tents were removed to Craney Island, near Fort Monroe, and a hospital was established there by Surgeon A. E. Stocker, U. S. V., who conducted the removal and re-establishment of the hospital speedily and well. The transports for the sick and wounded, except those that had been sent to the North from the Pamunkey River, reached the army on the 2d of July. These vessels were fitted up with beds, bedding, medicines, hospital stores, food with many delicacies, and with arrangements for their preparation; everything, indeed, that was necessary for the comfort and well being of the wounded and sick. Surgeons, stewards, and nurses were assigned to their respective boats, and remained with them wherever they went. I doubt if ever vessels had been so completely fitted up for the transportation of sick and wounded of an army as these vessels had been by your orders. The shipment of the wounded and sick began on the 2d of July, in the rain, and was continued day and night until a very large number had been sent away. The want of shelter and proper accommodations at that time, at Harrison’s Landing, rendered it necessary to send away many who, under more favorable circumstances, would not have been sent out of the army. The weather was so inclement, the mud so excessive, and the shelter so wholly inadequate, that there was an evident disposition on the part of medical officers to consider compassionately any case of sickness or of wounds which presented itself. Had they not been sent on ship-board, they must have remained out in the rain and mud, shelterless and without proper food. On the 15th of July, about seven thousand had been sent to Fort Monroe or to Northern hospitals. A large number still remained, and, during the first week while the shipment was in progress, the troops that remained by the colors were suffering seriously from the effects of the late campaign. The deadly malarial poison was producing its full effects, and, with the want of proper food, and exposure to the rain, and fatigues, was now being fully manifested in the prevalence of malarial fevers of a typhoid type, diarrhœas, and scurvy. Whilst the shipment of wounded and sick was going on, and as soon as the pressing necessities of the first few days were provided for, my attention was given to ascertain the most expeditious method of improving the health of the army. The results of the investigations made and the means considered proper for adoption, many of which had already been enforced in the case, were set forth in a communication I transmitted to Brigadier General S. Williams, Assistant Adjutant General, on July 18th. An extract from this communication was published to the army, in orders, and from this extract I quote enough to indicate the views which I then submitted for the consideration of the Commanding General: ‘The diseases prevailing in our army are generally of a mild type, and are not increasing. Their chief causes are, in my opinion, the want of proper food, and that improperly prepared, exposure to the malaria of swamps, and the inclemencies of the weather, excessive fatigue, and want of natural rest, combined with great excitement of several days’ duration, and the exhaustion consequent thereon. I would recommend, to remedy these evils, that food, with abundance of fresh vegetables, shelter, rest, with a moderate amount of exercise, be given all the troops, and general and personal police be enforced. To accomplish this, I would suggest that an abundant supply of fresh onions and potatoes be used by the troops daily, for a fortnight, and, thereafter, at least twice a week, cost what they may; that the desiccated vegetables, dried apples or peaches, and pick1es, be used thrice a week; that a supply of fresh bread, by floating ovens or other methods, be distributed at least three times a week; that the food be prepared by companies, and not by squads; and that there be two men detailed from each company as permanent cooks, to be governed in

making the soups and cooking by the enclosed directions; that wells be dug as deep as the water will permit; that the troops be provided with tents or other shelter, to protect them from the sun and rain, which shall be raised daily and struck once a week upon new ground; the tentes d’abri also to be placed over new ground once a week; that the men be required to cut pine tops, spread them thickly in their tents, and not sleep on the ground; that camps be formed, not in the woods, but at a short distance from them, where a free circulation of pure air can be procured, and where the ground has been exposed to the sun and air to such an extent as to vitiate the noxious exhalations from damp ground saturated with emanations from the human body and from the decaying vegetation. Sleep during the day will not compensate for the loss of it at night: and I suggest that, as far as possible, the troops be allowed the natural time for rest; that not more than two drills per day be had, one in the morning, from six and a quarter to seven, and one in the evening, from six and a half to seven and a quarter; that the men be allowed to sleep until sunrise, and that they have their breakfast as soon as they rise. This, with the labor required for policing, will be sufficient during the present season. That when troops march, they should have breakfast, if only a cup of coffee, before starting, and after their arrival in camp, each man be given a gill of whiskey in a canteen three-fourths filled with water. I would also recommend that the strictest attention be paid to policing, general and special; that all the troops be compelled to bathe once a week, a regiment at a time, if possible, being marched to the river, from a brigade, one hour after sunrise, or an hour and a half before sunset, to remain in the water fifteen minutes; that sinks be dug and used, six inches of earth being thrown into them daily, and when filled to within two feet of the surface, new sinks to be dug and the old ones filled up; that holes be dug at each company kitchen for the refuse matter, and filled in like manner; that the entire grounds of each regiment be thoroughly policed every day, and the refuse matter, including that from stables and wagon yards, be buried two feet below the surface or burned; that dead animals, and the blood and offal from slaughtered animals, be not merely covered with a layer of earth, but buried at least four feet under ground. That the spaces between regiments be kept policed, and no nuisance whatever be allowed anywhere within the limits of this army; and that regimental commanders be held strictly accountable that this most important matter is attended to. I think if these suggestions be carried into effect, that we may, with reason, expect the health of this army to be in as good a state as that of any army in the field. Every effort is being made by the commissary and quartermaster departments to provide such articles as I have mentioned, belonging to their departments.’ This extract will, perhaps, be sufficient to explain the views entertained by me on this subject. so vital to the army and to the country. After about seven thousand sick and wounded had been sent away, there remained twelve thousand nine hundred and seventy-five, making a total of nearly twenty thousand. The greater portion of thin army reached Harrison’s Landing on the 2d of July. On that day, I addressed a letter to the Surgeon General, asking that one thousand hospital tents and two hundred ambulances might speedily be sent for the use of the army. I felt convinced that great destitution in tents would be found to exist, and that many ambulances had been lost, and that it would be necessary to have both of these articles replaced. The tents, I considered, would be especially needed to shelter the wounded and sick, whom it would be desirable to keep with the army. No one thing so much disheartens troops and causes homesickness among those who are well, as sending sick to hospitals outside of the army to which they belong. Such was the experience of the armies in the Crimea, and such is the experience of all armies. On the 7th day of July, the following communication was sent to me from Washington by the Quartermaster General: ‘You were, this day, telegraphed as follows, viz: Have ordered tents for fifty thousand men sent to Harrison’s Landing. Few hospital tents on hand; more making. For the present, I advise the use of some of the wall tents lately shipped to Harrison’s Landing. But why not send your sick and wounded at once to Fort Monroe, to be transferred to a healthier place? Sick and wounded are not useful at such a place as that at Harrison’s Landing.’ On the 9th of July, General Meigs informed me that he had ordered two hundred ambulances from Philadelphia, and two hundred and fifty hospital tents from Washington to Fort Monroe, saying, the remaining seven hundred and fifty hospital tents will be forwarded as soon as made. It will be perceived that it was owing to no want of foresight on the part of the medical department, if proper shelter was not provided. Three hundred hospital tents reached Harrison’s Landing on the 18th of July. On the 1st of August, I was informed that a large number had arrived, together with a number of ambulances. The tents, as far as they were needed, were used for the accommodation of the sick. The ambulances were distributed before we marched towards Yorktown. Before the communication to Brigadier General Seth Williams, Assistant Adjutant General, of July 18th, was written, the existence of scurvy attracted my serious consideration, and, upon consultation with Colonel F. H. Clarke, chief commissary of the army, large supplies of potatoes, onions, cabbage, tomatoes, squash, beets, and fresh bread were ordered by him. The first arrival of antiscorbutics was on the 7th of July. Potatoes and onions arrived on July 20th, and, thereafter, the supplies were so abundant that potatoes, onions, and cabbage rotted at the wharf for want of some one to take them away. The fresh bread was eagerly sought for by the men, as they loathed the hard bread which they had used for so many weeks. This loathing was no affectation, for this bread is difficult to masticate, is dry and inspid [insipid], absorbs all the secretions poured into mouth and stomach, and leaves none for the digestion of other portions of the food. The craving for fresh bread was founded in reason, and was not a mere whim. In addition to these vegetables and fresh bread procured by the commissary department, fifteen hundred boxes of fresh lemons were issued by the medical purveyor to the various hospitals and to the troops. The beneficial effects of this treatment soon became perceptible on the health of the men, and, when we left Harrison’s Landing, scurvy had disappeared from the Army of the Potomac. Whilst the army remained at that place, supplies of every kind appertaining to the medical department were abundant, and large amounts were used, as it was found necessary to re-supply the regiments of almost the entire army. Ice was freely, and almost daily supplied by the medical purveyor to the general and regimental hospitals and to the hospital transports. The recommendations contained in my communication to General S. Williams, which I have quoted, were ordered to be carried into effect by the General. The attention of the Adjutant General was called to the subject of police, a matter all important in an army, on July 12th. Inspections were made frequently by medical officers in the different corps, by officers sent upon this duty from the medical director’s office, and by myself, to see that the instructions just alluded to were enforced. The duty was laborious, and especially so because of the excessive heat in July and August. These inspections were purposely made without any intimation to the commands to be inspected. The beneficial effects of the inspections were very evident, in the improvement of the various camps and regimental hospitals. In

