At the Battle of Wilson’s Creek, Missouri, in August 1861, the wounded could not be moved for six days due to the lack of ambulances. In November of that same year, Brig. Gen. Ulysses S. Grant abandoned his wounded at Belmont, Missouri, because there were no ambulances. In 1861, Lawson was replaced by Dr. William Hammond, who appointed Dr. Jonathan Letterman as surgeon general of the Army of the Potomac. Letterman immediately set about creating an ambulance corps.
Each army corps now acquired its own organic medical transport. Each division, brigade, and regiment had its own medical officer who answered to the corps’ medical officer responsible for coordination at all levels. The chief surgeon within each division controlled the ambulance corps. Each regiment was assigned three ambulances and a complement of drivers and litter-bearers, and each division had its own ambulance train of 30 vehicles. The ratio of ambulances to men averaged 1 to 150. Only medical personnel were permitted to remove the wounded from the battlefield, a regulation designed to reduce the manpower loss that often resulted when several men left the line to transport their wounded comrades to aid stations. Ambulance wagons were removed from control of the quartermaster and used only for medical transport. They were posted near the front of the column to be within easy reach once a battle began.
Transporting the Wounded: Letterman’s Ambulance System
The first test of Letterman’s ambulance system came at the Battle of Antietam in September 1862. Union forces alone suffered 10,000 wounded scattered over a six-mile area. The system reached and evacuated most of them within 36 hours. A month later at Fredericksburg, the system worked so well that the wounded piled up at aid stations faster than they could be treated. Within 12 hours, all 10,000 wounded had been located, transported, and cleared through the aid stations. Letterman’s ambulance system was integrated into the larger network of casualty evacuation from field hospitals at the front to general hospitals in the rear. Railroads evacuated casualties from collection points behind the battlefields to the general hospitals. By the end of the war, Northern railroads had transported 225,000 sick and wounded men from the battlefields to the general hospitals.
The Union medical service also used coastal steamers and river steamboats under the control of the medical corps to transport the wounded. In 1862, the Union Army contracted for the use of 15 steamboats on the Mississippi and Ohio Rivers and 17 seagoing vessels for use along the Atlantic coast. In the last three years of the war, 150,000 casualties were transported by boat to the general hospitals. The first use of a hospital ship was at the Battle of Fort Henry in February 1862, when the City of Memphis transported 7,000 casualties to hospitals along the Ohio River. Also in 1862, the navy purchased the D.A. January as its first hospital ship. By the end of the war, January had transported 23,738 casualties on the Ohio, Missouri and Illinois rivers, with a mortality rate of only 2.3 percent, significantly lower than the rate in land-based hospitals. The first naval nurses in America, the Catholic order of the Reverend Sisters of Mercy, served aboard Red Rover, tending the wounded after the siege of Vicksburg, Mississippi. In March 1862, Hammond recommended that all Union armies adopt Letterman’s system, which until then had been limited to the Army of the Potomac. Congress approved the recommendation in March 1864. It was only at the end of the war, however, that Letterman’s reforms were fully implemented.
Reforming the Field Hospital System
Letterman also changed the structure of the field hospital system by turning regimental hospitals into frontline aid stations. Treatment of the wounded at these stations was limited to control of bleeding, bandaging wounds, and administering opiates for pain. This allowed medical officers to hold the slightly wounded there and return them to the line, reducing manpower loss due to needless evacuation. Behind the aid stations, Letterman created mobile surgical field hospitals. These hospitals were the critical link between the frontline aid stations and the rear-area general hospitals. The system was tied together by the field ambulance corps, railways, and hospital ships.
The general hospitals were located in major cities along established water and rail routes. By 1862, a building program was undertaken in the North to construct additional hospitals. A year later, the Union Army had 151 general hospitals with 58,715 beds ranging in size from small facilities of 100 beds to the Mower General Hospital in Philadelphia with 4,000 beds. Some of these hospitals became treatment centers for medical specialties such as orthopedics, venereal disease, and nervous disorders. St. Elizabeth’s in Washington, D.C., became the first military psychiatric hospital in the country.
