A Complete Transformation of Medicine: John Letterman’s Ambulance Corps

By Savannah Labbe ’19

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A Civil War Ambulance Corps (via Library of Congress)

At first glance, the photo above does not seem to really depict much of any importance. It simply seems to be a photo of soldiers transporting a wounded comrade into a wagon. While these men were doing important work and giving wounded soldiers the chance to live, it does not seem as if they are doing anything revolutionary. However, the picture actually shows a radical improvement in medical treatment brought about by the Civil War. Looking back on the practices of Civil War Americans, many people tend to believe the Civil War was a particularly dark time in medical history, a time when doctors sawed off limbs to solve any problems and often did it with dirty instruments and no anesthesia. This idea of Civil War medicine is a misconception because most amputations were, in fact, done with anesthesia and the Civil War did introduce many improvements in the medical field. In fact, the Civil War can be seen as a turning point from more ancient practices of medicine to more modern practices. The fact that the Civil War was a turning point in medical history is evident in the Union’s development of ambulances and the ambulance corps, one of which is depicted in the photo above. The Union’s ambulance corps radicalized battlefield medical treatment, allowing the majority of soldiers to receive care much more quickly and efficiently, something the South never accomplished.

While the Union Army eventually developed efficient battlefield treatment like what is being displayed in this photograph, at the beginning of the war the medical department was disorganized, chaotic, and in need of much improvement. After the First Battle of Bull Run, wounded soldiers were left scattered over the field and most of them were eventually captured by the enemy. Although there were only 1,011 Union wounded, much fewer than in later battles, many of these wounded remained on the field for days and some were forced to walk all the way back to Washington D.C. just to receive treatment. Those who were unable to walk had to face days of suffering, exposure, and thirst, that would eventually lead to their death. This disaster within the Union’s medical department and its failed care for soldiers was not limited simply to Bull Run, but continued throughout the entire first year of the war. Doctors lacked supplies, many soldiers suffered from scurvy, and the wounded piled up waiting for transportation to northern hospitals. In addition, doctors and quartermasters were responsible for the management of the ambulance teams, which was not practical during battles as doctors could not attend wounded men and supervise the ambulances at the same time. Also, the quartermasters were often more concerned with supplies or providing transportation for high-ranking officers than providing the ambulance corps with the necessary wagons and horses they needed to perform their job. The early ambulance teams would have been nowhere near as organized and efficient as the team pictured above.

The significantly improved orderliness depicted in the photo was largely due to Jonathan Letterman, who was appointed medical director of the Army of the Potomac on June 23, 1862. He realized that an efficient system of care was a matter of life and death for the soldiers. The men in the photograph above were key players in the crucial first step in this system, rescuing the soldiers from suffering in the field and bringing them to doctors. This task of putting the medical department in order was a hard one. Out of an army of 103,000 men, Letterman found that 29% were listed as ill or unable to fight, most due to easily treatable illnesses. Letterman started by asking General McClellan for more medical supplies for doctors and a greater variety of foods for soldiers in order to prevent malnutrition based illness, like scurvy. McClellan not only granted these requests, but also issued a general order dictating that the quartermasters keep the soldiers well supplied with vegetables. While this was an important first step in the right direction, Letterman would soon radicalize the entire system for treating wounded. He set up a triage system, started the ambulance corps, and instituted standard operating procedures. The men carrying the stretcher and driving the ambulance in the photo above were taking part in this ingenious system. They were not only a part of an important moment in medical history, but they also ensured the efficiency of Letterman’s system, giving wounded soldiers a greater chance at survival than ever before.

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Dr. Jonathan Letterman and his medical staff. Letterman seated furthest left. (via Library of Congress)

More soldiers were able to survive due to Letterman’s methods of organization, triage, and specialization. Once Letterman had obtained more supplies, he began reorganizing the ambulance corps to create teams such as the one in the photograph above that worked like a well-oiled machine. On August 6, 1862, he created an official ambulance corps in which the men therein were dedicated solely to ambulance work. Previously, soldiers just simply rotated through ambulance duty and were not specifically assigned to an ambulance team. Letterman structured the ambulance corps similarly to the army itself, with a captain as commandant of each of the infantry corps’ ambulance teams. A lieutenant would direct the ambulances for each division and brigade and a sergeant directed ambulances for each regiment. This organization solved the problem of who was in charge of the ambulances and allowed the doctors to focus on treating the wounded. Each regiment was allotted one transport cart and two ambulances and the officers of these ambulance crews were responsible for the training of crews, maintenance of vehicles and equipment, as well as the welfare of the horses. With the ambulances now under the sole control of the ambulance crews, the men in the photo above could focus on the most important part of their job: Healing the wounded and saving lives.