very few regiments sickness increased. In others, the sick list remained stationary; in others, it decreased. On the whole, the health of the army improved. On July 30th, I informed the Surgeon General that the number of sick in the army was about twelve thousand, of whom two thousand could take the field. The cases became less severe and more manageable, yielded more readily to treatment, and continued to indicate a general tendency to improve, until the army evacuated Harrison’s Landing. It is impossible to convey, in writing, to any one not mingling with the troops, a true idea of the improvement which took place in the health of the men while we were encamped at that place. The number reported sick on the regimental reports cannot by any means be taken as the true condition of the health of the army upon its arrival there; it does not give the real amount of its effective fighting strength. Time want of proper nourishment, the poisonous exhalations from the streams and swamps of the Peninsula, the labor undergone, and the anxiety felt, had undermined the strength and withered the spirits of a great many who were apparently well. The effective strength of the army when it reached Harrison’s Landing, and for some time thereafter, was less than time returns would indicate; and then, on the other hand, there are many ways in which improved health manifests itself that cannot be adequately described. There was so much in the appearance, in the life and vivacity exhibited by the men in the slightest actions, even in the tone of the voice, which conveyed to one’s mind the impression of health and spirits, of recovered tonicity of mind and body, of the presence of vigorous and manly courage; an impression which, to be understood, must be felt and cannot be told. The real strength of the army, when it left Harrison’s Landing, was greater than the large number at that time sent on the transports for the sick would lead you to suppose. It was agreeable to notice that the measures adopted for the improvement of the health of the troops were so ably and so cordially seconded by the medical directors of corps that, by their exertions and that of the officers under them, encouraging results were brought about, and that they were so able and so willing to assist in efforts towards restoring the health, and re-establishing the vigor of the Army of the Potomac. Time showed that those who were not sick were well, that the spirits of the troops had risen, and that the army, when it left Harrison’s Landing, was in a better condition by far than when it reached that place, and that there was every evidence to expect the health of this army to be in as good a state as that of any army in the field. From July 15th, the transports for the sick were chiefly employed in bringing our wounded and sick exchanged prisoners from Richmond, and carrying them to the northern cities; principally to Baltimore, Philadelphia, and New York. They were almost wholly occupied in this duty until August 3d, when the last exchanges were made at City Point. Shortly after communication was opened with the Confederate authorities, large supplies of fresh lemons, brandy, lint, and other necessaries were, by direction of the commanding general, sent to City Point, to be turned over to the Confederate authorities for the use of the wounded, but would not be received by them, and were returned. The commanding general visited the transports, on their return from that place with our wounded, and I inspected every vessel before it was allowed to leave for the north, that I might be certain that everything was done, and done properly, that was necessary for the welfare of those on board. Three thousand eight hundred and forty-five sick and wounded were thus transported. After this time, a portion of these transports, which had been while north taken from their legitimate use, were occupied in carrying exchanged Confederate prisoners from the north to City Point. On the return of these boats from this service to Harrison’s Landing, they were found to be excessively filthy, and required a great deal of labor to render them again suitable for the transportation of the sick. The use of these vessels in this way embarrassed me. * * On the 3d of August, the shipment of the sick from the army commenced, and was carried on as rapidly as time transportation could be obtained. It will be perceived from what I have just said that I had at my disposal only a portion of the boats set apart for that purpose, and the hospitals I had drawn plans for, and which the commanding general had directed the chief quartermaster to procure, were not allowed. These two things embarrassed me much. * * Colonel R. Ingalls, Quartermaster U. S. A., made every effort in his power to aid me in removing the sick, and placed at different times temporarily at my disposal, for this purpose, ten steamers. Some of these could make but one trip, others made more, and carried, in all, from the 9th to the night of the 15th of August, five thousand nine hundred and forty-five men. One thousand nine hundred and eight men were sent away before the 9th on the regular transports. The total number sent away, consequent upon the movement of the army, was fourteen thousand one hundred and fifty-nine. The largest number of boats was obtained on the 15th, and on that day and night five thousand six hundred and twenty-nine were sent away. This fact will, I think, show that the medical department was not idle. The delay arising from the use of the transports for purposes other than that for which they were designed, it was impossible for me to avoid, and it, at the same time, was the cause of another serious evil, the want of time to have the cases to be sent away properly examined. From this cause, many were taken on board who should not have been received; many men were sent from regiments, by colonels or captains, without the knowledge of the medical officers, who were fully able to do the duty required of them, and, under the circumstances, it became necessary to send them on to the boats. This state of things could have been prevented, could the medical department have had full control of its vessels, when the preparations were commenced to embark the sick. The delay involved an emergency, under which, it was impossible to have every case thoroughly examined. There are always numbers of skulkers and worthless men in an army, who are on the watch for an opportunity to escape duty, and these always furnish the cases which require the most careful examination, and the men who raise the cry of inhumanity, want of attention, and cruelty of surgeons, so frequently taken up and re-echoed from one end of the country to the other. Out of three thousand cases examined, upon one arrival at Fort Monroe, six hundred were fit for duty, and ordered to their regiments. When the time and the means are considered, it will, I think, be conceded that seldom have so large a number been transported without accident and without suffering. A careful and attentive medical officer was placed on each boat, with medical supplies sufficient for use. Credit is very deservedly due to Doctor Dunster, and the medical officers of the vessels, for the manner in which this large number was transported and provided for. The labor was great. The supplies appertaining to the medical department were, owing to the excellent manner in which the purveying was performed by Assistant Surgeon Alexander, U. S. A., in every way abundant while at Harrison’s Landing, and when the army left that place, it was, so far as the medical department was concerned, fully, I might almost say elegantly equipped with all that was requisite for another campaign.

The subject of the ambulances, after the health of the troops, became a matter of importance. Medical officers and quartermasters had charge of them, and, as a natural consequence, little care was exercised over them, and they could not be

depended upon during an action or upon a march. It became necessary to institute some system for their management, such that they should not be under the immediate control of medical officers, whose duties, especially on the day of battle, prevented any supervision, when supervision was, more than at any other time, required. It seemed to me necessary, that whilst medical officers should not have the care of the horses, harness, etc., belonging to the ambulances, the system should be such as to enable them, at all times, to procure them with facility when wanted for the purpose for which they were designed, and to be kept under the general control of the medical department. Neither the kind nor the number of ambulances required were in the army at that time, but it nevertheless was necessary to devise a system that would render as available as possible the material upon the spot, particularly as the army might move at any time, and it was not considered advisable to wait for the arrival of such as had been asked for, only a portion of which ever came. In order to inaugurate a system which would make the best of the materials on hand and accomplish the objects just referred to, the following order was written and published by direction of the commanding general. * * [For the details of the ambulance system here referred to, see the account of the ambulance system in the Surgical History of the War.—Eds.]

