Jonathan Letterman: Civil War Doctor.
In the middle of the 1800s, the United States struggled through the most devastating conflict in American history, the American Civil War. This war consumed more American lives than all American conflicts from the Revolutionary War to the Korean War combined. The actual number of dead is still unknown; however, approximates range from 620,000 to 752,000. These casualty figures are shocking considering the national population in 1860 was 31,443,321. Overall, between 1860 and 1865, nearly 2.1 million Northerners and 880,000 Southerners entered the war. As a stark comparison, the total of 620,000 dead equaled about two percent of the 1860 population. Two percent fatalities of our population today would equal nearly six million deaths. This war forced the United States into a new and horrendous relationship with death: from battlefield destruction and carnage, to wounded and dying, to debilitating outbreaks of disease. From July, 1862 to January, 1864, the man tasked to counter these overwhelming effects of war for the Army of the Potomac was Medical Director, Jonathan Letterman. His new position allowed him to reinvent military medicine by creating the first ambulance corps, and reorganize the field hospital system among other renovations. In addition, he was instrumental in improving the health, hygiene, and dietary standards of the Army. This reorganization became known as The Letterman System. Despite The Letterman System and the advancements and procedures it introduced, many of the Civil War scholars who were sourced for this report disregarded Letterman’s and Scott McGaugh’s claims that The Letterman System improved the lot of soldier. Many of these scholars leave Letterman and The Letterman System out of their works. They do not give him credit, they attribute parts of The Letterman System to other parties, and claim his System did not change the medical conditions on the frontlines; as such, are these disputes valid?
Susan-Mary Grant, author of The War for a Nation: The American Civil War discussed a wide range of topics in her book: the founding of Jamestown and the United States, the buildup of tensions in the early 1800s, the divisions that developed between the North and the South, the settlements or compromises that were agreed upon to ease tensions, the beginning of the war, the war itself, and the legacy of the war. A surprising feature of The War for a Nation is that Jonathan Letterman is not mentioned by name anywhere in her book, nor is The Letterman System, his autobiography, or his biography, Surgeon in Blue, by Scott McGaugh. Medical references were also sparse. Grant did reference the medical field midway through her book with a couple quotes, “The death rate from wounds in the Civil War should be borne in mind when looking at casualty figures, especially the number of wounded. In this conflict, disease – some of it derived from wounds or from the treatment of same – accounted for two-thirds of total deaths…” She continued, “Civil War-era medical care was, at best, primitive; surviving the battlefield wounded all too often meant a slower death in unhygienic and disorganized hospitals.” Grant continued the medical references, but this time about contraband camps, “The contraband camps that sprung up in the vicinity of the Union army at various points across the South were, in effect, refugee centers, comparable with the worse examples of these in our own day in their unhealthy, unsanitary, and generally inadequate conditions.” To further these thoughts, the Battle of Fredericksburg, December 13, 1862, was a futile attempt by Union General Ambrose Burnside “to implement a feinting maneuver.. and then make a rapid movement upon Richmond.” By December 14, Burnside was convinced the battle was lost, “Union losses were simply too appalling, the dead too numerous, the wounded too damaged, the living too disillusioned – and the Confederates too secure.” After another debacle called the “Mud March” in early January, Burnside knew he had lost the support of his officers and men, and on January 25th Burnside offered his resignation. In his place, General Joseph Hooker was appointed commander of the Army of the Potomac.
An interesting caveat was found on page 152, where Grant seems to ascribe parts of The Letterman System to General Hooker and gave him full credit for them. In early February 1863, Grant states that Hooker “[began improving the Army of the Potomac’s] physical health, providing better medical treatment, food, and sanitation.” However, on July 18, 1862, a year earlier, Letterman recommended “food with abundance of fresh vegetables, shelter, rest with a moderate amount of exercise, be given all the troops… that the troops be provided with tents to protect them from the sun and rain… [that the army be] struck once a week and placed upon new ground… that all troops be compelled to bathe once a week… and that refuse matter, including that from stables and wagon yards, be buried two feet below the surface, or burned…” In addition to these recommendations, Letterman would also later create the first ambulance corps, August 1862, and reorganize the field hospital system in October 1862.
