In the mid-nineteenth century, the scalpel joined the sword as a tool of modern warfare. Major Jonathan Letterman, after whom the hospital at the Presidio was renamed in 1911, was the medical director of the Army of the Potomac. A founding father of military medicine, Letterman organized forward first-aid stations, mobile field hospitals, and ambulance services for the evacuation of wounded soldiers during the Civil War.
Later, military hospitals like Letterman became pioneers in orthopedics, rehabilitation therapy, and research in areas such as artificial blood. Just as important, over the course of the twentieth century the military developed comprehensive health care systems for members and their families, which provided coverage through retirement.
The U.S. Army General Hospital at the Presidio of San Francisco was established to cope with the health problems of the 22,000 troops at Camp Merritt, a cantonment of tents hastily set up in the sand dunes of the Richmond District south of the Presidio. W.H. Wilcox of San Francisco designed a 300-bed, pavilion-type hospital consisting of 10 wards, with administrative and support buildings arranged around a rectangular central green and linked by covered corridors. The facility was built between 1899 and 1902. Today, twelve surviving buildings of this complex have been reborn as the Thoreau Center for Sustainability.
As the United States expanded across the Pacific and into Asia, the hospital served troops in the western states and those returning from Hawaii, the Philippines, China, Siberia, the Panama Canal Zone, and Alaska. In 1901, Letterman was the first army general hospital to employ women of the Army Nurse Corps. Civilian San Franciscans were admitted to the hospital in the aftermath of the earthquake and fire of 1906, and medical officers from the Presidio took charge of sanitation in the post-quake refugee camps built in city parks and on the Presidio.
By 1918, Letterman Hospital was the Army's largest general hospital, and had opened a School of Nursing. Despite its distance from the battlefields, Letterman cared for many of the wounded returning from Europe during World War I. Staff physicians developed orthopedic devices including the Letterman Leg, and also pioneered the field of physical therapy.
To deal with the sudden influx of returning wounded, East Hospital, an orderly array of 21 frame buildings which more than doubled the patient facilities, was built east of the (since built over) O'Reilly Avenue parade ground. By 1921, Letterman hospital had 56 permanent buildings and 29 temporary ones staffed by 41 medical officers, 58 nurses, and 484 enlisted men.
In 1960, the Army began planning for a more modern hospital. The East Hospital complex was demolished and in 1969 a 10-story, 550-bed, reinforced concrete facility opened on the site. The new Letterman Army Medical Center trained a quarter of the Army's medical specialists. It served the wounded and POWs returning from Vietnam in the 1970s.
In 1971, the Army opened the adjoining Letterman Army Institute of Research. It consisted of four concrete buildings that housed research in artificial blood, laser physics, and the treatment of trauma. During these years, the Army began demolishing parts of the 1899 quadrangle to build housing for nurses and enlisted men; the remaining historic buildings housed support services. By the late 1980s, Letterman served mainly military retirees and their dependents. Both the hospital and the research institute were deactivated in 1995.
Letterman's history and contributions to medical and military history are shining and significant. Neither architecturally significant nor up to contemporary seismic standards, the 1960s Letterman complex will soon be removed to make way for the Letterman Digital Arts Center. This change guarantees the vitality of this site for years to come.
Stephen A. Haller, Letterman Hospital: A Summary of Its Significance and Integrity, 1994.
Erwin N. Thompson, Defender of
the Gate: The Presidio of San Francisco, A History from 1846 to
1995, vol. I, 1997.
When, in May 1898, the War Department ordered the formation of the 8th Army Corps at San Francisco for service in the Philippine Islands, volunteer troops from many states assembled at San Francisco. In a short time 22,000 men occupied Camp Merritt south of the Presidio, between it and Golden Gate Park. The area proved unsuitable as a cantonment. Cold winds, fog, drifting sand, and poor drainage wrought havoc with the health of the command. The morning sick reports increased in length as typhoid fever, spinal meningitis, and pneumonia swept through the camp. While the more serious cases found care in city hospitals, the tent hospital of forty-eight beds offered little comfort or relief from the cold for the majority of patients. Finally, the chief surgeon of the Department of California, Col. Johnson V.D. Middleton, urged the removal of the sick to the new brick barracks at the Presidio. He also wrote to the Surgeon General of the Army recommending construction of a 500-bed general hospital at San Francisco as soon as possible.
The Division Field Hospital moved to the Presidio in July 1898, occupying two of the new brick barracks. An increase in the patient load resulted in the addition of eight hospital tents and three conical wall tents. And before long, four wood frame barracks became part of the facility. Although far from satisfactory as a hospital overcrowding, inadequate water and plumbing in the wards, and poor ventilation the barracks provided better facilities than the former tent camp. In addition to the six medical officers, ninety enlisted men of the Hospital Corps, thirty-three contract nurses, and ten Sisters of Mercy volunteers administered to the ill.
By the end of 1898 nearly all the volunteer troops had departed for the western Pacific, but those contracting diseases overseas began to return to the United States. In a few more months the bulk of these troops would begin the return journey. At the same time, the Army realized the need for regular troops in the Philippines where insurrectionists complicated army administration. The need of a general hospital at San Francisco continued to be deemed urgent. On December 1, 1898, the War Department published General Orders 182 establishing the U.S. Army General Hospital on paper under the direct control of the Surgeon General, U.S. Army.
A Board of Officers, composed of Brig. Gen. Henry C. Merriam, commanding; Colonel Middleton, chief surgeon; and Maj. Charles B. Thompson, chief quartermaster, all on the Department of California staff, met to select a site for the urgently needed hospital. The Board considered Angel Island, southern Fort Mason, and the Presidio drill field that the Army had built up immediately to the northeast of the main post. Believing that the hospital would be only temporary in nature, the Board selected the Presidio site as the most economical even though it noted some objections to it.
The Army employed Architect W.H. Wilcox of San Francisco to prepare plans for a 300-bed, pavilion type hospital such as had been used by the British in the Crimean War, 1853-1856, and by the Union in the American Civil War. The plans called for wards, administration building, operating theater, kitchens and mess halls, laundry, boiler house for steam heating, and an electric plant surrounding a rectangle of covered verandas. Before construction started the Army eliminated the operating theater (part of a ward would serve as such) and Brig. Gen. William B. Shafter, prior to his departure for Cuba, struck out the boiler house, electric plant, and laundry to reduce expenses. Surgeon Middleton wrote, after this emasculation, "he [Shafter] forwarded the plans to the War Department and they seemed to be satisfactory, at all events the hospital was ordered to be built." Early in 1899 John T. Long won the construction contract with a bid of $113,340.
Although the general hospital remained incomplete, Maj. Alfred C. Girard took command in July 1899.
As the volunteers returned from the Philippines
in ever increasing numbers ill from tropical diseases, the hospital
proved its worth in a hurry. Major Girard had mixed emotions about
his new command. He wrote, "The location of the hospital
has its advantages and disadvantages. The advantages are proximity
to the city, to the post of the Presidio, and to the camps which
were to shelter the troops assembling for duty in the Philippines
and the volunteers returning therefrom. The disadvantages are
exposure to the high winds and fogs . . . the low ground . . .
the proximity to the liquor shops adjoining the Presidio."
An anonymous account noted that Major Girard struggled with incompetent
help, epidemics, shiploads of
wounded, and swarms of mosquitoes and flies (the cavalry stables stood 400 yards to the west). The civilian contract surgeons changed over so often they were more of a hindrance than a help. A later critic wrote, "The location of this site has often been regarded as the one great mistake in the hospital's formation." 