Whilst the army was at Harrison’s Landing, the hospitals at Point Lookout, Fort Monroe, and its immediate vicinity, Portsmouth, and Newport News were within the jurisdiction of the Army of the Potomac, and all of them I visited. On the 1st of August, there were in these hospitals one thousand eight hundred and twenty patients; during that month, including the hospital at Craney Island, to which I have already alluded, they received five thousand one hundred and ninety-one; making a total of seven thousand one hundred and eleven. Of these, seven hundred and sixteen were returned to duty, one hundred and one discharged, four sent on furlough, nine deserted, and eighty-four died, leaving under treatment five thousand eight hundred and seventy-nine. On the 31st of August, in these hospitals, during that month, sixty-six surgeons, twelve medical cadets, twelve hospital stewards, five hundred and thirty-seven nurses, and one hundred and twenty-six cooks were on duty. The army had to be transported northward, by water, from this place. All the vessels that could be obtained, the transports fitted up for the sick, as well as others, were required by the quartermaster`s department for this object. It appeared that it was necessary to have the troops transported with rapidity, as they were sent with scarcely any baggage. It resulted, that the ambulances and all their appurtenances were left behind, to be sent up as vessels could be spared for the purpose. Some of the vessels never arrived. A large portion of the medical supplies were also left behind, in some cases everything but the hospital knapsack, by orders of colonels of regiments, regimental quartermasters, and others; in some cases, without the knowledge of the medical officers; in others, notwithstanding their protest. For such acts as these, medical officers have been severely censured, and they were censured afterwards for not having the very supplies which had been left behind in this manner. From the date of the embarkation of the troops at Fort Morn, up to the time when the general was placed in command of the defenses of Washington, I know personally but little of the medical department of the Army of the Potomac. It was not under my control. On the 2d of September, when the general was placed in command, it came once more under my control, and I found it in a most deplorable condition. The officers were worn down by the labors they had in the meantime undergone; a large portion of their supplies, as I have stated, had been left at Fort Morn, and even much of that which they had brought with them was thrown on the roadside, I have been informed by commanding officers, on the way to join General Pope. This state of things, taken in connection with the effects upon the medical department, arising from the campaign, left it in a condition deeply to be deplored. The labor expended at Harrison’s Landing in rendering it efficient for active service seemed to have been expended in vain, and before it could be in a condition to render such service again it was necessary that it should be completely refitted. The circumstances under which the army was then placed made this simply impossible; there was not time to do it, for as soon as the troops reached the defences of Washington, they were marched into Maryland, and no time could be allowed for medical officers again to equip themselves with the medicines, instruments, dressings, and stores necessary for the campaign in that state. In a few instances, the medical officers who returned with the first troops were able to obtain a few supplies, but these opportunities were few. Some corps, which did not belong to the Army of the Potomac whilst it lay at Harrison’s Landing, were also marched rapidly into Maryland, of the condition of whose medical supplies I could know nothing, except on the way to meet the enemy. The medical department had to be, as it were, reorganized and re-supplied, and this had to be done while upon a rapid march over different sections of the country, and almost in face of the enemy.

Before leaving Washington, I had ordered a number of hospital wagons from Alexandria, Virginia, which reached me at Rockville, in Maryland, whence they were distributed to the different corps. While at this place, I directed the medical purveyor in Baltimore to put up certain supplies, and have them ready to send to such a point as I should direct. Upon our arrival at Frederick, on September 13th, directions were given for the establishment of hospitals at that place, for the reception of wounded in the anticipated battles, and additional supplies, to a large amount, were ordered to be sent from Baltimore at once. The Confederate troops had been in this city but the day before our arrival, and almost all the medical supplies had been destroyed, or had been taken by them. Just previous to our arrival in Frederick, two hundred ambulances were received from Washington, which I distributed to the corps, as rapidly as the movement of the troops would permit. The failure of the railroad company to forward the supplies caused serious annoyance. The railroad bridge over the Monocacy creek, between Frederick and Baltimore, having been destroyed by the Confederate troops, made it necessary to have all the supplies of the quartermasters and commissary, as well as medical departments, removed at that point. A great deal of confusion and delay was the consequence, which seriously embarrassed the medical department; and not from this cause alone, but from the fact that the cars loaded with supplies for its use were on some occasions switched off and left on the side of the road, to make way for other stores; and some of the supplies, I have been informed, never left Baltimore. The battle of South Mountain took place on the 14th. The village of Middletown, about four miles in rear of the scene of action, was thoroughly examined before the battle began, to ascertain its adaptability for the care of the wounded. Churches and other buildings were taken, as far as was considered necessary, and yet causing as little inconvenience as possible to the citizens residing there. Houses and barns, the latter large and commodious, were selected in the most sheltered places, on the right and left of the field, by the medical directors of the corps engaged, where the wounded were first received, whence they were removed to Middletown, the Confederate wounded as well as our own. The battle lasted until some time after dark, and as soon as the firing ceased I returned to

Middletown and visited all the hospitals and gave such directions as were necessary for the better care of the wounded. On the following morning, Assistant Surgeon Wm. Thomson, U. S. A., was directed to take charge of all the hospitals in the village, and Surgeon T. Theodore Heard, U. S. V., Surgeon P. Pineo, U. S. V., and Surgeon C. J. Nordquist, 83d New York Volunteers, were sent to consult together, and with him, and to perform such operations as were demanded. The object in sending these officers was to have all necessary operations done as soon as possible, as it would be impracticable for the surgeons in charge of the different hospitals to perform them all in season, and at the same time to attend to the other duties required of them. The work of these officers was very satisfactorily performed. The hospitals were soon put in good condition, and the men were well attended to. Supplies of medicines and stores were, in part, obtained from the supplies in the army, and, in part, from Frederick. Owing to the causes already alluded to, it required no little exertions to obtain them from this place. The difficulty was, however, overcome, and such as were needed, were, from time to time, procured. The task of providing food for time wounded was one of still greater difficulty; but was accomplished by having it brought from Frederick, and by purchasing from the people living in the village and vicinity. As was anticipated, the wounded, under the supervision of Assistant Surgeon Thomson, who labored unceasingly, were attended with great care, and the hospitals placed in excellent condition. Great kindness was shown by the citizens, and especially by the ladies, to our wounded, until the hospitals were broken up.

The battle of Crampton’s Gap took place also on September 14, 1862, at the same time that the engagement at South Mountain was in progress. The hospitals for the wounded were located at Burkettsville, about a mile in the rear of our troops. As in the village of Middletown, churches and other buildings were here appropriated for hospital purposes. A sufficient number of surgeons were detailed by Surgeon W. J. H. White, U. S. A., Medical Director of the Sixth Corps (the only corps engaged), who had charge of the medical department in the action. There was but short time given to prepare hospitals in either of these villages, as the troops left Frederick and fought both battles the same day. By the exertions of the medical officers in charge, the hospitals in Burkettsville were in a short time put in good order, and every care taken of the men brought to them. * * The same difficulty existed here as in Middletown, regarding supplies of medicines, hospital stores and food, and were overcome in like manner. The most reliable reports that can be obtained show one thousand two hundred and fourteen wounded in these two engagements. While these figures are not deemed entirely accurate, they are thought to approximate very nearly to the actual number wounded, those of the Confederate forces not being included.

The army pushed on rapidly, and passing through the village of Boonsboro’ on the following day, the 15th, it was examined, to ascertain what accommodation it afforded for hospital purposes, in the event they should be required there. Later in the evening, we passed through the village of Keedysville, a few miles beyond, which was also subjected to a similar inspection. Passing beyond this village, we came in sight, late in the evening, of what afterwards proved to be the battlefield of Antietam. As soon as the nature of the country and its resources for hospital purposes could be ascertained, and when a conception was formed of the nature of the anticipated battle, and the position to be occupied by our troops, directions were given to the corps medical directors to form their hospitals, as far as possible, by divisions, and at such a distance in the rear of the line of battle as to be secure from the shot and shell of the enemy; to select the houses and barns most easy of access, and such as were well supplied with hay or straw, and water; and, when circumstances would permit, to designate barns as preferable to houses, as being at that season of the year well provided with straw, better ventilated, and likely to enable the medical officers with more facility to attend to a greater number of wounded, and to have all the hospital supplies taken to such points as were selected. These directions were generally carried into effect, and yet the hospitals were not always beyond the range of the enemy’s guns. Very few hospital tents could be obtained, owing to the haste with which the army marched from Virginia into Maryland; but the weather was such as to enable the wounded to be cared for without them. A reference to the map accompanying this report will exhibit better than any description the location of these hospitals, which were necessarily numerous, from the length of the line of battle and the obstinacy with which the engagement was contested.