Not only were the ambulance crews better led, they also practiced improved care techniques, like the new triage system. Letterman designed this system to be three-tiered. First, a wounded soldier would be removed from the field on a stretcher and then loaded onto a wagon, as shown in the photo above. The soldier would then be brought to a field station close to the battlefield to receive initial treatment, which would be very simple, akin to first-aid treatment today. If the wound was not very severe, the soldier would just be administered to here and then sent back to his regiment. If a soldier needed more advanced treatment, he would be transported to a divisional hospital at the rear of the lines, which was the second phase of treatment. At this stage of the system, doctors would perform surgeries, extract bullets, amputate limbs, and anything else that the soldier needed, depending on the wound. The final stage was recovery, and many soldiers stayed at divisional hospitals for short-term rehabilitation. However, if the soldier’s recovery was going to be long-term and they needed more intense care, they would be moved to a general hospital in a nearby town or city. Patients could rest and recuperate in these hospitals that had more resources and better ensured the soldier’s recovery than a divisional hospital that was always swamped with critical injuries.

In conjunction with this system of care, particularly the second stage, Letterman also began the practice of medical specialization by mandating that only highly qualified and experienced doctors could perform amputations and surgeries. This specialization was important, as no matter how hard the ambulance crew in the photo above worked, it meant nothing if the doctor was not experienced enough to actually treat the wounded. Letterman’s new system of specialization and organization was first tested in 1862, after the Battle of Antietam. The system functioned well despite the vast amount of casualties. Ambulance teams cleared 12,410 casualties in less than 48 hours, which was a drastic improvement from Bull Run, when many wounded remained on the field days later even though there were fewer wounded. By the Battle of Gettysburg, the system was perfected and the Union ambulance corps was able to evacuate 14,193 Union and 6,802 Confederate wounded, providing treatment for them within three days of being wounded. Not one wounded soldier remained on the battlefield the morning after the battle concluded. This system’s success is evident in the fact that the Union Army’s mortality rate for those who died of wounds reduced drastically from 25.6% in the first year of the war to 13.3% after Letterman’s changes. This system was so much more effective that it was soon adopted by all Union armies as well as some European armies. In March 1864, Congress passed a law that officially established Letterman’s system for all Union armies.

War often has a significant impact on medicine, and the Civil War was no exception. With Letterman’s guidance, an efficient practice of battlefield care was established for the first time in the Civil War and the basic principles of this system would be used in many wars to come. For example, Letterman’s three-tiered system of field treatment, divisional hospital, and then general hospital was used extensively in World War II, with soldiers who were most seriously injured often being transported to Great Britain or even the United States to recover. The men in the photograph helped ensure the success of this system, and the actions they are performing are still performed today: Wounded soldiers are still removed from the battlefield on stretchers with critical efficiency and transported to hospitals for better, and often times life-saving, treatment. John Letterman revolutionized the field of medicine, and soldiers of the Civil War and all wars after are indebted to him. Letterman’s innovation is why this photo is so important. It shows the successful working of that system as well as an important moment in the history of medicine. The photo is also important for its multi-dimensional meanings and the many different feelings it evokes. The photo displays the inherent suffering and pain of the wounded soldier, surrounded by the chaos and confusion of the battlefield. However, the photo also symbolizes hope and healing; the opportunity for a wounded soldier to live another day. It is a testament to the efficiency and innovation of Letterman’s system, and the evolution of medical practice as a whole, ironically borne out of the widespread death and unnecessary sufferings inflicted by war on a nation unprepared for such brutality, that has come to save thousands of lives around the world since its inception.


Sources:

“EMTs, Civil-War Style.” Civil War Times 45, no. 1 (February 2006): 74. Accessed November 8, 2018.