Throughout 1899, military patients continued to occupy both the barracks and the new hospital. During the year, 5,400 patients entered the facilities and 5,200 were discharged.
taffing consisted of nineteen medical officers,
158 Hospital Corps enlisted men, and thirty-six nurses. The most
serious drawback at this time was the lack of a power plant. Coal
and kerosene stoves heated the buildings and kerosene lamps provided
lighting. The ten forty-man wards in the general hospital were
divided into: seven for general medical service, two for surgical,
and one for venereal disease. Soldiers in the Presidio camps suffered
from typhoid fever, measles, mumps, pneumonia, rheumatism, bronchitis,
and venereal disease.
Veterans from the Philippines brought home chronic diarrhea, dysentery, and malaria fever. The Surgical Service operated for hernia, appendicitis, gunshot wounds, hemorrhoids, and circumcision.
In early 1900 almost 15,000 Regulars passed through San Francisco en route to China where the Boxer Rebellion threatened the foreign legations. In just two years about 80,000 enlisted men and 2,500 officers, coming and going, spent time at the Presidio and the general hospital treated all those in need.
The largest number of patients in one day
in 1899 amounted to 1,040 on August 2. Plant improvements in 1900
included the power house, an ice machine, and a laundry. Wooden
sidewalks and tin roofing on the verandas improved the grounds.
Hospital equipment gradually improved. Still, the patient load
caused the continued use of the Presidio's barracks.
The following year, 1901, saw a marked improvement in the hospital's functioning, especially in a more proficient staff. The number of patients decreased as the volunteer troops returned to civilian life. Yet, the Presidio barracks and tents continued to house patients. An intercom telephone system connected all the wards and the administration building. X-Ray equipment, still primitive, came into use. The total number of cases treated during the year amounted to 3,180, of whom ninety-two died. Fire on June 10 caused a setback by destroying the patients' and the hospital corps' dining rooms, kitchens, storerooms, and two wards. Damage amounted to $56,000. A tent hospital with forty-five tents sprang up to take care of the emergency.
A month before the fire and a few months before his assassination, President William McKinley visited the general hospital and addressed the veteran-patients from the China Expedition. His visit was but the first of many by civil and military dignitaries.
Colonel Girard transferred in June 1902 and Maj. William P. Kendall succeeded him as commander. Before Girard left he had the pleasure of being the first occupant of the new commanding officer's quarters (Building 1000) completed, along with a duplex officers' quarters (Building 1001), in March. Before he departed, Girard also supervised the suppression of a serious measles epidemic that had begun at the Presidio in December 1901:
December, 8 cases
January, 70 cases
February, 79 cases
March, 116 cases
April, 82 cases
May, 24 cases
June 1902, suppressed
During the epidemic the measles patients were first isolated in two of the Presidio's barracks. In March, as the epidemic slowly began to decline, the patients moved into the hospital. By the time it was over, measles had claimed eighteen deaths.
Letterman was the first army general hospital to employ women of the Army Nurse Corps, it being established in 1901. By 1902 forty-one of these nurses, along with eleven medical officers and contract surgeons and 180 enlisted men of the Hospital Corps, comprised the hospital's staff. The nurses did not receive commissions until much later; for the time being they received $40 per month for their valued duty.
The total number of patients in 1902, 4,828, dropped precipitously the following year when only 2,252 were admitted, allowing the hospital to turn one of the two brick barracks back to the Presidio. At the same time the physical plant expanded with the addition of a storehouse, a second barracks for the enlisted men, and additions to the wards. The central veranda that bisected the courtyard was enclosed with glass, and painters spruced up the entire hospital. By 1903 the hospital maintained four messes: nurses, Hospital Corps enlisted men, officer and civilian employees, and enlisted patients and civilian employees.
For reasons remaining unclear, War Department General Orders 25, January 30, 1904, placed the general hospital under the general supervision of the commanding general, Department of California, upon the recommendation of the Surgeon General, U.S. Army. In March 1904, Lt. Col. George H. Torney became commanding officer of the general hospital. A most capable administrator, Torney presided over an important period in the hospital's evolution. Finally, an operating pavilion, that had been canceled in 1898, came to be. Located in the center of the quadrangle and considered a model of its kind, it cost $22,000. Other new construction that year included a guardhouse at the north end of the compound and an iron flagstaff at the front of the administration building. Rebuilt roads and new sidewalks graced the grounds. A post exchange featuring billiard and pool tables became available for staff and patients alike.
Measles again brought a slight increase in the number of patients. More important, however, changes in the general hospital's missions became apparent, "The large majority of all the medical cases treated during the year, contrary to former years, were admitted from the United States. This is explainable by the fact that prior to this year the Presidio Post Hospital [Building 2] had served as a post hospital for all commands casually at the Presidio as well as for two regiments of infantry stationed at the [East and West] Infantry cantonments, which custom was discontinued in the early part of this year by the General Hospital being made to take up patients from these sources."
The mean daily average of the sick load in 1904 dropped to 257, indicating that the general hospital no longer needed to make use of the Presidio's barracks. Even those suffering from the measles were kept in the hospital, in Ward A.
Colonel Torney recorded further changes
in the hospital's missions in 1905. He wrote that the hospital's
aim "has been to develop a high standard of specialized professional
services fitted to meet the demands of the Army. When the hospital
was established its purposes were stated to be to receive the
sick from troops en route to and from the Philippines and to care
for patients transferred to the States from the Manila hospitals,
and this was the hospital's only real reason for its existence
up to the present year." But
now, in addition to receiving all patients from the Presidio's garrisons, the general hospital's mission had increased significantly by the handling of special cases from all over the United States obscure diseases; serious surgical cases; and eye, ear, nose, and throat (ENT) cases throughout Western military installations, and all dental work in the Department of California.
The hospital staff this year consisted of
eleven medical officers, 156 enlisted men, and thirty-nine army
nurses. Dora E. Thompson replaced Helene M. Gottschalk, who had
served for the past four years, as head nurse in August. Although
the nurses' quarters continued to be inadequate, a third floor
had been added to the administration building, 1016, to serve
as bachelor officers' quarters for the medical officers, cost
$6,776. At the beginning of 1905 the hospital held 330 patients,
at the end of the year, 303. Thirty-eight deaths had occurred
in those twelve months.
Several attempts to create a coherent organization among the separate services had been attempted in these early years; then about 1905 Colonel Torney published the comprehensive "Rules and Regulations for U.S. Army General Hospital." Thirty pages of fine print set forth the organization, duties, administration, fire protection, and procedures for all personnel. These regulations overlooked little.
Rules specified how a nurse should be evaluated for promotion. The names of patients being photographed had to be accurately recorded. Enlisted attendants had responsibility for sanitation in the wards, including the floors, windows, bed pans, spit cups, toilets, and lavatories. No one could chew tobacco in a ward. Rheumatic patients being considered for transfer to the Army and Navy General Hospital at Hot Springs, Arkansas, for treatment in the waters had to be thoroughly inspected for gonorrhea. Also, patients or Hospital Corps men awaiting trial by summary court martial were confined to the hospital guardhouse when necessary.
Still other regulations concerned security. A guard near the front door of the administration building refused admission to unauthorized persons, directed legitimate visitors to the officer of the day to obtain a pass, checked patients going on leave for their passes, and insured that such patients departed and returned through only this door. Guards locked the hospital's gates at retreat and unlocked them at reveille. At night, other guards, checked all doors and windows to insure they were locked.
Thus did the U.S. Army General Hospital evolve in five short years. It sprang up on the lower Presidio to treat successively thousands of soldiers departing for an returning from the Philippines, China, and Hawaii. Despite inadequate or missing facilities in the beginning, its staff gradually improved the hospital's services and its professionalism. In a short time it became responsible for the large garrisons at the Presidio and Fort Mason as well. In its fifth year, it acquired the responsibility of treating special cases from army installations all over the United States.