The battle commenced on the evening of September 16th, and continued until dark; it was renewed early in the morning of the 17th, and lasted until night. During the day, I received valuable aid from Assistant Surgeon B. Howard, U. S. A., who was busily engaged while the battle was in progress in riding to different parts of the field, and keeping me informed of the condition of medical affairs. After night, I visited all the hospitals in Keedysville, and gave such directions as were deemed necessary. The subject of supplies, always a source of serious consideration, was here peculiarly so. The condition of affairs at Monocacy Creek remained as heretofore described, and the action of the railroad was not commensurate with the demands made upon it. The propriety of obtaining the hospital wagons from Alexandria was evident, as these gave a supply for the emergency, and enabled surgeons to attend to the wounded as soon as the battle opened. On the close of the battle, supplies of medicines, stimulants, dressings, and stores were sent for and brought from Frederick in ambulances, and were distributed to the different hospitals as they were needed. The fear of the supplies becoming exhausted, for the difficulty of procuring them was well known, caused uneasiness on the part of some medical officers, who did not know the efforts that had been made before, and were made during and after the battle, to have enough furnished to supply their wants. I visited, after the battle, every hospital in the rear of our lines, and in no instance did I find any undue suffering for lack of medical supplies. Owing to the difficulty in having them brought from Monocacy Creek, for the first few days, the supplies of some articles became scanty, and in some instances very much so; but they were soon renewed, and, at the temporary depot established in Sharpsburg, shortly after the battle, a sufficient quantity of such articles as were necessary from time to time arrived, and when this temporary depot was afterwards broken up, about the middle of October, a portion of the supplies remained on hand. Not only were the wounded of our own army supplied, but all the Confederate wounded, which fell into our hands, were furnished all the medicines, hospital stores, and dressings that were required for their use. The difficulty of supplying the hospitals with food was a much greater one than that of providing articles belonging to the medical department, and was a matter of very great concern. This, a matter in all battles of moment, was, in this, particularly so, on account of the distance of the depot of supplies. An order was procured from Colonel Ingalls for twelve wagons to bring up from Frederick supplies of medicines and food. These wagons could not be obtained. Two were then procured from the chief quartermaster at headquarters, and I sent them in command of a medical officer, who brought up supplies of coffee, sugar, and bread. The hospitals were soon afterward abundantly supplied. I have

already mentioned, that the ambulances had been left at Fort Monroe, when the troops embarked, and that no system existed, except in the corps which belonged to the Army of the Potomac, while at Harrison’s Landing. A portion of the ambulances of some of the corps arrived just prior to the battle; a large number had been distributed in other corps, but were yet unorganized, and was not expected that they would prove as efficient as was desired. Notwithstanding, the wounded were brought from the field on our right before two o’clock on the following day. The ambulance train of the Second Corps was more fully equipped, and did most excellent service, under the charge of Captain J. M. Garland, who labored diligently, and with great care, until all his wounded were removed. The troops on the left were those among whom no well organized ambulance system existed; but here, owing to the exertions of the medical officers, the wounded were removed by the evening of September 18th. When we consider the duration and magnitude of the engagement, and the obstinacy with which it was contested, it is a matter of congratulation to speak of the expeditious and careful manner in which the wounded were removed from the field. Compiled from the most reliable sources at my command, the number of wounded amounted to eight thousand three hundred and fifty. This number is not entirely accurate, as many who were slightly wounded were attended to, of whose cases no record could, under the circumstances, be taken. The removal of so large a body of wounded was no small task. The journey to Frederick in ambulances was tedious and tiresome, and often painful to wounded men. It was necessary that they should halt at Middletown for food, and to take rest; that food should always be provided at this place at the proper time, and for time proper number; that the hospitals at Frederick should not be overcrowded; that the ambulances should not arrive too soon for the trains of cars at the depot at Frederick, the bridge over Monocacy Creek having been rebuilt; and that the ambulance horses should not be broken down by the constant labor required of them. With rare exceptions, this was accomplished, and all the wounded whose safety would not be jeopardized by the journey, were sent carefully and comfortably away. The hospitals in Frederick were soon established and put in order by Surgeon J. J. Milhau, U. S. A. In addition to the hospitals in the city, two large camps of hospital tents were formed on the outskirts of the city, capable of containing one thousand beds each. One hospital had been established in Frederick some months before our arrival; but at that time it was filled chiefly with Confederate sick and wounded, who had been left there. All the available buildings in this city, six in number, were taken for hospitals. * * These were fitted up with great rapidity, the buildings selected and prepared; beds, beddings, dressings, stores, food, cooking arrangements made; surgeons, stewards, cooks and nurses detailed, and sent for. On September 30th, these hospitals contained two thousand three hundred and twenty-one patients. The camps, to which I have just alluded, were formed in October, in very eligible and pleasant locations, on the outskirts of the town. In these hospitals and camps, sixty-two surgeons, fifteen medical cadets, twenty-two hospital stewards, five hundred and thirty-nine nurses, and one hundred and twenty-seven cooks were on duty during the month of October, when all were in operation. During this month, three thousand and thirty-two patients, chiefly wounded, were received into these hospitals, making, with those then under treatment on the 30th of September, five thousand three hundred and fifty-three. Of this number, four hundred and three were returned to duty, twenty-three were discharged, three deserted, four were sent on furlough, two thousand and sixty-four were sent to other hospitals, and two hundred and fifty-three died; leaving, on the 31st of October, two thousand six hundred and three remaining in the hospitals. A large number of wounded were sent from the hospitals on the battlefield, through Frederick, to other hospitals, of whom no record was kept, as they were not received into any of the hospitals in that city. Few, who saw these hospitals after their establishment, could form any conception of the labor required to put them in the good condition in which they were kept. The zeal and ability displayed by Surgeon J. J. Milhau, U. S. A., in their organization and management, and the hearty cooperation he at all times gave me, deserve especial mention. In addition to our own wounded, we had to care for two thousand five hundred Confederate wounded from the battle of South Mountain, Crampton’s Gap, and Antietam. Those captured at South Mountain were taken to Middletown, and those at Crampton’s Gap, to Burkettsville. When the general assumed command of the defences of Washington, the hospitals in Washington and its vicinity were placed under my control. We left that city for Maryland on September 7th, and a few days thereafter, these hospitals, and the medical affairs of the troops in and around Washington, were placed in the immediate charge of Surgeon R. O. Abbott, U. S. A. * * The following table exhibits the number of hospitals there, and some points of interest connected with them:

TABLE X.

Statistics of Military Hospitals in Washington from August 31st to December 31st, 1862.

No. of hospitals	35
No. medical officers	224
Remaining list report, August 31, 1862	11,797
No. of patients admitted	44,253
Total	56,050
Returned to duty	12,200
Discharged	5,454
Deserted	973
Sent to other hospitals	19,708
On furlough	2,099
Died	2,684
Remaining December 31^st, 1862	12,932

The excellent administration of these hospitals, and the complete system of records adopted and carried out, reflect the highest credit upon the officer in charge, for to him it is due. The very great assistance Dr. Abbott^*so uniformly and so unreservedly gave me upon all occasions requires especial notice, and it affords me the greatest pleasure to ask your attention to the richly deserving merits of this officer.

* Whose untimely death the medical staff had since had to deplore.—Eds.