There is nothing wrong with Grant implying that Hooker went about improving the army’s physical health, especially after Fredericksburg. However, Grant does not give details on how the physical health of the army was improved or what was improved upon, what the medical treatments were lacking before Hooker began improving them, what the diet was before and after Fredericksburg, nor how Hooker’s improved them, and what the sanitation was like before and after Hooker’s enhancements. It is assumed on the part of the reader that if the conditions needed improvement, it must have been bad. She writes this sentence and moves on with the war. Grant does not acknowledge that Letterman’s System was well established by this time and much of Hooker’s improvements should not have been necessary, minus improving the army’s physical health.
Letters of a Civil War Nurse: Cornelia Handcock, 1863-1865 was authored by Miss Hancock, but compiled and edited by Henrietta Stratton Jaquette and published in 1937. Hancock was a volunteer nurse from 1863 to 1865. Although not part of the nursing corps officially, she was determined to help those in need. She arrived in Gettysburg three days after the Battle of Gettysburg, July 1-3, 1863. Letters of a Civil War Nurse like The War for a Nation did not mention Jonathan Letterman, The Letterman System, Surgeon in Blue, or Medical Recollections. However, these oversights can be over looked because Surgeon in Blue was written after her death, and Medical Recollections was published after her time as a nurse. When it comes to Letterman and his System, The Letterman System was everywhere she went as a nurse. Hancock inadvertently witnessed an aspect of The Letterman System when she traveled to a frontline field hospital after arriving in Gettysburg to volunteer as a nurse, “the few surgeons who were left in charge of the battlefield after the Union army had started its pursuit of Lee had begun their paralyzing task by sorting the dead from the dying, and the dying from the those whose lives might be saved; hence the groups of prostrate, bleeding men laid together according to their wounds.”’ Although untrained, she heard soldiers in a local field hospital were from her state, New Jersey, so she decided to start her volunteer work there. Later in July, Hancock was transferred to the newly built Camp Letterman Hospital in Gettysburg, although she did not know its name- stake.
In August 1863, “we had the medical director around yesterday, had a big inspection; he was a real alive man, went with the surgeon in charge of this hospital, went into every tent, pointed to every man, asked him the pointblank question “Do you get enough to eat?”’ The men, of course, answered in the negative. The medical director then said, “The first thing to set yourself about is feeding these men; there is nothing better, feed them, I say, feed them.” Interesting though, Hancock does not mention if this medical director was Letterman, but as a nurse, she would not be privy to this type of information unless told. She did not know the surgeon in charge of this hospital either.
Margaret Humphreys, author of Intensely Human: The Health of the Black Soldier in the American Civil War, discussed a wide variety of themes including: the enlistment statistics of Black troops, the deformity some recruits were said to have, diseases Black troops were most susceptible to including malaria, yellow fever, tuberculosis and pneumonia, the medical care Black troops received versus White troops, the number of Black surgeons and assistants during the war, the quality of care given to Black soldiers, and how specific regions of the South where Black troops were deployed were more deadly than others, especially when concerning disease.
Following suit with Letters of a Civil War Nurse and The War for a Nation, Humphreys did not mention Jonathan Letterman, The Letterman System, Surgeon in Blue or Medical Recollections. This is quite surprising considering Humphreys dedicated chapter four to medical care, and included issues such as mediocre White physicians assigned to Black regiments, the refusal of White officers to promote Black stewards to the rank of surgeon in their regiments, some Black units receiving medical students or recently graduated surgeons with no battlefield experience, pharmacy or hospital stewards were sometimes ordered to fill in as surgeons but had no medical training, and White doctors believed Black bodies were different than White bodies especially when it came to illness. Humphreys references The Letterman System in chapter four, and insinuates that the procedures Letterman established are in effect, especially concerning medical care; however, due to blatant racism and lack of qualified doctors, Black troops suffered.