The year 1906 began with the ordinary routine
at the general hospital. Then, just before dawn, April 18, a tremendous
earthquake struck San Francisco. Immediately thereafter a terrible
fire swept through the city. Units from U.S. Army posts in the
Bay Area immediately came to the aid of the stricken city and
military supplies from around the nation began the journey to
California. Col. George Torney at the general hospital immediately
organized his resources to assist in efforts to care for the steady
stream of sick and injured citizens coming from the downtown area,
including the unconscious fire chief, Dennis Sullivan. Attendants
crammed beds together to make room for more and they set up an
operating pavilion. Volunteer civilian medical people came to the hospital to help. By April 20 an army doctor reported that the hospital had taken in 200 civilians. The staff cared for them in the wards, halls, porches, and grounds. One history recorded that Mrs. Frederick Funston, the wife of the commanding general of the Department of California, came to the hospital (she had lost her own home to the fire) and made the rounds with Colonel Torney demanding the utmost effort be made to care for the victims.
Colonel Torney took charge of sanitation throughout the city and in the hastily established refugee camps. He received full authority to draw up and enforce the necessary regulations and through his capable staff supervised all sanitary work. Throughout the emergency the hospital's medical officers inspected the camps and enforced strict measures concerning sanitation. Given much credit for his efforts in this disaster, Torney later was "jumped" over several senior doctors to become Surgeon General of the U.S. Army, 1909-1913.
While San Francisco began its recovery from the devastating earthquake, the general hospital suffered a minor disaster of its own when the laundry building burned to the ground early in May. The records do not disclose how this travail was overcome except to say that it severely hampered medical service for a time."
Following San Francisco's rebirth from the earthquake and fire, the general hospital returned to its traditional missions. An anonymous source described the period as "a base hospital for the Philippines and Hawaii, a post hospital for the Presidio, Fort Winfield Scott [established in 1912], and several smaller posts in the harbor of San Francisco, and a general hospital for the western part of the country." In 1907 Maj. William W. Harts, Corps of Engineers, prepared an elaborate master plan for the future expansion on the Presidio military reservation. Recalling the hospital's earliest days on the edge of a swamp, facing a dusty plain, and on low ground he proposed abandoning the existing plant and constructing a new general hospital near the reservation's southern boundary, land on which the Presidio Golf Course had been established. The hospital remained where it was.
In 1911, when Lt. Col. James D. Glennan commanded the hospital, the War Department issued general orders naming it in honor of the late army surgeon Maj. Jonathan Letterman. Born the son of a doctor in Pennsylvania in 1824, Letterman graduated from a Philadelphia medical school. He entered the Army as an assistant surgeon in 1849. His first assignment took him to Florida where he participated in the Third Seminole War campaigns from 1849 to 1853. Letterman next transferred to the Department of the Pacific for service in New Mexico, Arizona, and California. In the spring of 1860 he arrived at Fort Tejon, 150 miles northeast of Los Angeles. Almost immediately he accompanied the 1st Dragoons to the Mojave Desert where Camp Cady protected the route to Salt Lake City during the campaign against the Paiute Indians. He next moved to Camp Fitzgerald at Los Angeles in 1861.
Like many other regular officers, Letterman
went east to participate in the Civil War. Promoted to major surgeon
in April 1862, he became the medical director of the Army of the
Potomac. He promptly reorganized that Army's ineffective medical
service by setting up forward first-aid stations, mobile field
hospitals, general hospitals, an ambulance corps, and the medical
supply system. Letterman made use of the doctrines of Baron Larrey,
Napoleon's chief medical officer, and adapted them to conditions
in the Civil War. He placed great emphasis on the rapid evacuation
of the wounded thus saving a great many lives. Four-wheel ambulances
replaced the former two-wheel carts. Enlisted men, trained by
Department, took the place of hired civilians. He adopted the pavilion type hospital that the British had employed in the Crimean War. This type later formed the basis of the general hospital at the Presidio, which, in turn, served as a model for hospitals in the American Expeditionary Force in World War I.
Letterman's organization and procedures so improved the medical service in battle that they were later enacted into law for the U.S. Army. Soon his scheme was adopted by major armies in other countries.
Major Letterman resigned from the United States Army in December 1864. This departure was brought about by poor health and the dismissal of his friend and commander, the Surgeon General William A. Hammond.
The doctor moved to San Francisco to practice medicine. In 1867 he became coroner for San Francisco.
A year later he accepted the position of Surgeon General for the State of California's military organizations. The Regents of the University of California elected him to its board of medical examiners in 1871, the same year he became a member of the first class of the Military Order of the Loyal Legion. That December Letterman retired. He died March 15, 1872, age 48 years. Later his daughter had his remains moved to Arlington National Cemetery.
Various improvements and additions had been made to the general hospital during its first decade, yet a serious deficiency remained - the lack of quarters for the noncommissioned officers. The hospital's quartermaster officer, Capt. H.B. McIntyre, wrote in 1910 that he rented quarters for nine NCOs attached to the hospital in the nearby community. The Quartermaster General, however, had not approved any leases for the current fiscal year and these sergeants were paying rent out of their own pockets an average of $23.50 a month which they could ill afford. He went on to describe one sergeant's arrangements. He was "situated in the low-lying, unhealthy district of lower Lombard Street. The houses in this vicinity are almost exclusively occupied by colored people and low class foreigners, and, during high water, excreta and other refuge from the sewer back up into the drains."
The Army's solution to this situation has
not been found. An inspection a few months later revealed that
four sets of quarters for noncommissioned officers remained a
Besides these quarters the 1911 inspection report listed other structures that the hospital required: storehouse for combustibles, new kitchen, new stables, and another quartermaster storehouse. Some additional structures were erected during this period, particularly quarters for medical officers and for nurses. Officers' row east of the hospital reached completion in 1908 with the addition of three duplexes.
An interesting note was that the northernmost set of quarters housed not an officer but the hospital's sergeant major, a mark of respect for this important personage. The army nurses received new housing with the construction of two buildings, one three story and the other four story, concrete, and with clay tile roofs. Later numbered 1022 (built in 1915) and 1024 (built in 1916) they formed parts of Thompson Hall, now demolished.
Col. Frederick Von Schrader's inspection listed some of the various vehicles employed by the hospital:
Station wagon, for meeting trains and transportation of officers to and from the depot Wagonette, for taking children to and from school and for same purposes as station wagon
Express wagon, for baggage and marketing
Two delivery wagons, one used for delivering supplies to offices from the commissary, the other used as milk and ice wagon
Two ambulances, field, for conveying patients to and from hospital and for emergency calls
Ambulance, city, rubber tired, for same purposes as field ambulances in more serious cases
Cart, dump, for removing dry garbage and for general police work
Cart, sanitary, for removing garbage
Two carts, hand, used by organizations for hauling commissaries and other supplies
In addition to these vehicles, Letterman experimented with "motor ambulances" in 1912. Alas, "They were not a success."
Thus the years between the San Francisco earthquake and World War I passed at Letterman. During this time Letterman was the largest general hospital in the U.S. Army and remained so until the extraordinary needs of the Great War. The average annual admittance of patients hovered at 3,000. In fiscal year 1916 the hospital admitted 3,195 patients including general prisoners and civilians. That year seventy-four deaths occurred in addition to the tragic deaths in the Pershing family in a house fire. The operating pavilion carried out 771 operations. The hospital began a new service in 1916 orthopedics.