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Immediately after the retreat of the enemy from the field of Antietam, measures were taken to have all the Confederate wounded gathered in from the field over which they laid scattered in all directions, and from the houses and barns in the rear of their lines, and placed under such circumstances as would permit of their being properly attended to, and at such points as would enable their removal to be effected to Frederick, and thence to Baltimore and Fort Monroe to their own lines. They were removed as rapidly as their recovery would permit. The duty of attending to these men was assigned to Surgeon J. H. Rauch, U. S. V., to whom assistants were given from our own officers, and by all the medical officers who had been left by the enemy to look after their wounded. A sufficient number of ambulances and supplies having been placed at the disposal of Surgeon Rauch, these wounded were collected in convenient places, and every thing was done to alleviate their sufferings that was done for our own men. Humanity teaches us that a wounded and prostrate foe is not then our enemy. There were many patients whose wounds were so serious that their lives would have been endangered by removal; and to have every opportunity afforded them for recovery, the Antietam hospital, consisting of hospital tents, and capable of comfortably accommodating nearly six hundred patients, was established at a place called Smoketown, near Keedysville. for those who were wounded on our right. and a similar hospital, less capacious, the Locust Spring hospital, was established in the rear of the Fifth Corps, for the wounded on our left. To one or other of these hospitals, all the wounded were carried, whose wounds were of such a character as to forbid their removal to Frederick or elsewhere. The inspections made of these hospitals made known to me the skillful treatment which these men received, and the care with which they were watched over, and convinced me of the propriety of the adoption of this course in regard to them. Surgeon B. A. Vanderkieft, U. S. V., who was in charge of the Antietam hospital, was unceasing in his labors, and showed a degree of professional skill and executive ability much to be admired. Great care and attention was shown to the wounded at the Locust Spring Hospital by Surgeon T. H. Squires, 89th New York Volunteers, who had charge of it. Both hospitals were kept in excellent order. Immediately after the battle, a great many citizens came within our lines, in order to remove their relatives or friends who had been injured, and in a great many instances when the life of the man depended upon his remaining at rest. It was impossible to make them understand that they were better where they were, and that a removal would probably involve the sacrifice of life. Their minds seemed bent on having their friends in houses. All would, in their opinion, be well if that could be accomplished. No greater mistake could exist, and the results of that battle only added additional evidence of the absolute necessity to wounded men of a full supply of pure air, constantly renewed, a supply which cannot be obtained in the most perfectly constructed building. Within a few yards, a marked contrast could be seen between the wounded in houses, barns, and in the open air. Those in houses progressed less favorably than those in the barns, those in the barns less favorably than those in the open air, although all were in other respects treated alike. The capacious barns, abundantly provided with hay and straw, the delightful weather with which we were favored, and the kindness exhibited by the people of the neighborhood afforded increased facilities to the medical department for taking care of time wounded thrown upon it by that battle. From the frequent inspections which I made from time to time, and from the reports of inspections made of the hospitals, and the manner in which the duties required in them were performed by medical officers, it gives me no little pleasure to say that the wounded had every care that could be bestowed upon them; that they were promptly, willingly, and efficiently attended, and, although I have more than once spoken concerning the conduct of medical officers on that battlefield, I cannot refrain from alluding here to the untiring devotion shown by them to the wounded of that day. Until all the wounded were finally disposed of, no pains were spared, no labor abstained from, by day or by night, by the medical officers of this army, to alleviate the sufferings of the thousands of wounded who looked to them for relief. The medical directors of corps, especially Surgeon A. N. Dougherty and Surgeon John McNulty, were untiring in their exertions and unceasing in their labors, and were ably assisted by the staffs under their command. Very few delinquencies occurred, and these were swallowed up by the devotion exhibited by the rest of the medical staff during and long after the battle. The surgery of these battlefields has been pronounced by some journals butchery; gross misrepresentations of the conduct of medical officers have been scattered broadcast over the country, causing deep anxiety to those who had relatives in the army. It is not to be supposed that there were no incompetent surgeons in the army; but these sweeping denunciations against a class of men who favorably compare with the military surgeons of any country, because of the incompetency of a few, are wrong, and do injustice to a body of men who have labored faithfully and well. It is easy to magnify faults beyond the bounds of truth; it is equally easy to ignore the good that has been done. Some medical officers lost their lives in their devotion to duty in the battle of Antietam, and others sickened from the excessive labor which they conscientiously performed. If any objection could be urged against the surgery of those fields, it should be to the efforts of surgeons to practice conservative measures to too great an extent. I had better opportunities, perhaps, than any one else to form an opinion, and, from any observations, I am convinced that if any fault was committed, it was that the knife was not used enough. So much has been said on this matter that, familiar as I am with the conduct of the medical officers on those battlefields, I cannot, as the Medical Director of the army, see them misrepresented and be silent. After these battles, the army remained some time in Maryland, preparing for the coming campaign in Virginia. During this time, I was occupied in having the wounded well cared for, and properly sent away; in making suitable provisions for those whose safety required that they should not be removed, and in making such changes as experience and observations, during those battles and the short time that I had occupied the position of medical director, convinced me were necessary. Hitherto large amounts of medical supplies had been lost, and in various ways wasted, and, not unfrequently, all the supplies for a regiment had been thrown away for want of transportation, and, of course, were not on hand when wanted. It was necessary that this should be remedied, and, in order to do so, it was necessary to diminish the amount that was furnished a regiment at one time, which would affect the whole existing system, and make the change a radical one. The objects which it was considered as desirable to attain were, to reduce the waste which took place when large supplies were at one time issued to regiments, to have a supply given them, small, but sufficient for all immediate wants, and to have these supplies easily attainable, and replenished without difficulty, when required, and without a multiplication of papers and accounts. It was necessary, also, that they should be transported with facility, and that no trouble should be experienced in having them in abundance at the field hospitals in time of action; and yet, at the same, to preserve a proper degree of accountability. To accomplish this, a system of supplying by brigades was

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adopted on the 4th of October, 1862. * * Before the adoption of this system, one, and sometimes two wagons were required to transport the medical supplies of a regiment, and another wagon was required to transport cooking utensils, hospital tents, and baggage of medical officers. With time new system, one wagon sufficed for the medical department of a regiment; one wagon was added to a brigade, and the essential medicines and supplies were in such shape as permitted them to be carried on a horse, if necessary, and not abandoned and lost as heretofore. * * No system of field hospitals existed, that I was aware of, and being convinced of the necessity of adopting some measures by which the wounded could receive the best surgical aid which the army afforded, and with the least delay, my thoughts were naturally turned to this most important subject. On the field of battle, above all other places, confusion is most liable to ensue, and, unless some method is observed by which certain surgeons have specific duties to perform, and every officer has his place pointed out beforehand and his duties defined, and held to a strict responsibility for their proper performance, the wounded must., of course, suffer. To remedy the want which existed the following circular was issued. * *

[For the details of the plan here referred to, see the account of the ambulance system in the Surgical History of the War.—Eds.]

I have alluded to the loss of medical officers in battle. Three of them fell upon the battlefield of Antietam, whose devotion to duty I cannot pass over. Surgeon W. J. H. White, U. S. Army, medical director of the Sixth Corps, under Genera] Franklin, was killed on that field by a shot from the enemy. He was a skillful surgeon, a gallant officer, and a gentleman whose deportment was kind and courteous to all who had intercourse with him. These admirable traits, together with his familiarity with the medical affairs of that corps, made his loss deeply to be deplored, and especially on that day. Assistant Surgeon Revere, of the 20th Massachusetts Volunteers, accompanying his regiment into the midst of the fight, fell by the hands of the enemy, nobly and fearlessly discharging his duty to the wounded. Assistant Surgeon A. A. Kendall, of the 12th Massachusetts Volunteers, was killed by the enemy while with his regiment in this battle. He was a faithful and efficient officer, active and zealous in his devotion to his duty, to which he fell a victim in the midst of battle. I cannot act justly without mentioning the faithful services of Hospital Steward Kaldeway, U. S. Army, who has been constantly with me. His attention to duty has been invariably most marked. Shrinking from no labor by day or by night, in everything he has acquitted himself to my entire satisfaction, and it gives me no little pleasure to bring to your notice a non-commissioned officer who has acted so well.