Another of Letterman’s innovations was the establishment of a modern medical supply system that worked well under field conditions. Until this reform, medical supplies and equipment were obtained from the quartermaster through the usual supply system. This often led to medical units not receiving adequate supplies. Letterman established basic medical supply tables, equipping all medical units from regiment through corps with basic loads of medical provisions. Each unit was to carry with it supplies for 30 days. A medical purveyor accompanied the army and was responsible for continually replenishing the medical supplies of each unit.
13,ooo Physicians and Surgeons
Most surgeons in both armies were commissioned by state governors to provide medical support for the regiments raised by the states. With few standard licensing procedures for medical certification, it is not surprising that basic competence was a major problem. Few of the physicians entering the state regiments had surgical training. As the war dragged on, however, many of the marginally competent physicians and surgeons became excellent practitioners as a result of their battlefield experience.
About 13,000 physicians and surgeons served with the Union Army. Of these, 250 Regular Army surgeons and assistant surgeons were appointed by Congress to serve as staff and administrators. Some 547 brigade surgeons were commissioned by Congress to assist the corps of regular surgeons. Another 3,882 regimental surgeons and assistants were appointed by governors to state regiments. These surgeons usually served in the aid stations and mobile field hospitals. The army hired 5,532 contract surgeons, mostly civilian doctors, to staff the general hospitals. An additional 100 doctors staffed the Veterans Corps to provide aid to the disabled, and 1,451 surgeons and assistants served with the 179,000 Black troops in 166 regiments. One of the Union surgeons was Mary Edwards Walker, the first woman in American history to hold such a position. Women mostly served as nurses, however. In the North, 3,214 female nurses served in military hospitals under the control of Dorothea Dix, who had been appointed as superintendent of Women’s Nurses. One of Dix’s nurses, Clara Barton, went on to found the American Red Cross. The special place of women in Southern culture militated against using women in military hospitals. Consequently, female nurses were not used there on a large scale.
With the end of hostilities, the Union Army was demobilized and along with it the military medical service. By the end of 1866, the Union Army had been reduced to a force of only 30,000 men. The army and its skeleton medical corps were scattered among the 239 military posts throughout the country. By 1869, the entire medical service corps consisted of only 161 medical officers. Most military posts had no surgeons at all, and they were forced to rely on contract physicians for medical support. Only 282 surgeons were available to the military. Letterman’s system for dealing with mass casualties disappeared virtually overnight.
The Confederate Medical Corps
In general, the Confederate medical service was organized and operated very much like the Union system, although it suffered more from shortages of personnel and equipment that magnified its shortcomings. The total number of medical officers in the Confederacy was 3,236, of which 1,242 were surgeons and 1,994 assistant surgeons. The Confederate naval medical corps had only 107 medical officers, including 26 surgeons and 81 assistant surgeons.
The South’s shortage of physicians was to some extent self-inflicted. For reasons that remain unclear, all medical schools in the South with the exception of the University of Virginia were closed at the start of the war, cutting off the Confederate armies from an invaluable source of trained medical personnel. Moreover, the Confederate surgeon general established unrealistically high qualifications for physicians wishing to join the medical service, causing still more shortages. Worse yet, he examined those physicians already in the medical corps for competency, forcing significant numbers to resign. The Confederacy was never able to provide adequate numbers of surgeons and other physicians to deal with the heavy casualties it suffered on the battlefield.
Deficiencies in Confederate Supplies
The Confederate ambulance service was never adequate and suffered from a chronic shortage of wagons and other transport. In 1863, Confederate medical officers complained that there were only 38 ambulances in the entire Army of the Mississippi. The situation worsened as the war continued. In 1865, not a single ambulance could be found in the combat brigades of the armies of West Virginia and East Tennessee. The shortage of ambulances forced the South to make greater use of steamboats and railroads to transport its wounded. But the undeveloped nature of the Southern railroad system resulted in a shortage of efficient track routes over which to transport casualties. Small 100-bed hospitals were constructed at rail junctions to deal with the problem.