Although Letterman lay far from the conflict in Europe in 1917, it became a most important army hospital during and following that great war. The U.S. Army mobilized and trained troops in California and throughout the West. One result was increased admissions at Letterman. For the two years of the American entry into the war, 1917-1918, Letterman received a total of 18,700 patients, three times its annual load for the past several years and the largest number of admissions ever. Once the fighting stopped, Letterman's mission increased ever greater as the stream of wounded and sick soldiers flowed from Europe. In the year 1919 the total admissions reached 12,400.
At the beginning of the war the U.S. Army had four general hospitals: Letterman; the Walter Reed General Hospital, District of Columbia, founded in 1909; the General Hospital at Fort Bayard, New Mexico established in 1900; and the Army and Navy General Hospital, Hot Springs, Arkansas, established as a general hospital in 1887. The Army and Navy hospital cared for arthritis and rheumatism cases and Fort Bayard was used solely for the treatment of pulmonary tuberculosis. Only Letterman and Walter Reed were true general hospitals.
The commanding officer of Letterman during the war years, Col. Guy L. Edie, had been the personal physician of President William H. Taft. Under his administration Letterman's bed capacity reached 2,200.
In 1918 Letterman was one of the army hospitals selected to establish a unit of the Army School of Nursing. One of the more important wartime developments at Letterman came about with its designation as an Orthopedic Center for amputation cases from the American Expeditionary Force.
Forty-six amputee cases arrived at Letterman from Europe between April 1, 1918, and June 30, 1919.
The Surgeon General also established a Division of Neurology and Psychiatry at Letterman. During the war the hospital also specialized in the treatment of venereal disease.
Letterman had a casualty of its own in October 1919. That year Col. Robert M. Thornburgh replaced Colonel Edie as commanding officer. Thornburgh had seen service in the Philippine Islands, the Mexican Punitive Expedition, and in France. On October 10 he attended a dinner honoring Herbert Hoover at the Bohemian Club in San Francisco. When returning to his Letterman quarters, Thornburgh's automobile was hit by a municipal bus at 19th Avenue and Lincoln Way, killing the colonel.
Letterman's physical plant underwent great
changes during the war when it almost doubled in size. On the
former drill field to the east a complex consisting of eighteen
patient wards, two barracks for Hospital Corps men, a kitchen
and mess hall building, and a Red Cross building sprang up. Soon
this area became known as East Hospital. At the main hospital
many changes took place. New construction included a psychopathic
ward for 100 patients, a stable for twenty-eight animals, a garage
holding twelve ambulances, permanent barracks for seventy-five
men, four temporary barracks each holding sixty-seven men, another
nurses' dormitory having sixty rooms, an additional dining room
for 300 men, and still
another dining room and kitchen for 500 men. Additions were made to the disinfecting and sterilization plant and to the power and heating plant. Painters put a fresh coat on the entire exteriors of all the buildings and most of the interiors. Old roads became macadamized and new roads were built.
The Army's Medical Department praised the new psychopathic ward, building 1050, as a vast improvement in the care of mental patients who previously had been housed in the overcrowded detention ward, 1051, along with general and garrison prisoners. The new building opened to patients on October 17, 1918. In contrast to the detention ward with its barred doors and windows and cells, the psychopathic ward had no bars and patients were placed in rooms and dormitories that were located around the outside, "hotel fashion." The many windows and air shafts allowed for adequate ventilation.
Offices and hallways had hardwood floors,
while other floors were colored concrete. A dormitory for sick
patients on the second floor had a screened porch where patients
enjoyed the air and a view of the bay. A complete hydrotherapeutic
department occupied the basement. After the signing of the armistice,
the hospital began to receive large numbers of cases returning
from France and Siberia and this ward, originally designed for
sixty patients, had as many as 130 men at one time.
Other buildings existing by 1919 included a green house, solariums in the central court, crematory (for trash), bakery, tennis court, a small building for (experimental?) animals, a stage for entertainment, and three long runways for orthopedic patients. Construction materials included both wood frame and concrete covered with stucco. (Letterman avoided brick construction that had proven unstable during the 1906 earthquake.) Across the road to the south the YMCA erected a building that offered aid and comfort to the hospital.
The U.S. Army operated eighty-four hospitals in the United States by the end of World War I:
48 general hospitals (four named, rest numbered)
33 base hospitals
3 miscellaneous hospitals
The Army prepared a schedule for abandoning most of the hospitals and reducing the number of beds in the others. By October 30, 1920, the number of available beds had been reduced to 3,750 in only five general hospitals:
|Walter Reed General Hospital||2,000||500||1,500|
|Letterman General Hospital||2,200||1,500||700|
|Army and Navy General Hospital||266||16||250|
|General Hospital 19, Oteen, North Carolina||1,300||800||500|
|General Hospital 21, Denver, Colorado||1,603||803||800 |
In 1921, when matters had settled somewhat, a report summed up Letterman General Hospital:
56 permanent buildings
29 temporary buildings
41 medical officers
108 student nurses
484 enlisted men
In the years between the two great wars, Letterman General Hospital continued to improve both its plant and its missions. While the number of beds was reduced to 750 [sic] in 1921, admissions never fell back to the pre-war annual average of 3,000. Rather, increases were fairly common:
1920 4,988 admissions
Patients now came from the Western states (Ninth Corps Area), the Philippines, Hawaii, Alaska, China, and military installations in Panama. In 1924 an Intern Training Program began for budding doctors. About that same time the hospital originated an Outpatient Clinic. Beginning in 1933 Letterman treated the young men in the Civilian Conservation Corps in the Ninth Corps Area. In 1920 army nurses acquired the relative rank of officers (but not the commissions) and wore the appropriate insignia. Some noncommissioned officers continued to live in the city and received 75 cents a day to help defray expenses insufficient. But a few married soldiers had quarters in one of the wards that had been converted to the purpose. In September 1923 Letterman sent a detachment of thirty-nine personnel to Japan for earthquake relief in the great quake that had devastated Tokyo and Yokohama. They returned to San Francisco in December. 
In the year 1929 two descriptions of Letterman General Hospital emerged that, at first glance, seemed contradictory. In a history of the U.S. Army's Medical Department, the author stated that Letterman was "the hospital for reception and definitive treatment of the more serious cases of the army stationed on the Pacific Coast and nearer states and for the sick returned from trans-Pacific stations. It has 1,000 beds, abundant medical, dental, nursing, and enlisted personnel, is beautifully situated and well arranged."
About the same time Brig. Gen. Wallace DeWitt, Letterman's commander, described the hospitals buildings saying that they had been constructed of wood frame, stucco, and concrete. He considered the concrete structures to be excellent buildings that should be retained. As for the others, "The frame and stucco buildings are old, and, with the exception of the Officers' Quarters and Noncommissioned Officers' Quarters [in converted wards?], do not meet modern requirements and constitute a potential fire hazard." These, he concluded, should be replaced. DeWitt was but the first to argue for modern facilities. Had he been asked, he probably would have agreed that Letterman's mission was ever more important and that the Presidio of San Francisco was indeed beautifully situated and well arranged. 
DeWitt's words must have hit at least a small nerve in Washington. The construction quartermaster at San Francisco reported that in fiscal year 1930 he had built for Letterman a $50,000 concrete ward building, 1009, to replace the original wood frame ward "H," and two additions to the nurses' quarters (Thompson Hall) at a cost of $69,000. Three more concrete wards, including building 1008 that replaced old wood frame ward "G" and a new ward, 1012, came into being the following year and costing another $150,000, and other construction valued at $115,000 was underway.
The San Francisco Chronicle reported on April 24, 1938, that the depression-era Works Progress Administration had authorized almost $2 million for construction on the Presidio reservation. Of that amount $345,000 pertained to Letterman General Hospital. This money was in addition to $117,500 worth of work that had been completed at the hospital in 1937 and 1938. As war clouds gathered in Europe and Asia, Letterman began to stir anew as the United States considered expanding its armed forces while maintaining a neutral stance in the affairs of nations.