We crossed the Potomac, and entered Virginia early in November, in anticipation of another battle soon taking place. Nothing of special interest occurred in the medical department during our very rapid march through that portion of the state which was traversed by the army. My arrangements had been made, and the necessary instructions given to the medical directors of the corps, and with the hearty cooperation they were affording me, I felt that, should the anticipated battle occur shortly after our arrival at Warrenton, the medical department would be more able than it had been hitherto to discharge the duties devolving upon it.

General McClellan was relieved from the command of the Army of the Potomac on the 5th of November, and the battle did not take place. Upon my first interview with him at Harrison’s Landing, I perceived the great interest taken by General McClellan in everything connected with the medical department of this army. Time only served to strengthen my convictions, and continued to assure me of his constant solicitude for the welfare of time sick and wounded in the army under his command. Amidst the most pressing engagements, he found time to give his attention to every suggestion for their benefit which I hail to offer, and I feel the most grateful remembrance of the unvarying confidence and support which he heartily gave me in everything which I considered condusive [sic] to that end.

Major General A. E. Burnside assumed command of this army on the 9th day of November, 1862, at Warrenton. On the 17th of that month, we left that place for Fredericksburg, and arrived opposite that city on the 19th of the same month. It was generally believed that, upon our arrival there, we would at once cross the Rappahannock and take possession of the city. This was not done, and it soon became apparent that, if we attempted to do so, a battle would ensue. Shortly after we left Maryland, the medical purveyor of this army, Assistant Surgeon T. J. McMillin, U. S. A., was directed to leave Knoxville, Maryland, and to proceed with his supplies to Washington, and await orders, and be prepared to leave at any moment. He was ordered to Warrenton, whither he arrived shortly after the army, and was engaged in issuing supplies until the troops left that place, when he was ordered to Washington, and thence to Aquia Creek, where he was to be prepared to issue. After the arrival of the army before Fredericksburg, it became evident that we could not occupy that city, nor proceed further on, without a battle. Great uncertainty existed as to the time such an engagement would take place. It became necessary to see that everything in the medical department should be ready for any emergency which might arise. The principal objects to be accomplished were, that an extra amount of supplies for such an occasion should be on hand and easily attainable when wanted, that the organization of the ambulance corps should be carried into effect in those corps which did not belong to this army when the order establishing it was issued, and that it should be more perfectly put in force in the others than it had been hitherto. Ample supplies of medicines, instruments, stimulants, and anaesthetics were ordered from New York and Washington for the medical purveyor, who, after his arrival at Aquia Creek, was kept busily employed at this depot in issuing to the medical officers. In addition to these supplies, large quantities, over and above what were required for issue, of beef stock, stimulants, dressings, milk, coffee, tea, blankets, and underclothing were ordered and kept on hand, ready to be sent to any point where they might be needed. All the hospital Autenrieth wagons that could be procured were distributed. I regretted that there were not enough to supply each brigade; but this I had no power to remedy. The medical directors of corps were informed that an extra amount of the articles needed during an engagement would be on hand at an easily accessible point, and would be obtained without difficulty. This information they were directed to convey to the officers under them, which was promptly done. The requirements institution of field hospitals were to be attended to. The details were made in each corps, the necessary blanks distributed, and every step taken, as far as could be, before an action, to carry the instructions contained therein into effect. The ambulance corps in each army corps was examined, and requisitions made for such numbers as were needed to make up the allowance. Horses, harness, stretchers, lanterns, and all that was necessary for putting the trains in

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serviceable order were procured, and officers were assigned, and men detailed to complete and render effective the organization. The operations of this corps upon the field of battle will give ample evidence of the propriety of the order establishing it, and of expending time and labor in its organization and equipment. Five hundred hospital tents were, at my request, ordered by Colonel R. Ingalls, the chief quartermaster of the army, and kept at the depot, ready, at any moment, for use when required. These arrangements required no little expenditure of time and labor. During this period frequent interviews took place with the medical directors of corps and other medical officers and with the ambulance officers, and such advice and instructions were given as were deemed expedient.

On the 10th of December, the pontoons were ready to be thrown over the Rappahannock, and the batteries were placed in position on the north side of the river. I did not anticipate many wounded among the artillerists, and therefore directed but three places to be selected for the whole line, near which the hospitals for the batteries should be located, and had officers detailed to attend to them. My anticipations regarding the number of wounded were realized. The nature of the battle which was about to occur, so far as the medical department was concerned, was peculiar. It was necessary that provision should be made for the wounded near where they might be injured. In the attempt to throw the pontoons over the river, great opposition was probable, and should the bridge be constructed and the troops attempt to cross, it was thought that it would be done under the fire of the enemy`s guns, which, planted on the heights beyond the city, commanded the bridges and streets leading from them into the city. In this case, ample accommodations must be made for a large number of wounded on the north side of the river. Should we succeed in crossing, and carry the place without opposition, the troops would, in all probability, be at once pushed on, and attempt to carry the heights beyond which commanded the city. In this case, everything must be prepared for the establishment of hospitals at once on the south side of the river. It was necessary that both these contingencies should be provided for. In case we attempted to carry the works of the enemy, hospitals were to be provided immediately in Fredericksburg, with all their appliances; and yet it was equally necessary, even if we crossed without molestation, that we should be prepared to move the wounded at a moments notice from the city to the opposite side; for, if we did not succeed, the city would be at the mercy of the enemy, whose guns commanded it. These preparations were required not only for the troops attacking the enemy in the rear and to the right of Fredericksburg, but also for those on our left wing. For the accommodation of the wounded of the troops designated for the attack on the enemy upon our right, and before our bridges were laid, the hospital organizations of the first and second divisions of the Ninth Corps were established on the morning of the 11th, in a ravine near the Phillips house, about two-thirds of a mile distant from the river, where they would be protected from the guns of the enemy, easy of access, and have an abundance of wood and water. A number of hospital tents were here erected, and others were kept in store, ready to be pitched if they should be needed. As Surgeon P. A. O’Connell, U. S. V., medical director of the Ninth Corps, remarks, in his report, ‘the surgeons were at their posts ready for duty, with their attendants, nurses, food, medicines, and all that the wounded might need.’ Further to the right, and in a sheltered spot near the railroad, where there was an abundance of wood and water, a number of hospital tents were pitched, which constituted one of the division hospitals of the Second Corps. A house on the bank of the river, opposite the city, was also used as an hospital by the Second Corps. On our left wing, the same kind of preparations were required and made as upon our right. The arrangements of the Sixth Corps were completed by Surgeon Charles O’Leary, U. S. V, its medical director, which he reports were in ‘such order and system as gave me (him) the must pleasing assurance of their efficiency to meet the emergencies of the approaching engagement.’ The First Corps was upon the extreme left; its medical department, controlled by Surgeon J. T. Heard, U. S. V., by whom one of the division hospitals was established in like manner on the north bank of the river.