Place, Ronald J. “The Strategic Genius of Jonathan Letterman: The Relevancy of the American Civil War to Current Health Care Policy Makers.” Military Medicine 180, no. 3 (March 2015): 259–62. Accessed November 8, 2018.

Smith, Dale C. “Military Medical History: The American Civil War.” OAH Magazine of History 19, no. 5 (September 2005): 17–19. Accessed November 8, 2018.

Weirt, Jeffry D. “Dr. Letterman’s War.” Civil War Times 45, no. 7 (September 2006): 7–8. Accessed November 8, 2018.

Inspirations of War: Innovations in Prosthetics after the Civil War

By Savannah Labbe ’19

In early 1861, a Confederate soldier named James Edward Hanger waited on the ground to die. Minutes before, his left leg had been shot off above the knee while he was sitting with his comrades in the loft of a barn in Philipi, Virginia. As soon as the cannonball burst through the barn, the rest of the men fled, leaving Hanger behind. He was found by enemy troops and brought to a doctor, who amputated his leg. Hanger became the first person to have a limb amputated during the Civil War. When one thinks of Civil War injuries, amputations often come to mind, and, to be sure, there was an unprecedented number of amputations performed during the Civil War. Surgeons on both sides performed at least 60,000 amputations during the war and 45,000 patients survived the surgery.

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Soldier with an amputated arm. Photo via Wikimedia Commons.

This increasing number of amputees presented a new problem. Before the Civil War, peg legs and other prosthetics were not very common, but now there was a new demand for this kind of product. James Hanger, who had been sent to Camp Chase until he was exchanged two months later and sent home to Churchville, Virginia, was so frustrated with his peg leg that he stayed in his room for months, trying to build a better one. He was aided in this endeavor by his engineering education from Washington College in Lexington, Virginia, which he attended for two years until he dropped out to join the Churchville Calvary at the start of the Civil War. When he emerged from his room at Camp Chase, he had created a comfortable leg that had a foot and hinged at both the ankle and knee. He wanted to share his creation with other veterans, so he set up Hanger Inc., which is still one of the largest prosthetic manufacturers today.

Many others took up the call to create prosthetic limbs, and the industry blossomed after the war, especially as the government paid for Union veterans to buy replacement limbs. Since Confederates had rebelled against the government and were not considered to be veterans, they were not eligible for this program, although some states such as North Carolina and Virginia set up programs similar to the federal one. By 1870, the federal government had paid $500,000 for 7,000 veterans’ limbs. Of course, some probably did not actually get a limb since the federal government just gave the stipends to the soldiers and allowed them to spend it how they pleased. However, most of them likely did buy a limb in order to walk better or to feel normal and whole again. In addition, ideas of manhood and masculinity during this time period stressed self-sufficiency, and especially for veterans who had lost a leg, amputations made it much easier for them to walk around and fulfill a normal masculine role. However, many veterans did view their amputated limbs with pride, as they served as an outward mark of their bravery and sacrifice for their country.

The Civil War created a change in government policy regarding veterans. In the Revolutionary War, Congress struggled to pay the Continental Army, both during and after the war, and many veterans did not get nearly as much payment as they were promised. In addition, pensions for Revolutionary War veterans were rejected by the public because they believed it would diminish the patriotic nature of veterans’ service. The Civil War was the first time that the government really showed much concern for its veterans. The most vocal advocates for government recompense for veterans were the limb manufacturing companies themselves. Their campaign was so successful that they got the federal government to pay for research grants for innovations in prosthetics as well as limbs for any Union veteran that needed one. Civil War soldiers not only received limbs but also pensions and government hospital care, after much lobbying by the Grand Army of the Republic (GAR). The GAR was a political organization, which allowed it to accomplish so much in a way that veterans of the Revolutionary War could not, due to public fear that a strong military establishment would form an upper, aristocratic class and could possible use force to radically change the government or impose their will on the people. The Civil War was when the government, at the behest of groups like the GAR, began to assume responsibility for their veterans and felt like they had a debt to repay them.