World War II in the Pacific brought a vast increase in Letterman General Hospital's responsibilities as hospital ships brought home tens of thousands sick and wounded men from far-flung battlefields that extended from the Aleutian Islands to the southwest Pacific. Before then, beginning in 1939, the United States increased its military strength sharply when war began in Europe. The first peacetime draft began in September 1940. At the Presidio of San Francisco the Army began a substantial program for temporary housing on November 1, 1940. Of the five areas on the reservation selected for the emergency construction, three in the lower Presidio would have a strong association with Letterman General Hospital:
Area A, on the bay front between Marine Drive and Mason Street and east of Crissy Field. It contained ten 2 story, wood frame barracks, two 1 story dayrooms, administration building, post exchange, three combination company administration and storehouse (supply room) buildings, and two mess halls. (Later, in 1941, additional structures in this area consisted of five barracks, two administration-storerooms, a 250-man mess hall, and a recreation building.)
Area B, on the bay front between Marine Drive and Mason Street and west of Crissy Field. It had a similar combination of structures except that a large warehouse replaced the administration building.
Area C, between Mason Street and the Golden Gate Bridge Approach and south of Crissy Field. This area had similar mobilization-type structures but was much smaller than the other two. In 1945 Area C housed Letterman's detachment of WACs.
Construction completed by March 1941, the contractor received his final payment (total contract, $298,300) and painters applied a gray color from the ground to the water table and to the trim and a cream color to the rest of the buildings.
Letterman decided in the fall of 1940 that
in order to meet the needs of an expanding military force, it
would no longer receive admissions from the Veterans Administration
and it reduced the number of CCC enrollees accepted for treatment
(twenty percent of the patients had been coming from the CCC).
At that time the hospital counted fifty-nine permanent structures
and twenty-seven temporary structures; of all these there were
thirty-three wards having a normal capacity of 904 beds and a
maximum capacity of 1,191 beds. The 1940 patient load at the hospital
amounted to about 9,000. Early in 1941, the Surgeon General announced
that Letterman and Walter Reed general hospitals, as well as the
Army and Navy
Hospital at Hot Springs, Arkansas, would establish facilities for the care of cases of resection and amputation requiring the fitting of prostheses.
Japanese aircraft attacked military installations
on Oahu Island in Hawaii on December 7, 1941. By the end of December
Letterman's emergency bed capacity had increased to 1,589. On
December 31 the first convoy of patients from Hawaii arrived in
San Francisco Bay. Letterman's annual report for 1941 added a
new mission to its purposes for being: Because of the Japanese
attack, Letterman was now in the combat zone and it served the
triple function of Port of Embarkation Hospital, General Hospital,
The forty-eight acres now contained 100 buildings. Seven buildings that had housed enlisted men had been converted to wards, bringing the number to forty (1,471 beds). Construction completed in 1941 included three Special Service schools and their administration building, six barracks, storehouse, new bakery, and over at East Hospital a 1,000-man mess. During 1941 Letterman admitted 12,290 patients, of whom 103 had died.
In 1942 battle casualties and tropical disease cases arrived from the Pacific. A special emergency developed when the hospital admitted 600 patients suffering from acute hepatitis associated with jaundice following inoculation with yellow fever vaccine. Six of these patients died. By the end of 1942 Letterman had occupied at least Area A east of Crissy Field, mostly as quarters for its growing enlisted men staff.
The hospital now had forty-three wards (1,627 beds), nine officers' quarters (no change), and accommodations for 150 nurses. It operated no fewer than seven messes: officers, general, ward, nurses, ambulatory patients, East Hospital, and Crissy Annex. The seven professional divisions consisted of: Medical, Surgical, Outpatient, Radiological, Dental, Laboratory, and Nursing. There had been substantial peaks of patient admissions before, but a new high was reached this year 20,881 admissions of whom 107 died.
In 1941 the hospital began an in-house newspaper called Fog Horn, Letterman General Hospital, an upbeat paper intended for information, morale, and, possibly, future historians. An issue might run articles on military government, the Army Hour radio program, nurses' column, the soldier of the week, Purple Heart awards, sports, or the medical detachment. From time to time it contained longer, historical articles, such as the September 13, 1943, issue that had a history on the Army Nurse Corps. It concluded by saying that Capt. Margaret Knierin, with twenty-nine years service, was Letterman's Chief Nurse. Captain Knierin retired that December.
Shortly after Pearl Harbor the headquarters of the Ninth Corps Area had moved from the Presidio of San Francisco to Fort Douglas, Utah, where it reorganized as the Ninth Service Command. From the Fog Horn one learned that Letterman General Hospital had come under the administration of the Ninth Service Command rather than the Surgeon General. Not until the end of the war did the Surgeon General regain control.
The newspaper also informed its readers of medical news, such as the arrival of the newly-invented electro-encephalograph, or brain wave, machine in July 1943. The Christmas edition that year said that Letterman was one of two army hospitals that had a Vascular Surgery Section that treated vascular injuries such as frost bite, immersion foot, arteriovenous fisulae, circular deficiencies, varicose veins, etc.
Other news covered the activities of the Grey Ladies volunteers at the hospital. The newspaper also announced that 1,000 members of the Women's Army Corps (WACs) would be trained as medical technicians.
Developments at Letterman in 1943 included an increase in the number of military patients from Australia and New Zealand. The hospital added a Maxillo-facial Plastic Center that year and began plastic surgery in June. A fire station for the hospital became an important new feature. It operated from building 1149 in the East Hospital area. Associated with the fire station, four 20,000-gallon emergency water tanks were constructed. As the war in the Pacific and Asia continued, the hospital received 39,349 patients in 1943, of whom only seventy-five died.
The tempo of allied advances in the Central, South, and Southwest Pacific increased greatly in 1944. So did activities at Letterman. Its primary purpose now was being an evacuation hospital for the reception of overseas patients arriving at the San Francisco Port of Embarkation and the prompt evacuation of those patients to other general hospitals in the interior. Also, the hospital provided definitive care for army units in the Bay Area and for retired personnel. By 1944 Letterman served for the definitive care of cases requiring deep x-ray or radium therapy.
A year earlier the San Francisco Port of Embarkation had taken over the civilian Dante Hospital, 328 beds, at Broadway and Van Ness in San Francisco. Now, in August, the "Dante Station Hospital" merged with Letterman, thus making a total of 2,338 beds available. In personnel matters, Pvt. Helen Thompson became the first enlisted WAC assigned to Letterman. A new chief nurse, Maj. Josephine Motl, took office on July 1. A month before, army nurses finally received temporary commissions in the Army of the United States. Army brass remained uncommitted to nurses being in the Regular Army. An unfortunate incident occurred in mid-summer when an army officer, Lt. Beaufort Swancutt, under sentence to be hanged for murder, committed suicide in the hospital. At the end of the year plans were ready for the construction of a gymnasium (1152) and a swimming pool (1151) at East Hospital.
The Fog Horn carried an extensive article on July 1 recording that Fred M. Diernisse served as Letterman's head gardener. The old greenhouse had been moved to a site northwest of the main hospital.
The former tall privet hedge around the
oval in front of the hospital had been replaced with a low boxwood
hedge and flowers. The hospital nursery grew snapdragons, hododendrons,
azaleas, begonias, pansies, gladiolas, and dahlias. Most of the
cut flowers went to the wards. Arrangements were available for
executive offices, the officers' club, nurses' mess, the chapel,
and the Red Cross. Patients over at the Crissy Annex did their
own gardening. Many of the hospital's civilian gardeners were
high school boys employed in summer work.