Humphreys references The Letterman System by stating, “In the best of circumstances, physicians served as vocal patient advocates, protesting inadequate supplies, granting sick leave to weakened men, calling on the U.S. Sanitary Commission for extra food, and clothing, and rigidly enforcing contemporary standards of hospital cleanliness and wound care.” In addition, “Official policy dictated that each regiment should have one surgeon and two assistant surgeons.” However, Humphreys argues that, “Even by the standards of the time, African-American regiments received decidedly second-class medical care… [and few] black regiments ever had their full complement of medical attendants.” Humphreys continues by stating, “Toward the end of 1864 it had become so routine to promote [White] hospital stewards to surgical rank that when a capable [Black] steward failed to receive such promotion, the only apparent explanation was the commanding officer’s racism.” In addition, Humphreys states, “the indifference to formal educational qualifications was probably typical among officers appointing surgeons to black regiments by the summer of 1864.” and “Other black physicians did not receive commissions at all but were hired to be contract surgeons and appointed to hospitals that served black soldiers or refugees. Contract surgeons threatened no one’s rank, and could be dismissed without a court-marshal.” Humphreys’ critiques of the medical treatment of Black soldiers, doctors, and stewards are valid, especially with the examples she put forth.
The time and place of some of Humphreys’ examples need to be investigated further. Intensely Human is a highly detailed and thorough book; however, when some examples are given in chapter four, the medical care section, Humphreys does not explain where her example took place, be it, military theater, state, or region; sometimes dates are not mentioned at all, or at other times a month and year are mentioned but with no background context in the paragraph to back up the date. At times her examples are great in substance and further her purpose, but the exclusion of dates, locations, and war theater leaves the reader in limbo. If, in chapter four, her focus was to present, with detail and examples, how badly Black troops suffered under official medical policies, and indicates these policies were in place, she should have stated where these policies came from, and explained how they were ignored. Many of her examples would have had an even greater impact if she had done that. It is unclear if any of the examples or regiments she references belonged to the Army of the Potomac. If they did, and it was between July 1862 through January 1864, the treatment she claims Black troops suffered should not have occurred due to The Letterman System. Under that system, all soldiers, no matter what regiment they belonged to, were to receive medical treatment at the local aid station, field divisional hospital or general hospital.
Andrew McIlwaine Bell author of Mosquito Soldiers: Malaria, Yellow Fever, and the course of The American Civil War, discussed a wide variety of themes including: the diseases that plagued Union and Confederate troops in the South, i.e., Malaria and Yellow Fever, statistics that document where the outbreaks and cases occurred, the most common diseases and number of cases that occurred with each disease, how these diseases spread and why they spread. As epidemics occurred the medical personal were as much at risk as the patients. Bell also included in his works a summary of the four kinds of Malaria strains, the mosquito that spread them and the most “potent weapon Civil War surgeons had in their fight against Malaria…quinine.” In addition, Bell documents that Malaria outbreaks could occur anywhere, as well as along the water ways, and stagnant pools of the South and border states. He contrasts Malaria with Yellow Fever outbreaks which mainly occurred along the coasts, from the eastern seaboard down to Florida, and along the Gulf of Mexico to Texas.
Mosquito Soldiers breaks with our current scholarly tradition, and mentions Jonathan Letterman and Medical Recollections; however, Letterman is only cited twice, and only briefly in this book. Medical Recollections is cited in Bell’s Notes and bibliography and is referenced throughout the book. The Letterman System is hinted at too, but not specifically cited, and Scott McGaugh’s book Surgeon in Blue is not referenced either. Bell first referenced Letterman when he officially assumed his post from outgoing medical director, Charles Tripler. The second mention is slightly longer, detailing that after the Peninsula Campaign, “The sick list was initially between 20 and 40 percent, but Letterman, the army’s newly appointed medical director, thought the health of the troops was improving as the summer wore on.” Letterman’s assumption that the health of the troops was improving, was indeed true, as is seen in a quote from Scott McGaugh’s book, Surgeon in Blue, “By August, the Army of the Potomac disease rate declined by one-third in Letterman’s first month of medical command.” Only a month into establishing The Letterman System, Letterman was already seeing results due to his changes in the diet and sanitation of the Army of the Potomac. Bell’s very slight reference to The Letterman System, or what it was one month after he became medical director, was Bell’s only credit to Letterman and his System in his book.