Many parallels can be drawn between the Civil War and the present. Since 2003, soldiers in Iraq and Afghanistan have been losing limbs at twice the rate of previous wars, including the Civil War. Like in the Civil War, this has provoked innovation in the field of prosthetics. In the Civil War it was all about making the limb comfortable, but now the focus is on making the limb just like the one that was lost, making it realistic and able to move around and even grab things, in the case of prosthetic hands. Computer chips and wireless technology are being utilized to make “robot hands” that are mobile and able to pinch, grip, and flex. There have even been some limbs made with sensors that are able to pick up small signals from the brain and move  in response. This research is again being funded by government grants in order to meet the need of veterans, just like in the Civil War.

Throughout history, conflict has been the driving force for change, with war being the ultimate conflict. While war causes immense suffering, it also has the ability to create, to inspire. As the author Stephen Cushman puts it, war can be a “belligerent muse.” Not only does it provoke innovations in science and technology like prosthetics, it inspires works of literature and art. War creates specific needs, and those needs are often met by advancements in science. It can be the driving force of not only inherently harmful technology, such as the atomic bomb, but it can also be used to help. War also has the ability to transform, as one can see in the example of the change in the relationship between the government and veterans. The Civil War really established a precedent for repaying the debt owed to veterans who sacrificed so much to preserve the ideals that the republic was founded upon.


Sources

Brink, Tracy Vonder. “The Man Who Built a Better Leg.” Cricket 44, no. 9 (July 2017): 21. Accessed February 10, 2018.

Clarke, Frances M. War Stories: Suffering and Sacrifice in the Civil War North. Chicago: University of Chicago Press, 2011.

Cushman, Stephen. Belligerent Muse. Chapel Hill: University of North Carolina Press, 2014.

Daloz, Kate. “A Call to Arms (And Legs) in the Civil War and the Iraq War.” Huffington Post, n.d. Accessed February 11, 2018.

Gannon, Barbara A. “A Debt We Never Can Pay, A Debt We Refuse to Repay: Civil War Veterans in American Memory.” South Central Review 33, no. 1 (Spring2016 2016): 69. Accessed March 3, 2018.

Herschbach, Lisa. “Prosthetic Reconstructions: Making the Industry, Re-Making the Body, Modelling the Nation.” History Workshop Journal, no. 44 (1997): 22-57.

A Home for Volunteers: Togus and the National Soldiers’ Homes

By Savannah Labbe ’19

The current U.S. Department of Veterans Affairs traces its origins to the Civil War. Before the Civil War, there had been some attempts to provide services for veterans but these benefits were solely for career military veterans and not volunteers. Since Civil War veterans were mostly volunteers, this became a problem. The services provided before this had been mostly in the form of homes like the U.S. Naval Asylum in Philadelphia where veterans could receive long-term care. Many felt that homes were the best way to care for soldiers and so, in March of 1865, legislation passed to create a national asylum for disabled volunteers. On November 10, 1866, the first branch of three national homes was established. At first, the branches were open to all Union soldiers who could prove a connection between their service and their injury. They then later welcomed veterans of the War of 1812 and the Mexican War as long as they didn’t fight against the Union in the Civil War. Confederate veterans were never allowed. Each home had a barracks, dining halls, hospital, cemetery, and recreational facilities.

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The eastern branch of the National Home for Disabled Volunteer Soldiers in Togus, ME. Via Wikimedia Commons.

Continue reading “A Home for Volunteers: Togus and the National Soldiers’ Homes”

Battlefields and Supermarkets: The Importance of Battlefield Preservation and the Case of Camp Letterman

By Savannah Labbe ‘19

Gettysburg National Military Park is an immense park, encompassing and preserving a large section of the battlefield. What many don’t realize, however, is that the battlefield was not confined only to the areas that have been preserved, but also to a much larger section of the greater Gettysburg area. Where now stands the Giant supermarket was once home to land that the Confederates retreated over and also, more importantly, to a large battlefield hospital, Camp Letterman.

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Tents at Camp Letterman in August, 1863. Photo courtesy of Wikimedia Commons.