At the end of 1944, Letterman General Hospital reported that it had admitted 45,168 patients over the past twelve months. The original hospital, East Hospital, and the Dante Annex had a total of fifty wards.
The Letterman Fire Department closed down after a brief existence, the probable reason being that the Presidio of San Francisco had agreed to take over Letterman's repair and utility operations.
As early as 1943 Letterman became concerned about procedures for evacuating war-related patients to inland hospitals. The hospital had admitted more than 25,000 patients that year and had evacuated nearly 27,000. An innovation involved aerial transport. Letterman and the Air Transport Command cooperated in the endeavor in May. Ambulances and busses moved 375 patients to nearby Mills Field, the present site of the San Francisco International Airport, where a fleet of twelve C-47 aircraft evacuated them to inland destinations.
The principal means of evacuation, however, remained the hospital trains from the Crissy yard in the vicinity of Area A, lower Presidio. The Fog Horn described a hospital train in April 1944. The Army had decided on a ten to twelve car train in accordance with the Medical Department's requirements.
Manufactured by the Pullman-Standard Car Manufacturing Company in Massachusetts, a typical train consisted of the ward cars, utility car, officer personnel car, orderly car, and a kitchen-dining-pharmacy car, each forty-four feet long and mounted on two 4-wheel trucks. A ward car had eight two-tier bunks. The officer car had facilities for four officers at one end, and six nurses at the other.
A report at the end of 1944 stated that Hospital Train Unit Service Command Unit (SCU) 1960 operated as many as four full trains a day out of the Crissy spur. In September Letterman had evacuated 6,000 patients by train and expected the number to climb to 8,000 in October. The Surgeon General had stationed forty hospital train cars at San Francisco and planned to increase the total to 111.
By early 1945 the Army had added new hospital unit cars. Each contained a kitchen, small surgery, bunks for thirty-two patients, and sleeping accommodations for Medical Department technicians. Usually a captain of the Medical Corps commanded a train, assisted by five or six army nurses and from fifty to sixty medical detachment enlisted men. When first activated in July 1944 SCU 1960 had had thirty officers, fifty-nine nurses, and 435 enlisted. By June 1945 the numbers had increased to 122 officers, 90 nurses, and 1,700 men.
The War in the Pacific came to a bitter close on August 14, 1945. The previous seven months had witnessed an explosion of activity at Letterman General Hospital, and there was the promise of even more to come. In February the Fog Horn reported that the hospital would expand to 3,500 beds and that up to two companies of WACs and a WAC band would join the command. Since the 1920s a chapel on the second floor of one of the administrative buildings had served the hospital. Wheelchair patients had no access to it. In August the hospital unveiled plans for a new chapel along with other construction.
Areas A and B, by now referred to as the Crissy Annex, underwent conversion beginning in the spring to facilities for hospital patients. (The train unit personnel moved to Area B.) Ready in September, Crissy Annex was a self-contained unit having a theater, post exchange, chapel, library, arts and skills center, and accommodations for 900-1,000 patients.
Letterman now looked forward to caring for former American prisoners of war at the Annex. The first of these men arrived at San Francisco on September 2. By the end of the year the hospital had processed 3,780 of these people.
Letterman's annual report for 1945 announced a stunning record of accomplishments. The Crissy Annex hospital had become a fully operating facility. Letterman's main function now was that of a debarkation hospital for the Pacific Theater. For patients too ill to travel farther, Letterman offered general hospital care, in addition to definitive care for patients from the local area. Of the 3,500 beds, 1,825 were strictly reserved for severe cases, 775 for ambulatory convalescents, and 900 in the Crissy Annex for debarkees.
During the year no fewer than 76,313 patients entered Letterman General Hospital and the annexes. Of these, ninety-two had died. At the end of the year less than 2,000 remained.
In March 1945 so many patients awaited evacuation by rail that Letterman had to set up additional wards at the Presidio of San Francisco and Fort Cronkhite in Marin County. In May thirty-eight trains evacuated 9,000 patients. The largest daily count occurred October 20, when 1,862 patients were admitted. That month the hospital held 10,000 patients, half of them freed prisoners of war. During the year 209 ships had arrived bearing 56,433 sick and wounded, with another 7,659 arriving by air. All told, 304 trains had departed bearing 60,425 patients.
One account summarized the war years' admissions:
In November 1945 Letterman created the Neurology and Neurosurgery sections. In December the hospital was designated a center for general surgery, neurosurgery, orthopedic surgery, general medicine, closed ward neuropsychiatry, open ward neuropsychiatry, neurology, x-ray therapy, and radium therapy, in addition to the continued processing of debarking patients. The year 1945 concluded with a visit from the war hero and former prisoner of war Lt. Gen. Jonathan Wainwright.
A discussion of Letterman's wartime activities would be incomplete without mention of its prisoner of war camp. In 1941 a small annex of mobilization-type buildings had been addedto the east side of Annex A. It consisted of five barracks, two combination administration and storehouse buildings (orderly and supply rooms), a 250-man mess hall, and a recreation building. In 1944 Letterman converted four of these buildings into a stockade to house Italian prisoners of war who remained "uncooperative" when, after the fall of Italy in 1943, the majority of Italian prisoners of war became "co-belligerents" and cooperated with the Allied forces.
On January 4, 1945, 178 Italian prisoners of war arrived at Letterman to spend the next twelve months in the stockade at Annex A. The four buildings two 2 story barracks, T272 and T276; the prisoner of war headquarters, supply room, and day room, T274; and the kitchen and mess hall, T275 - were surrounded by a barbed wire fence enclosing a compound 125 feet wide and 250 feet long. The American guard was composed of three officers and twenty-two enlisted men. The Italians had their own organization consisting of the administrative overhead and the laborers. Their function was simply to furnish labor to Letterman General Hospital.
When the Italians left for their homeland on December 15, a detachment of 150 German prisoners of war replaced them (Germany had surrendered on May 7). Little is known about these men's activities. They departed Letterman on June 21, 1946, bound for the New York Port of Embarkation. The Army promptly inactivated the camp.
With the return to peace Letterman's patient load declined rapidly, but not down to the pre-war level. In 1946 the hospital admitted 22,150 patients (22 percent were battle casualties) and the number of authorized beds dropped from 3,500 to 2,525. The Army inactivated the hospital's 402d WAC Band. By the end of 1946 all the Hospital Train personnel moved back to Area A and the hospital turned Area B back to the Presidio. Area A, still called the Crissy Annex hospital, also housed convalescents, the Separation Detachment, and any overflow from the main and East hospitals. The Catholic Church regained control of the Dante Annex in June 1946, although army nurses retained their quarters there for the time being.
Letterman reorganized its activities into
"centers" amputation, hand plastic, orthopedic,
neurosurgical, and tumor. In June the hospital transferred from
under the Ninth Service Command back to the control of the Army's
Surgeon General. Another general, Dwight D. Eisenhower, who led
the Allied armies in Europe, visited the hospital that year, meeting
some of the wounded veterans. With the coming of peace, discussion
renewed concerning constructing a new hospital to replace Letterman
now described as "antiquated." 
Army nurses finally received permanent commissions in the Regular Army in 1947 and the chief of the Army Nurse Corps was promoted to the temporary rank of colonel. Adequate quarters for nurses at Letterman, however, continued to be a problem. The hospital had an authorization for 266 nurses at this time of whom 242 were present for duty. Thompson Hall and other spaces had only 201 single rooms for female officers and that included forty-five rooms four miles away that the Army leased in the city.