On the morning of December 11th, an attempt was made to throw the pontoons across the river. General Hunter’s reserve artillery opened upon the enemy`s works beyond the city, and upon that portion of the town which skirted the river, where the riflemen of the enemy were pouring a deadly fire upon the engineers engaged in constructing these bridges. In the afternoon, the fire was tremendous; such, I imagine, as has seldom been heard, at least upon this continent. Under its effect, the enemy, who were but few in number, were, late in the day, driven from the cellars and other places of concealment along the bank of the river, and the bridges were constructed. Three of them were thrown over on our right. Upon our left, two bridges were made, but without so much opposition, and were done earlier in the day. On the afternoon of the 11th and on the 12th, the troops crossed the Rappahannock, a portion only of the city being in our possession on the evening of the latter day. Those who were wounded previous to the night of the 12th were promptly and properly cared for in the hospitals prepared on the north side of the river. In passing through the city on the afternoon of the 12th, for the purpose of examining that part of it in possession of our troops in regard to its adaptability for hospital purposes, I found desolation everywhere visible from the effects of the bombardment of the previous day. Some houses were shattered, others in ruins, and others burned. The court-house, several churches, and such other buildings as were deemed suitable, were selected by and under the immediate direction of the medical directors of the right and centre grand divisions, and medical directors of the corps to be engaged. As many hospital wagons as were required were sent over, and the organization of each hospital was commenced. So earnestly did the medical officers eater upon the discharge of their duties, that before the action began on December 13th, the hospitals were in readiness, with officers, attendants, guards, instruments, dressings, stimulants, food, candles, etc. Mattresses and beds were procured from the dwellings. These, with a limited amount of straw, enabled the surgeons to have everything necessary to put the hospitals in order for the proper and speedy treatment of the wounded. The wounded, who, on the north side, had been, as I have just stated, attended to, were left in charge of a sufficient number of medical officers and attendants, and plenty of medical and surgical appliances and food. All the tents were left standing, and others on band, ready for use, should they be wanted. A portion of the troops on our left crossed the river on the 11th; the others, on the 12th. The best attainable positions for the hospitals were selected, although not entirely out of range of the guns of the enemy, as this was found to be impracticable. The organization by divisions had been, owing to the nature of the action on this wing, more fully put into operation. Surgeon Charles O’Leary, U. S. V., of the Sixth Corps, reports that, in the corps under his charge, ‘each hospital had three operating tables, with the requisite number of surgeons and attendants assigned to them separately. Instruments, dressings, and all necessary appliances, were arranged with an order, precision, and convenience

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rarely excelled in regular hospitals. Each surgeon knew his proper place, and devoted himself to the duty pertaining to it with a zeal and fidelity worthy of the highest commendation. I only give the testimony of commanding officers, as well as medical officers, when I state that the preparations here made in a very short time presented the completeness in detail belonging to the long-established, rather than to extemporized field hospitals.’ On the right, the location of the hospitals was made known to the medical officers and the litter-bearers who followed their regiments. Here the action was to take place but a short distance beyond the city, which, itself, was completely under the command of the enemy’s guns, and, until the enemy should be dislodged, the ambulances could not be used whilst the engagement was going on. On the left, the medical officers who were detailed to accompany the regiments into the field, were ordered to establish themselves in the rear of their respective brigades, in the most easily accessible and sheltered places, where the wounded were to be carried by the stretcher-bearers, who were to be kept informed constantly of the position of these officers. These officers were directed to give such attention as was imperatively required to the wounded. After this attention, the wounded were to be conveyed to the field hospitals by the ambulances, whose officers were to be kept informed of the position of these officers whenever the brigade should move. Before the action commenced, extra supplies of such articles as were deemed necessary were sent, in accordance with my directions, to the railroad depot, not far from Fredericksburg. The medical purveyor, Assistant Surgeon T. Macmillin, U. S. A., came up with them, to be near the scene of operations, and ready to comply with any orders he should receive in reference to supplies, when he returned to Aquia Creek.

I have already stated that the medical directors were informed that supplies would be on hand; and as soon as they arrived, the information was given them, and they were directed to have it conveyed to nil officers under them. These supplies were in a central position, and were easily attainable by medical officers, who were only required to send a memorandum of what they required.

On the morning of December 13th, the battle continued, and was contested with great obstinacy throughout the day. The conduct of the troops on the right was excellent, as they were seen advancing and driven back, and again and again reforming and pressing forward close to the fortifications, rifle pits, and stone walls, behind which the enemy was concealed and protected. Their gallantry and perseverance won the admiration of every one who beheld the courage displayed under circumstances so disheartening. As I have stated, the medical officers and their attendants were prepared with all the appliances requisite for the treatment of the wounded, who were rapidly brought in by the stretcher-bearers throughout the day and evening, and were promptly and efficiently treated. The labor of the medical officers did not, of course, cease with the close of the day. The ambulances now commenced their legitimate duties. Hitherto the men belonging to this corps bad been employed in making the necessary preparations in the hospitals, and in attending on and administering to the wounded, under the directions of the medical officers. As night closed in, the firing slackened, and shortly after altogether ceasing, this corps began gathering in the wounded who yet remained upon the field. The night was very dark, and the difficulty great in finding the objects of their search. The lanterns could not be used, as the glimmering of a candle invariably drew the fire of the enemy; but notwithstanding these difficulties, the officers and men continued their labors, and, before dawn, all the wounded who were inside our lines had been taken to the hospitals prepared for them in the rear. Here, throughout the night, the medical officers were sedulously engaged in attendance upon them, as they were brought in, blankets being fastened over the windows and every aperture to conceal the lights, every appearance of which drew a shot from the enemy’s guns planted on Marye’s Heights. During the day, the hospitals were not infrequently struck by shot and shell from these guns, but, fortunately, no one was injured. The preparations made here for the reception and treatment of the wounded were found to be judicious and equal to the wants of the occasion. The ambulance service was, in this portion of the army, so efficiently performed, that, although it was not commenced, for the reasons already stated, until after dark on the 13th, the most accurate information obtainable shows that, before daylight, all the wounded, save twenty, in a house outside of our pickets, beyond whose line the ambulances could not be permitted to go, were brought from the field. It is unnecessary to go much into detail concerning the operations of the medical department on the left wing, as I have already described the arrangements which had been made previous to the commencement of the battle. These preparations were found fully equal to the wants of the service. The operating staff, with the required assistants, attendants, and guards, with the necessary appliances, were at the hospitals, as had been directed. The officers accompanying the troops selected the places most fitting for the performance of the duties devolving upon them. The wounded were rapidly brought by the stretcher-bearers to the points ordered, of the position of which they were kept informed. Here the sufferers received such attendance as was absolutely necessary, and were conveyed thence by the ambulances to the field hospitals. Everything in the ambulance service was well conducted. Promptness, order, and precision characterized the actions of this corps throughout that exciting day; and it is gratifying to be able to state, from reliable sources, that not one wounded man was left on that portion of the field that night. The action of this corps met the hearty approbation of those who were cognizant of the admirable manner in which it performed the duties required of it, and fully justified and amply repaid the time and labor expended in its organization. In that portion of it attached to the First Corps, one sergeant was killed, one private wounded, one lieutenant and one private missing, supposed to have been taken prisoners; and one ambulance was so much damaged by a shell from the enemy that it had to be left on the field.

On December 14th, the troops remained on the field, and the surgeons in both wings of the army continued the labors of the preceding day and night, and on the evening of that day comparatively few operations remained to be performed. Late at night, orders were given to have the wounded removed to the north side of the river. On December 15th, and early next morning, the removal began. On the left, a number had been removed on the 13th, whilst the action was taking place. The propriety of leaving the hospital tents standing, and of having more at hand ready to be pitched, was now apparent. Early in the morning, it was understood that no ambulances would be permitted to cross the river on the right, orders regarding them having been partially misunderstood. This created for a short time some delay and confusion at the upper bridge, which I soon remedied, and directed them to be crossed over on the lowest bridge, opposite the city, taken along a street parallel to the river, which was unencumbered by artillery or infantry, receive the wounded, who were directed to be carried to them from the different hospitals on stretchers, and thence to recross the river at the upper bridge. This order was at once carried out,

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and long trains of ambulances might be seen crossing over, halting in the city to receive the wounded, and then filing out and crossing again at the upper bridge, and winding their way with care to the hospitals on the north side of the river. This was done without disorder or confusion, and, at the same time, expeditiously; and the operation reflected great credit upon the officers of the ambulance corps, especially so when it is considered that the city was at the mercy of the enemy, who, it was thought, would undoubtedly direct their artillery upon it. In the evening, before six o’clock, every wounded man was transported to the hospitals on the north side of the river. After the last ambulance had left the city, it was thoroughly inspected and policed by my direction, and not one wounded or sick man was found. Every one thus transported was sheltered, fed, and attended to that night. Many mattresses had been brought from the town, and an abundance of hay for bedding was provided in all the division hospitals. Fifteen patients were left in the ambulances from their own choice, and not from a want of room; of these, six were slightly wounded. It rained very heavily during the night of December 15th, but no suffering was occasioned by the storm.