Bell makes a claim toward the end of his book where it appears he is giving credit for much of The Letterman System to Surgeon General Hammond, Letterman’s immediate superior. “Hammond had secured [his] position…[because] the U.S. Sanitary Commission…[wanted] the Lincoln administration to appoint a younger man to the run the army’s Medical Department, [and] who would enact sweeping changes… in medicine and disease prevention.” And that “His reforms were one reason the North’s early “improvised war” became a more organized one by 1863.” These statements are partially true, Hammond “placed the health of the Union army’s highest profile command in the hands of a man he had grown to trust, despite Letterman’s lack of battlefield experience.” As such, Letterman was given the authority by Hammond, “to call directly upon the Medical Purveyors at New York, Philadelphia, and Washington, for all that [he] consider[ed] necessary…[so] the Medical Department…[is] fully supplied [to treat] the sick and wounded.” So, authorization was approved and given by Hammond, but the mind behind the “sweeping changes …in medicine and disease prevention” came from Jonathan Letterman.
The book, Clara Barton, by Leni Hamilton is a biography about a remarkable woman who was a nurse for the Union Army during the Civil War. She collected medical and other supplies for the frontlines in Washington D.C. and finally contacted the army quartermaster to locate a warehouse so she could store them. “Throughout 1862 Barton’s stock of provisions never averaged less than five tons.” After the First Battle of Bull Run, she nursed wounded on the docks of the Potomac River. When the Second Battle of Bull Run was fought on August 31, 1862, Barton was in a boxcar with three other nurses bringing supplies to the front. At Antietam, Barton brought supplies to the front in a mule-drawn wagon “as part of a 10-mile-long Union army caravan,” with soldiers as assistants.  However, her supplies were at the rear of the caravan so she and her driver drove the wagon all night. She reached the cannon in the caravan by daybreak. By nightfall, she reached General Ambrose Burnside’s corps. For the Battle of Fredericksburg, the army quartermaster gave her “six wagonloads of supplies and an ambulance, each drawn by a team of six mules.” When the mule drivers chafed under her command, she fixed them a good dinner and told them she would share in their fortunes. They apologized and had no more complaints. Toward the end of the war, she was placed as the superintendent of nurses for the Army of the James under General Benjamin F. Butler in Petersburg, Virginia. After the war, she created the “Office of Correspondence with Friends of the Missing Men of the U.S. Army,” an organization in Annapolis, Maryland to help find men who went missing in action during the war. She was successful in locating the whereabouts of 22,000 men for their families during the four years at this post, 13,000 of which died at Andersonville, the South’s most infamous prison. It was while on a sabbatical trip to Europe that Miss Barton was approached by Dr. Appia, the head of the International Red Cross, seeking her assistance in having the United States join that relief organization. Barton promised she would help, but in the meantime, she brought Red Cross relief efforts to the cities of Karlsruhe, Germany and Strasbourg, France. Having participated in relief work of the Red Cross in Europe, she returned to the United States where she began the American Red Cross on May 21, 1881. In order to prove its effectiveness in time of emergencies, her local Red Cross chapters assisted with a large fire in northern Michigan and a flood on the Ohio River. After that, President Chester A. Arthur signed the Geneva Treaty on March 16, 1882, making the United States the 32nd member of the International Red Cross.