The annual report for 1947 shed light on the hospital's Special Services Branch that provided recreation, entertainment, and information for all personnel. It operated the East Hospital Service Club, the library, tackle shop and fishing pier (the old Presidio wharf), and the former army mine layer L-101, now used by fishing parties. It also ran the radio station KLAH. Special Services cooperated with Physical Reconditioning in operating the gymnasium, swimming pool, and bowling alleys. Crissy Annex also had a service club as well as a theater and chapel. The number of patients at Letterman in 1947 further declined, to 14,300. 
Letterman celebrated the fiftieth anniversary of the hospital in 1948. The number of authorized beds dropped slightly this year to 2,185. Patients filled most of them, the number admitted coming to 15,053, of whom 235 died. The annual report gave an interesting breakdown on the patients:
January 1, 1948-December 31, 1948
1. James A. Wier, "Letterman's Fascinating History;" J.V.D. Middleton, in "Letterman General Information;" Willard H.S. Mattison, a portion of his account, undated but ca. September 1898, in H.H. Rutherford, History of the U.S. Army General Hospital, Presidio of San Francisco, California (1905). Some documents give Mattison's name as Matthews. It is "Mattison" in the Post Returns, December 1898, Letterman General Hospital, Roll 973, Microcopy M617, NA.
2. Mattison; Isabella E. Cowan served as the first chief nurse. During the Spanish-American War more than 1,700 women nurses were employed on contract in both general and field hospitals. Edgar Erskine Hume, Victories of Army Medicine, Scientific Accomplishments of the Medical Department of the United States Army (Philadelphia: J.B. Lippincott, 1943), p. 28.
3. Rutherford, History, quoting a letter by Colonel Middleton, dated May 25, "1898," actually 1905.
4. Another Girard, Joseph B., had been the Presidio post surgeon, 1894-1896.
5. Wier, "Letterman;" War Department, GO 182, December 1, 1898; Middleton, "Letterman;" Anon, "Brief History of Letterman," p. 5, quoting Girard; Anon, "The History of Letterman General Hospital Published in 1919;" and Rutherford, History, p. 7.
6. Rutherford, History, pp. 70-81.
7. Anon, "Brief History of Letterman," p. 5; CO, PSF, March 22, 1900, to Department of California, Letters Sent, PSF, RG 393, NA; General Orders 13, April 30, 1900, General Orders 1898-1903, PSF, RG 393, NA; Listening Post, History of Letterman, p. 5; Secretary of War, Annual Report 1900, vol. 1, pt. 3, p. 239; Rutherford, History, pp. 86 and 100.
8. Originally designated building 21, the commander's quarters, now 1000, cost $10,000. In the 1920s it underwent renovations costing $5,000 and by 1931, $9,000 more. In 1930 the front porch was enclosed. Until World War I the exterior was cream in color; at that time it became white.
9. Department of California, May 13, 1901, to CO, PSF, Register of Letters Received April-June 1901, PSF, RG 393, NA; Rutherford, History, pp. 126-139.
10. F.J. Hughes, "Letterman Army Hospital" (1953); "History, Letterman Army Hospital," 1951; Rutherford, History, pp. 150-175.
11. Rutherford, History, pp. 179-194. The Presidio post hospital continued to be staffed and morning sick calls continued to be administered there. Soldiers needing hospitalization were sent to the general hospital.
12. Ibid, p. 207.
13. Ibid, p. 211.
14. Ibid, pp. 214-238.
15. G.H. Torney, Rules and Regulations for U.S. Army General Hospital Presidio of San Francisco, Cal. (n.d., but ca 1905); Rutherford, History, pp. 55-56.
16. Gordon Thomas and Max
Morgan Witts, The San Francisco Earthquake (New York:Stein
and Day, 1971), pp. 159-161; W. Stephenson, April 20, 1906, to
Letters and Endorsements, Medical Department 1904-1906, PSF, RG 393, NA.
17. Torney served at San
Francisco until 1908. He was reappointed Surgeon General in 1913
but died unexpectedly of broncho-pneumonia. When the new Letterman
Hospital was dedicated in 1969, the Army named the general assembly room in his honor. Ashburn, Medical Department, pp. 234 and 293; Lawrence Kinnard, "History of the Golden Gate and its Headlands," typescript 1962 and 1967, pp. 320-322; Booklet, "Dedication Ceremony, 14 February 1969, Letterman General Hospital, San Francisco," p. 3.
18. Fog Horn, April 14, 1956.
19. Anon, "Brief History of Letterman," p. 8; W.H. Harts, "Report Upon the Expansion and Development of the Presidio of San Francisco," General Correspondence 1890-1914, OQMG, RG 92, NA, p. 16.
20. Earle K. Stewart and Kenneth S. Erwin, An Untitled History of the Presidio of San Francisco (1959), p. 85; Webster's American Military Biographies; P.M. Ashburn, A History of the Medical Department of the United States Army (Boston: Houghton Mifflin, 1929), pp. 78-80; Sanford E. Leeds, "Jonathan Letterman: Soldier, Doctor, and Coroner of the City of San Francisco," Salvo, California and the American Civil War (Spring 1990), pp. 28-31; Hunt, The Army of the Pacific, pp. 268-269; U.S. War Department, General Orders 152, November 23, 1911. Maj. Gen. Leonard Wood, Chief of Staff, U.S. Army, formerly an assistant surgeon at the Presidio of San Francisco, signed these orders.
21. H.B. McIntyre, August
25, 1910, to QMG; Col. F. Von Schrader, March 1, 1911, Inspection
of U.S. Army General Hospital, both in General Correspondence
OQMG, RG 92, NA
22. Von Schrader, Inspection, 1911; Ashburn, History, p. 233.
23. Report of the Surgeon General, 1916, to the Secretary of War, Letterman General Hospital, RG 112, NA-Pacific Sierra Region.
24. Anon, "A Brief History of Letterman," p. 8; Letterman General Hospital, Annual Report, 1919, General Historical Data, Letterman, RG 112, NA - Pacific Sierra Region.
25. At the beginning of World War I the Army Nurse Corps had 403 nurses. Eighteen months later the figure stood at 21,000.
26. F.J. Hughes, "Letterman Army Hospital," August 1, 1953, in Presidio Army Museum; "The History of Letterman General Hospital Published in 1919." Five other general hospitals received more amputation cases than Letterman: Walter Reed (1,189); General Hospital 3, Colonia, New Jersey (168); General Hospital 6, Fort McPherson, Atlanta, Georgia (91); General Hospital 26, Fort Des Moines, Iowa (161); and General Hospital 29, Fort Snelling, Minnesota (102). Despite the relatively small number of amputees treated, Letterman made significant advances in the development of orthopedic devices at this time, "It was so effective in the rehabilitation of amputees that the "Letterman Leg," developed at the hospital, was used for more than twenty years." Weed, Medical Department, vol. 5 Military Hospitals in the United States , pp. 176-177; Stephen A. Haller, Letterman Hospital, "Work for the Sake of Mankind," A Summary of Its Significance and Integrity (April 1994), pp. 3 and 7.
27. Frank W. Weed, The
Medical Department of the United States Army in the World War,
Military Hospitals in the United States (Washington: Government
1923), 5:490-491; Civilian employees in the hospital in 1919 numbered 187. Letterman, General Historical Data, RG 112, NA - Pacific Sierra Region.
28. Listening Post, History of Letterman, p. 8; San Francisco Examiner, October 10, 1919. Listening Post was an in-house newsletter during World War I.
29. The Medical Department of the United States Army in the World War, vol. 10, Neuropsychiatry (Washington: U.S. Government Printing Office, 1927), pp. 128-130.