On the left wing, the wounded of the First Corps were removed to the north side of the Rappahannock during the night of December 13th, and were comfortably situated in the hospitals of their respective divisions, which were here prepared for them. The wounded of the Sixth Corps, on the 14th, were also removed to the north side of the river by one o’clock in the afternoon, to the hospitals made ready for them, the division organization being still kept up. A portion of the ambulances of that corps were used for their removal, the remainder being left undisturbed and ready for the renewal of the battle, which, it was thought, might, at any moment, occur. The movement of the troops rendered it necessary to remove the hospitals still farther to the rear, in order to prevent their being injured, should the enemy attack our forces while crossing to the north side of the river. This was done in the night, and the patients were comfortably and safely lodged in the hospitals which were under the same organization that they had been hitherto. The wounded transported by the ambulance corps to the north side of the river amounted to about five thousand. The operation of removing this number, in the short time in which it was done, without accident or confusion, but with great order, precision, and care, was a sufficient test of the efficacy of the system, and the manner in which this organization was practically tested at this battle, reflects the highest credit upon its officers. The safe and speedy removal, and the careful and expeditious manner in which this number of wounded were provided for when removed, afforded the liveliest satisfaction to the generals in command, and to me it was especially gratifying. But few operations remained to be performed after the removal to the north side of the river. * * It is scarcely necessary to go into all the details concerning the operations of the purveying department of this army. Large amounts of supplies were issued at Knoxville, Maryland, during the latter part of October. The movement of the army from Maryland into Virginia necessitated the removal of the depot from that place, and, on November 5th, the purveyor was ordered to proceed to Washington with his supplies, to keep them in his possession, and to await orders. He left Knoxville, Maryland, on October 8th, and arrived in Washington on the following day, where he found orders directing him to proceed to Gainesville, on the Manassas Gap railroad. The army, in the meantime, having moved to Warrenton, his destination was changed to the latter place, where he arrived on November 15th, and was engaged until the 17th in issuing large amounts of supplies. The army leaving that place for Fredericksburg, he was directed to proceed, by way of Alexandria, to Aquia Creek, upon the last train. There being no wharf at Aquia Creek, he remained in Alexandria until the 21st, where, storing his supplies on barges, he arrived at Aquia Creek on the 24th. Here lie was busy issuing from these inconvenient boats until December 10th, at which time a convenient steamer was, with difficulty, procured. I considered a steamer absolutely necessary for his use, as it was not considered that the army would remain long opposite Fredericksburg, but would move farther on into the enemy’s country, in which event it was a matter of necessity that his stores should be promptly transported, without dependence upon towed barges.

From October 18th to December 31st, 1862, there was issued to this army seventy-four horse wagon supplies, fourteen hospital wagon supplies, seven complete hospital wagon, and four horse wagon supplies, two hundred and seven panniers and medicine chests, and two hundred and fifty-six hospital knapsacks. These were special issues. Monthly requisitions were made, in addition, to keep up the brigade supply to the amount ordered to be kept on hand.

The manner in which Assistant Surgeon T. McMillin, U. S. A., the medical purveyer [sic], has conducted the business of his department has met my most cordial approbation. The energy be has displayed in overcoming difficulties, especially those of transportation, and the promptitude which he has at all times exhibited, are to be especially commended. On December 16th, the removal of the wounded from the army to general hospitals began, and was continued from time to time until the 26th, when the last were sent away. The preparations to be made for their transportation over a single track railroad, over which the supplies for this army had to be transported, required that a certain number of cars should be at the station, near Falmouth, at the proper hour; that a certain number of wounded should be made ready at this station, and prepare to leave at a fixed time; and that boats, properly fitted up, should be ready at Aquia Creek, on which they could at once be placed, and taken to Washington and elsewhere. With the assistance which Colonel R. Ingalls always readily afforded, this was done. While the battle was in progress, and after it was over, nearly one thousand, no one of whom was seriously injured, and some of whom were not injured at all, jumped on the cars at the station referred to, and climbed on top of them and went to Aquia Creek, where no provision had been made for the care of the wounded. Strict orders had, at my request, been given to the guard at this station to permit no one to get on the cars, but this guard, unfortunately, was utterly worthless, and allowed these men to go as fast as steam could carry them out of the reach of the hospitals, which these men well knew, had been prepared for their accommodation, and went to Aquia Creek, where they necessarily created confusion, which I foresaw would, of course, ensue. It was to avoid this that I desired the guards to be instructed to allow none to go to that point. Such men are those who, in all battles, run to the rear, beyond even the sound of the guns of the enemy, and raise the cry of inhumanity and want of attention on the part of surgeons, whom they sedulously avoid, lest it be found that their wounds do not prevent their returning to duty. It is almost invariably found that those men who bear the burden and heat of the day; those also, who, when slightly wounded, are eager to have their wounds dressed, that they may return to the battle again; those, too, whose wounds are grave, do not complain of any want of care. On the contrary, expressions of thankfulness often escape from their lips for the attention bestowed upon them. But those cowardly stragglers, who, upon the slightest bruise, run away out of the observation of the

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surgeons, raise this cry, which many are prone to echo. The slightly wounded were first sent away. In the cars provided for them, hay or straw was placed, surgeons and attendants, with instruments, stimulants, and dressings sufficient for ordinary and extraordinary emergencies, were with every train, and upon their arrival at Aquia Creek, were placed on the transports, and when the surgeons and attendants on board these vessels were not able to attend to them properly on account of their numbers, their surgeons and attendants accompanied them to their destination. It was not my intention to send away the very serious cases, such as amputations, and wounds of the head, chest, and abdomen, but to pursue the same course that was taken after the battle of Antietam in similar cases. I represented the matter to General Burnside, and informed him that these patients were as comfortable and as well taken care of as if they were then in Washington; that it was dangerous to remove them, as they must be more or less injured, no matter how carefully transported; and that the surgeons were taking the deepest interest in these cases. I added that, unless there was some military reason for removing these men, I wished to keep them where they were, such a course being, in my opinion, the best that could be pursued to give these sufferers every opportunity for their recovery. I suppose this military reason did exist, as I then received an order to remove them. In the removal of these cases, plenty of hay was put in the cars. Mattresses and beds and bedsacks filled with hay were used for them to lie upon, and in all the cases requiring it, the patients were not removed from the mattresses and beds upon which they were lying in the hospitals, but were carried upon them, placed on stretchers by the attendants, and put upon the cars, whence they were removed in the same way from the cars to the transports, remaining undisturbed upon their beds from the time they left the hospitals until they reached Washington. In each car was a surgeon and an attendant, provided with everything necessary in case any accident should happen by the way. Surgeons and attendants, whenever they were needed, accompanied them through to Washington. Every care was thus taken of these men, who often expressed their gratitude to the medical officers for the kindness bestowed upon them, and who very generally spoke with heartfelt satisfaction of the efforts made to render their transportation comfortable. I say, without fear of contradiction, that seldom, if ever, have wounded been so carefully transported, and felt assured that no more suffering was occasioned than the severity of the wounds, of necessity, entailed.

I regret again to be called upon to announce the death of a medical officer by the hand of the enemy, whilst in the discharge of his duty. Surgeon S. F. Haven, 15th Massachusetts Volunteers, while proceeding on the 13th of December with his regiment to meet the enemy, received, in the left popliteal space, a wound from a shell, from the shock of which he never rallied. This officer was highly esteemed, and his loss to his regiment and to the service was deeply deplored.

It is not an uncommon belief that medical officers are seldom exposed to the fire of the enemy. My observation and experience since I have been connected with this army, especially, has shown me that they are almost as much exposed as officers of the line. Some, I have informed you, have fallen in the discharge of their duties; and I am fully justified in saying that in no department has greater devotion or more courage been shown than by the medical officers in the battles which have been spoken of in this report.

In concluding this general report, I may be permitted to allude to the support and confidence which I have received from you in the discharge of the duties of a position difficult, under the most favorable circumstances, to fill satisfactory.

I am, general, very respectfully, your obedient servant,

(Signed) JONA. LETTERMAN,
Medical Director.

SURGEON GENERAL U. S. A., Washington, D. C.