Although this book does not mention Jonathan Letterman or The Letterman System, the author did mention that Clara Barton received direct permission from Surgeon General, William Hammond, Letterman’s superior, “to go upon the sick transports in any direction – for the purpose of distributing comforts for the sick and wounded – of nursing them, always subject to the direction of the surgeon in charge.” Barton first brought supplies to the Battle of Cedar Mountain in Virginia several weeks before the Second Battle of Bull Run at the end of August 1862. These two battles were not under the medical authority of Jonathan Letterman; however, Letterman resumed medical command of the Army of the Potomac on September 2, 1862. Once he returned, he found “it in a deplorable condition.” Under Hammond’s authority, Clara Barton was permitted to bring medical and food supplies to the front, and nurse the sick and wounded, but always under the supervision of the surgeon she worked with. She worked alone, and was not part of the U.S. Sanitary Commission, whose nurses did not go to the front, she was also not part of the nursing corps or the medical corps; she was just a volunteer. When bringing supplies to the front during the battles of Antietam and Fredericksburg, the overall medical regulations that she worked under were Letterman’s, adopted October 30, 1862. Since she was just a nurse, though, she would not have known anything about Letterman’s medical policies. Her orders were to follow the instructions of the surgeon she worked under. Medical Recollections and Surgeon in Blue were also not mentioned in Clara Barton. However, that is understandable for Surgeon in Blue since it was published in 2013 and Clara Barton was published in 1988. Leni Hamilton should have at least referenced Medical Recollections because it was published in 1866, but it is assumed that she did not because Letterman and his System really did not have anything to do with Clara Barton’s story, minus that it was officially established after Antietam and that she only became part of it once she worked a doctor.
Helle Mathiasen, author of the article, Bugs and Battles during the American Civil War, recounts the ways mosquitos spread Malaria and Yellow Fever thought out the South before, during and after the Civil War. Like Andrew Bell’s book, Mosquito Soldiers: Malaria, Yellow Fever, and the course of The American Civil War, Mathiasen, discussed the specific breeds of mosquitos that transmitted these diseases. She adds, that “blacks, West Africans in particular, whose slaved in cotton, rice, and tobacco fields, were thought to have some immunity to malaria, but by the time of the Civil War, West African slaves had mixed with other Blacks, Whites, and Indians, making them more susceptible to malaria. Mathiasen states that the Yellow Fever mosquito “killed thousands in New Orleans, Savannah, and Charleston; however, Texas saw more Yellow Fever cases than any other Confederate state.” Similar, to West African situation, Union troops who were in Confederate prison camps all fell victim to Yellow Fever. Quinine and whiskey were thought to have been cures for Malaria, so the Union Army would issue them sometimes daily. However, due the Union naval blockade of the South, the Southern army ran shot of quinine and was unable to issue it in large quantiles. It was not until the turn of the century, that a army surgeon named Walter Reed discover that a mosquito transmitted Yellow Fever.
Jonathan Letterman, The Letterman System, Medical Recollections and Surgeon in Blue are not mentioned in the article. Not surprising, Andrew Bell is mentioned because they wrote very similar works. However, Mathiasen does mention that “the Union army administered quinine and whisky together to their soldiers, practiced hygiene, and used nets around hospital beds.” Parts of which are discussed in Surgeon in Blue, such as hygiene and the use of nets, but outside of that very slight reference, Mathiasen is mute on The Letterman System.
Jim Downs author of Emancipation, sickness, and death in the American Civil War discusses how the diseases of Pneumonia, Typhoid Fever, Dysentery, Yellow Fever, Cholera and Smallpox not only plagued the American South prior to the Civil War, but also ravaged slaves, masters, Union and Confederate soldiers, and civilians on both sides. In addition, this article takes into account how the agent of slavery pre-and-post war created an atmosphere for former slaves to die of these diseases. Civil War doctors and medical knowledge were hampered by many factors which included unsanitary Army camps, polluted waterways, unburied bodies and animals, overcrowded cities and camps, and the uncertainty of doctors about how to respond to such massive outbreaks of disease.
Surprisingly, Jonathan Letterman nor his System are mentioned or referenced. This is strange considering Downs states, “The high rates of illness and mortality during the war resulted from a range of factors, including the unsanitary conditions of army camps, polluted waterways, unburied bodies of animals and soldiers, overcrowded populations, dislocation, and the medical profession’s uncertainty about how to respond to the many outbreaks of disease.” In addition, Downs comments, that the U.S. Sanitary Commission “attempted to prevent the further spread of disease by preaching a gospel of cleanliness… [but] their efforts proved ineffective in response to the smallpox and cholera epidemics the broke out during the war.” As with Margaret Humphreys book Intensely Human, these points are possibly valid, however, Downs, like Humphreys, did not specify when and where these outbreaks, unsanitary conditions, polluted waterways, unburied bodies of animals and soldiers, overcrowded populations, and dislocation occurred. The reader is not told if they happened in the South, North, or West, nor if they occurred within the area of the Army of the Potomac. If they did occur in proximity if the Army of the Potomac, The Letterman System, which was established in July 1862 with additions added in August and October of 1862 should have improved these conditions.