30. Weed, Medical Department, 5:176-177 and 190. General Hospital 21 became Fitzsimmons Army Medical Center.
31. Weed, The Medical
Department, 5:491; Anon, A Brief History of Letterman,
p. 9; "History, Letterman General Hospital, June 27, 1951,"
General Historical Data,
Letterman, RG 112, NA - Pacific Sierra Region.
32. Anon, "Brief History of Letterman," pp. 9-10; "History, Letterman Army Hospital, 1951," and Letterman, Annual Report 1923, both in General Historical Data, RG 112, NA - Pacific Sierra Region; The Officer's Guide (Harrisburg: Military Service, 1951), p. 31; Joseph D. Harrington, Yankee Samurai (The Secret Role of Nisei in America's Pacific Victory) (Detroit: Pettigrew, 1979), p. 60. Japan had been the most generous of foreign nations when San Francisco experienced the 1906 earthquake
33. Ashburn, History of the Medical Department, p. 216; DeWitt, February 25, 1929, to the Surgeon General, Master Planning Files 1935, Letterman, RG 112, NA-Pacific Sierra Region. DeWitt served as Letterman's commanding officer twice, 1927-1931 and 1940-1942. It should be noted that construction of the Panama Pacific International Exposition in the lower Presidio in 1914 had eliminated the cavalry stables and all marshes and lagoons that remained.
34. Office of the Construction Quartermaster, Fort Mason, October 7, 1931, Letterman files, RG 112, NA-Pacific Sierra Region. The third 1931 ward cannot now be identified. The concrete building 1013, containing a 22-bed ward and a receiving office, was constructed in 1933.
35. San Francisco Chronicle,
April 24 and June 25, 1938; Col. J.M. Graham, Annual Inspection
of Construction, San Francisco and Vicinity, May 14, 1938,
OQMG, RG 92, NA. Unfortunately for this report, Graham did not provide a breakdown of the funds. He probably had other matters on his mind.
36. J.H. Veal, Completion Report on Temporary Housing, October 28, 1941, RG 77, NA.
37. Anon, "A Brief History of Letterman General Hospital," pp. 10-11; F.J. Hughes, "Letterman Army Hospital," 1953.
38. Annual Report of Letterman General Hospital, 1941, pp. 2-9.
39. Annual Report of Letterman General Hospital, 1942.
40. Fog Horn, August 21-December 25, 1943. The first WAC, Lt. Elizabeth A. Rose, arrived at Letterman in February 1944.
41. Anon, "A Brief History of Letterman General Hospital," p. 12; J.H. Mackin, October 9, 1965, to Col. Boeckman, Letterman, RG 112, NA-Pacific Sierra Region; Annual Report of Letterman General Hospital, 1943. The fire station is no longer extant. Structure 1149 today is the Gorgas Avenue entrance to the Presidio.
42. Anon, "Brief History of Letterman," p. 13; Army and Navy Journal, July 8, 1944; A.H. Schwichtenberg, November 1, 1948, to CO, Letterman, RG 112, NA-Pacific Sierra Region; Annual Report of Letterman General Hospital, 1943 and 1944.
43. Anon, "A Brief History of Letterman General Hospital," p. 11; "History, Letterman Army Hospital, June 27, 1951," RG 112, NA; Fog Horn, April 8 and May 27, 1944, and February 17 and June 16, 1945; Col. H.H. Galliott, December 22, 1944, to District Engineer, San Francisco, Letterman, RG 112, NA-Pacific Sierra Region.
44. Fog Horn, February
3, April 7 and 14, July 28, August 4 and 11, September 8, and
December 1, 1945; Annual Report of Letterman General Hospital,
1945; Anon, "Brief
History of Letterman General Hospital," pp. 14-15; Stewart and Erwin, [AHistory of the Presidio], p. 73. Wainwright had been assigned to the Presidio of San Francisco in 1912 but had never joined. He went to Yellowstone National Park instead.
45. Annual Report of Letterman General Hospital, 1945 and 1946; Arnold P. Krammer, "German Prisoners of War in the United States," Military Affairs, 40: 68-72.
46. Anon, "Brief History of Letterman," p. 15; Fog Horn, June 8, 1946; The Star Presidian, July 5, 1963; Annual Report of Letterman General Hospital, 1946.
47. Anon, "Brief History of Letterman," p. 15; Extract from the Annual Report of Letterman General Hospital, 1947; The Officer's Guide, p. 32; Maj. E.A. Paxon, Letterman, February 16, 1947, to Surgeon General, RG 112, NA-Pacific Sierra Region. Buildings in the Crissy Annex Hospital, January 1, 1947:
T-232, commanding officer, adjutant, message center
T-233, unit surgeon, chief nurse, dispensary, dental clinic
T-234, evacuation office, transportation office, American Red Cross
T-253, 256, and 257, patients' recreation
T-259, theater and chapel
T-240, patients' clothing room
Wards: T-235, 241, 242, 243, 244, 245, 246, 247, 248, 249, 250, 251, 252, 255, 258, and 259.
The former prisoner of war compound had not yet been added to Crissy Annex hospital. Office of the Chief of Engineers, Washington, Entry 393, Box 197, RG 77, NA.
48. Annual Report of Letterman General Hospital, 1948.
49. F.J. Hughes, "Letterman
Army Hospital," 1953; James H. Mackin, "How Did
the New Letterman Come About?", ca. 1965; Anon, "Brief
History of Letterman," p. 15; Annual
Report of Letterman General Hospital, 1949.
51. Fog Horn, September 1, 8, and 15, 1951; Annual Report of Letterman Army Hospital, 1951. Secretary Acheson paid a short visit to Letterman on September 8.
52. Annual Report of Letterman Army Hospital, 1952; Fog Horn, June 28, 1952; Anon, "Brief History of Letterman Hospital," p. 16.
53. J.H. Mackin, "How Did the New Letterman Come About?"; "Buildings to be Demolished for New Letterman General Hospital," February 18, 1965.
54. L.L. illegible, September 11, 1956, to Deputy CO, PSF; "Analysis of Existing Facilities," Letterman, August 19, 1957; Col. C.C. Britell, March 26, 1957, to Lt. Col. Mudgett, Letterman, all in RG 112, NA-Pacific Sierra Region; Col. J.H. Mackin, April 23, 1965, Memo for the Record; Star Presidian, September 13, 1957; Fog Horn, December 1, 1948.
55. "1970 Historical Information Report, Letterman General Hospital;" Brig. Gen. C.H. Gingles, January 26, 1966, to Lt. Gen. J.L.Richardson, Sixth Army; and Gingles. February 26, 1968, to Reagan, Letterman, RG 112, NA-Pacific Sierra Region.
56. Two of the nine later faced charges of collaborating with North Vietnamese. Maj. J.D. O'Brien, April 16, 1973, to CO, U.S. Army Audio-Visual Agency, Letterman, RG 113, NA-Pacific Sierra Region.
57. "Dedication Ceremony, February 14, 1969, Letterman General Hospital;" "Annual Historical Information Report," Letterman 1978-1979; Folder, "Letterman General Hospital, Info Summary New LGH;" Voucher Files, 1972, Master Plans Office, DEH, PSF; San Francisco Examiner, December 22, 1973; G.K. Provoo, PAO, Letterman, July 29, 1976.
58. "Western Medical Institute of Research (WMIR) Fact sheet," August 6, 1971; Anon, "History of Major Tenants Presidio of San Francisco;" Fog Horn, September 16, 1971; U.S. Army, Final EIS.
59. Gordon Chappell, NPS,
telecom with Maj. David Hernandez, March 2 and 7, 1995, and with
Col. Michael Brenna, March 7, 1995; Letterman U.S. Army Health
Recognition Day Ceremony, June 14, 1994; List of closures or continuations, PSF, 1995.