After the Battle of Gettysburg, most of the wounded and the medical staff moved on with the army. However, some wounded couldn’t be moved due to the severity of their injuries. All these men were consolidated into the general hospital that became known as Camp Letterman, which housed around 21,000 badly wounded Union and Confederate soldiers. It was the largest field hospital of the Civil War with 500 tents and the capacity to house 21,000 wounded. About 1,200 soldiers died there, but that number could have been much higher if not for Major John Letterman’s advanced triage system. His system became the gold standard of medical practice during that time period. Since Camp Letterman treated both Union and Confederate soldiers, they were able to interact and help begin to heal the divide that was crippling the nation. For example, there was a picnic at Camp Letterman in which both Union and Confederate soldiers ate and played games together. Camp Letterman was also involved in the First World War, providing housing for soldiers in the wake of the Spanish flu epidemic. Continue reading “Battlefields and Supermarkets: The Importance of Battlefield Preservation and the Case of Camp Letterman”

A Taste of the Civil War: Barbara Sanders’ Lecture on Civil War Era Food

By Savannah Labbe ‘19

There are few ways to better immerse oneself in the past than through food. It is relatively easy to follow a recipe from the Civil War era and enjoy the same cuisine as Union and Confederate soldiers. In this way, one can experience the past in a most interactive way. Experiencing the past was accomplished in the lecture “Hearth, Hardtack, and Hospital: A Close Look (and Taste) of Civil War Era Food,” given by Gettysburg National Military Park education specialist Barbara J. Sanders. The lecture focused on the topic of the interaction between history and food, specifically in the Civil War.

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Many soldiers would fry their hardtack to make it more appetizing. Via Wikimedia Commons.

Sanders’s lecture, while directed at an older audience, was just as interactive as one she might give to a younger audience. She provided samples of food from the Civil War era for the audience to try and showed the audience how rations were issued, having an officer stand with his back to the rations, randomly reading off names of the soldiers to make sure that no soldier was purposefully getting a larger ration than another. She also ground up some coffee beans with a bayonet, as the soldiers would have done. All of these activities helped the audience better experience and imagine what a soldier’s diet and food preparation habits would have been. Continue reading “A Taste of the Civil War: Barbara Sanders’ Lecture on Civil War Era Food”

Grave’s Anatomy: Abolitionists, Body Snatchers, and the Demise of Winchester Medical College

By Kaylyn Sawyer ’17

GRAVE, n.  A place in which the dead are laid to await the coming of the medical student.

A census in 1890 listed Chris Baker’s occupation as “Anatomical Man.” While the title sounds like that one of today’s superheroes, the nineteenth century existence of this vocation kept people from lingering around medical colleges after dark. By day, Chris Baker worked as a janitor for the Medical College of Virginia in Richmond. By night, he had the darker task of obtaining corpses for the school. He was a “resurrectionist,” and he was not alone in his eerie nocturnal task of preying on the powerless and recently interred with a shovel, bag, and cart close at hand. Until legislation governing the supply of anatomical material in Virginia was passed in 1884, grave robbing and body snatching were primary means of obtaining cadavers for medical school instruction. African American cemeteries and potter’s fields were primary targets, and medical students themselves were often the perpetrators. For students at the Winchester Medical College, this unseemly practice would lead to the destruction of their school.

Chris Baker (left) with anatomy students at the Medical College of Virginia around 1899. Image courtesy of Special Collections and Archives, Tompkins-McCaw Library, Virginia Commonwealth University.
Chris Baker (left) with anatomy students at the Medical College of Virginia around 1899. Image courtesy of Special Collections and Archives, Tompkins-McCaw Library, Virginia Commonwealth University.

Continue reading “Grave’s Anatomy: Abolitionists, Body Snatchers, and the Demise of Winchester Medical College”

A Pohanka Summer: My Internship at Gettysburg National Military Park

This post is part of a series featuring behind-the-scenes dispatches from our Pohanka Interns on the front lines of history this summer as interpreters, archivists, and preservationists. See here for the introduction to the series.

By Savannah Rose ’17

Over the past eleven weeks, I have been interning with the Division of Interpretation at Gettysburg National Military Park. Throughout the summer, I have acted as a front line interpreter for the park, giving programs in numerous areas around the Gettysburg Battlefield. In addition to the knowledge I’ve gained about interpretation, I have learned more about my life goals as well, pushing me to pursue a career in the National Park Service. My experience at Gettysburg has given me an unforgettable summer with numerous new friends, lessons, and knowledge that I can utilize for the remainder of my life.