Outside of not referencing Letterman and The Letterman System, he also did not reference Medical Recollections or Surgeon in Blue, which may have given more depth and medical detail to his article. Medical Recollections would have added an extra layer of medical knowledge to his thesis and content that was lacking in the final product. Surgeon in Blue again was not cited because it had not been published yet.
Susan Sheehy, author of the article US Military Nurses in Wartime: Reluctant Heroes, Always There, details nursing throughout American history. Sheely states, “Throughout the history of the United States, whenever and wherever our country has been at war, nurses have been there to care for the wounded and the ill, often working in less than ideal and sometimes deplorable conditions and at great risk to their own lives.” In both the North and the South, there were many women who served as official and unofficial nurses during the war. Sheely covers four nurses, two for the North and two for the South. In addition, Sheely recounted an interesting story that nineteen hospitals were run by Catholic nuns and staffed by four hundred nursing nuns who cared for soldiers from both sides of the war.
Jonathan Letterman, The Letterman System, Medical Recollections and Surgeon in Blue are not mentioned in this article. However, Sheely does mention Annie Etheridge, a nurse who served with the Army of the Potomac and cared for wounded at Chancellorsville and Gettysburg. Etheridge no doubt fell under The Letterman System as her tenure fell within the years Letterman was medical director. Considering Sheely’s article covers nursing, and the Civil War, Letterman, his System and/or his Medical Recollections should have been mentioned within her article. Considering the United States did not have an official medical system until Letterman organized one in 1862. His contribution should not be overlooked.
Robert Reilly author of Medical and surgical care during the American Civil War, 1860-1865 discusses a multitude topics including, the advances made in medical and surgical care, why did so many people die, the organization of battlefield medical care, surgical procedures, combat related injuries, and non-combat related deaths and illness. Every topic is researched from a medical standpoint. He gives many details on such subtopics as how many died of Yellow Fever, how many became ill due to Malaria, how diarrhea and dysentery effected armies on the march, what was the hygiene and diet of the armies, what advances were made during the war, i.e., the use of quarantine to help eliminate Yellow Fever, and the performance of the first plastic surgery.
Surprisingly, Jonathan Letterman in mentioned by name in Reilly’s article, but his System is not specifically named, although it is referenced. Reilly writes about the establishment of the ambulance corps, who could remove wounded from the field, who could use the ambulances, the establishment of large general hospitals, and that soldiers could be transported to these hospitals by train or ship.  Reilly continues with that “Only the most senior and experienced surgeons preformed amputations” because there was a public outcry that amputations were being done to regularly. However, Scott McGaugh author of Surgeon in Blue, states, “Surgeons chosen to preform operations were to be selected “solely on account of their known prudence, judgment, and skill.”’ Medical Recollections and Surgeon in Blue are not mentioned, which is very odd considering this article was written in 2016, and they should have been cited.
Our major source for this paper was Scott McGaugh. author of Surgeon in Blue. In his book McGaugh thoroughly researches the life and contributions of Jonathan Letterman. Letterman reorganized and established the Union army’s ambulance corps, established policies for the diet, sanitation, and hygiene of the soldiers, and reorganized the medical supply system. “Again with McClellan’s endorsement, on October 30, 1862, Letterman issued a directive that recast the military hospital system as completely as his ambulance and medical supply orders had done in the preceding months.” Due to his contributions, it is amazing that most scholars referenced in this paper do not mention him, his System, or give him credit for what his system accomplished, and the legacy that his System established and is still being used today. It is hoped that further scholarship would lead to Jonathan Letterman receiving the accolades due him for his innovative and far-reaching contributions to the military medical field.
Scholarship on Civil War medicine is very thorough with a multitude of avenues, topics, resources, and museums that aid in the furthering of medical scholarship. The National Museum of Civil War Medicine in Frederick, Maryland tries to further medical scholarship daily. It is a public museum, which hosts a wide variety of medical books, artifacts, manuscripts, dioramas, and medical posters. The Museum also hosts a teaching institution called the Letterman Institute. “Under the leadership of Executive Director George Wunderlich and the museum founder, Gordon Dammann, the museum’s Letterman Institute has taught more than 4,500 medical professionals from the Army, Navy, Air Force, and Veteran’s Administration.” The Letterman Institute teaches the “value of linking battlefield medicine with military field command” In addition, “the institute imparts the golden lesson that integrated decision-making processes save lives and contribute to accomplishing command missions.” The Letterman Institute’s curriculum for teaching these modern day medical professionals is accredited to Jonathan Letterman’s legacy as medical director of the Army of the Potomac and his work during the Civil War.
The National Museum of Civil War Medicine and The Letterman Institute further the medical scholarship on an academic level, from an researching and writing level, Jonathan Letterman’s autobiography, Medical Recollections, should be a must read and requited source for citation. He goes into detail about his reorganization, recommendations and restructuring of the Union Army’s medical corps and the Army of the Potomac. Although dry at times, and written in the vernacular of the nineteenth century, it is a truly remarkable work that shed new light on the segmented scholarship of Civil War medicine. Segmented because, scholars at times focus only on their thesis and forget to have a holistic view on the topic. It is perfectly acceptable to research surgery tools, hospitals, diseases, wounded and death, but it should be grounded in a place, time or region. As such, the scholarship that can be furthered from Medical Recollections could cover, the 1861 to July 1862, year not mentioned in Medical Recollections? What if any medical polices or protocols were enforced during that year? Was The Letterman System kept together after Letterman left his post and after the war? Was The Letterman System ever adopted in the Western theater of war? How was this System adopted in Europe and did it change? All of these use Medical Recollections to more and new questions and research.
Bell, Andrew McIlwaine. Mosquito Soldiers: Malaria, Yellow Fever, and the course of The American Civil War. Louisiana State University Press, 2010.
Downs, Jim, PhD. “Emancipation, sickness, and death in the American Civil War.” The Lancet 380, no. 9854 (2012): 1640-1641.
Faust, Drew Gilpin. This Republic of Suffering: Death and the American Civil War. New York: Vintage Books, 2008.
Grant, Susan-Mary. The War for a Nation: The American Civil War. New York: Routledge, 2006.
Hamilton, Leni. Clara Barton. Philadelphia: Chelsea House Publishers, 1988.
Hancock, Cornelia. Letters of a Civil War Nurse: Cornelia Hancock, 1863-1865. Edited by Henrietts Stratton Jaquette. Lincoln: University of Nebraska Press, 1998.
Humphreys, Margaret. Intensely Human: The Health of the Black Soldier in the American Civil War. Baltimore: The John Hopkins University Press, 2008.
Letterman, Johnathan. Medical Recollections of the Army of the Potomac. London: Forgotten Books, 2015.
Mathiasen, Helle, PhD. “Bugs and Battles during the American Civil War.” The American Journal of Medicine 125, no. 1 (2012): 111.
McGaugh, Scott. Surgeon in Blue: Jonathan Letterman, the Civil War Doctor Who Pioneered Battlefield Care. New York: Arcade Publishing, 2013.
Reilly, Robert F, MD. “Medical and surgical care during the American Civil War, 1860-1865.” Baylor University Medical Center Proceedings 29, no. 2 (2016): 138-142.
Sheehy, Susan, PhD, RN, FAAN, FAEN. “US Military Nurses in Wartime: Reluctant Heroes, Always There.” Journal of Emergency Nursing 33, no. 6 (2007): 555-563.
 Susan-Mary Grant, The War for a Nation: The American Civil War (New York: Routledge, 2006), ix.