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The author’s program at the Soldiers National Cemetery began near this spot at the Rostrum. Photo courtesy of the author.

Continue reading “A Pohanka Summer: My Internship at Gettysburg National Military Park”

Disturbing and Informative: The Mütter Museum’s Broken Bodies, Suffering Spirits Exhibit on Civil War Medicine

By Alex Andrioli ’18

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Broken Bodies, Suffering Spirits is the perfect place to get your Mercy Street fix while awaiting a possible second season. Left to right in the glass jars: A wax model of an arm with smallpox made around 1850, a wet specimen of ileum (final section of small intestine) with typhoid fever, and a wet specimen of a colon with a dysentery ulcer. Courtesy of the Mütter Museum.

“In my dreams, I always have the use of both my hands,” Lt. Col. Henry S. Huidekoper confided in a letter to Dr. S. Weir Mitchell, a Philadelphia surgeon, on February 10th, 1906. Such a statement seems very odd because to have two hands doesn’t feel like a big deal, especially in a dream, but it’s easy to take for granted. For Huidekoper, having two hands, even if it was only in his dreams, was something worth writing about to a doctor.

Lt. Col. Huidekoper was just twenty-four years old when he served in the 150th Pennsylvania on the first day of combat at the Battle of Gettysburg in 1863. On that day, his regiment was in battle near McPherson’s Farm when he was shot through the joint of his right elbow. He walked over a mile under enemy fire to St. Francis Xavier, a Roman Catholic Church, where he had his right arm amputated while “never quite losing consciousness.” Forty-three years later, at the age of 67, Huidekoper had long since learned to cope with life as a “one-handed being,” as he described himself in the letter to Mitchell. Continue reading “Disturbing and Informative: The Mütter Museum’s Broken Bodies, Suffering Spirits Exhibit on Civil War Medicine”

A Nurse’s Life: Review of Clara Barton, Professional Angel

By David Bruce Smith

Clara Barton: Professional Angel
By Elizabeth Brown Pryor
444 pp. University of Pennsylvania Press
$27.50

Sometimes, Clara Barton defied men of military might to pass through Civil War battle lines, and nurse “her” boys.

She had no formal medical training, but Barton was palliatively precocious, and titanically talented in raising robust quantities of resources and relief supplies.

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Image courtesy of University of Pennsylvania Press.

Elizabeth Brown Pryor’s 1987 Clara Barton, Professional Angel, remains the most definitive biography of the future founder of the American Red Cross, but some of what is divulged is not flattering.

Barton was youngest of five siblings. Her miller-farmer father adored her, but her mother was critical, and to Clara “her very identity was submerged in the priorities of the rest of the grown-up family…” Continue reading “A Nurse’s Life: Review of Clara Barton, Professional Angel”

Special Collections Roadshow–Episode 9: Medical Kit

By Meg Sutter ’16 and Megan McNish ’16

For our ninth episode we welcome our guest Dr. Ian Isherwood ’00 to talk about a Civil War medical kit and how to do research relating to Civil War medicine, as seen in the PBS series Mercy Street.

Special Collections Roadshow was created by the Civil War Institute at Gettysburg College in the Spring of 2014. It showcases various artifacts from Special Collections at Gettysburg College.


Sources:

Clements, Lt. Col. Bennett. A Medical Record of the Army of the Potomac by Jonathan Letterman, M.D. and Memoir of Jonathan Letterman, M.D. Knoxville, TN: Bohemian Brigade Publishers, 1994.

Devine, Shauna. Learning from the Wounded: The Civil War and the Rise of American Medical Science. Chapel Hill: University of North Carolina Press, 2014.

Rutkow, Ira M. Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine. New York: Random House, 2005.

Schultz, Jane E. Women at the Front: Hospital Workers in Civil War America. Chapel Hill: University of North Carolina, 2004.

U.S. Army Medical Department. Illustrated Manual of Operative Surgery and Surgical Anatomy. San Francisco, Norman Publishers, 1990.

U.S. Army Medical Department. The Medical and Surgical History of the War of the Rebellion (1861-65). Washington D.C.: Government Printing Office, 1870.