 Drew Gilpin Faust, This Republic of Suffering: Death and the American Civil War (New York: Vintage Books, 2008) xi. and Robert F Reilly, MD., “Medical and surgical care during the American Civil War, 1860-1865.” Baylor University Medical Center Proceedings 29, no. 2 (2016): 138.
 Faust, This Republic of Suffering, 3.
 Ibid. xi.
 Scott McGaugh, Surgeon in Blue: Jonathan Letterman, the Civil War Doctor Who Pioneered Battlefield Care (New York: Arcade Publishing, 2013) 73.
 McGaugh, Surgeon in Blue, 153, 218, 268-271.
 Ibid., 273, 276.
 Johnathan Letterman, Medical Recollections of the Army of the Potomac. (London: Forgotten Books, 2015).
 Grant, The War for a Nation, 90.
 Ibid., 110.
 Ibid., 146, 149-150.
 Ibid., 150.
 Ibid., 151.
 Ibid., 152.
 Letterman, Medical Recollections, 11-14.
 McGaugh, Surgeon in Blue, 270-271.
 Cornelia Hancock, Letters of a Civil War Nurse: Cornelia Hancock, 1863-1865 ed.,Henrietts Stratton Jaquette (Lincoln: University of Nebraska Press, 1998) 2-4.
 Hancock, Letters of a Civil War Nurse, 5.
 Ibid., 4.
 McGaugh, Surgeon in Blue, 194-195.
 Hancock Letters of a Civil War Nurse, 24.
 Margaret Humphreys, Intensely Human: The Health of the Black Soldier in the American Civil War (Baltimore: The John Hopkins University Press, 2008) 54.
 Ibid., 57–67.
 Ibid., 58, 59, 60, 61.
 Ibid., 57.
 Ibid., 61.
 Ibid., 62.
 Ibid., 64.
 Jonathan Letterman’s tenure as Medical Director lasted from July 1862 through January 1864. and McGaugh, Surgeon in Blue, 132-133.
 Andrew McIlwaine Bell, Mosquito Soldiers: Malaria, Yellow Fever, and the course of The American Civil War (Louisiana State University Press, 2010) 6.
 Ibid., 122-128.
 Ibid., 73.
 Ibid., 75.
 McGaugh, Surgeon in Blue, 84.
 McGaugh, Surgeon in Blue, 80.
 Bell, Mosquito Soldiers, 86.
 Ibid., 86.
 Ibid., 77.
 Letterman, Medical Recollections, 17.
 Bell, Mosquito Soldiers, 86.
 Leni Hamilton, Clara Barton (Philadelphia: Chelsea House Publishers, 1988) 35.
 Ibid., 34-35.
 Ibid., 36.
 Ibid., 39.
 Ibid., 47.
 Ibid., 55.
 Ibid., 56-57.
 Ibid., 63.
 Ibid., 65.
 Ibid., 66- 67.
 Ibid., 69.
 Ibid., 73.
 Ibid., 85-90.
 Ibid., 37.
 Ibid., 39.
 Scott, Surgeon in Blue, 96.
 Hamilton, Clara Barton, 37, 39.
 Scott, Surgeon in Blue, 131.
 Helle Mathiasen, PhD, “Bugs and Battles during the American Civil War.” The American Journal of Medicine 125, no. 1 (2012): 111.
 Jim Downs, PhD., “Emancipation, sickness, and death in the American Civil War.” The Lancet 380, no. 9854 (2012): 1640-1641.
 Ibid., 1640.
 Letterman, Medical Recollections, 11-14 and McGaugh, Surgeon in Blue, 270-271.
 Susan Sheehy, PhD., “US Military Nurses in Wartime: Reluctant Heroes, Always There.” Journal of Emergency Nursing 33, no. 6 (2007): 555.
 Ibid., 556.
 Reilly, Medical and surgical care, 138-142.
 Ibid., 138, 141, 142.
 Ibid., 139.
 Ibid., 141.
 Scott, Surgeon in Blue, 131.
 Scott, Surgeon in Blue, 278-279.
 Ibid., 279.