From: history.amedd.army.mil
Soldiers wounded in July 1861 at First Bull Run had to fend for themselves because there was a "pitiful absence of provision for the wounded." Ambulance drivers were generally either impressed soldiers or wagon and hack drivers pulled from the streets of Washington, and rumors of forthcoming roundups sent drivers fleeing from the city. Surgeons reported drivers who were insubordinate or drunk or who appropriated space inside the ambulances intended for blankets and food. As to the vehicles themselves, the Army had been forced to round up commercial wagons and hacks to serve as ambulances.
Second Bull Run, the following summer, demonstrated that little had improved after a year of combat operations. Army surgeons at Centreville, Virginia, operated on casualties who lay without blankets on the bare earth. Surgeon Thomas A. McParlin, medical director of the Federal Army of Virginia, wrote that Americans should follow the lead of the Europeans. "A well-organized regularly established ambulance corps would have been a blessing." The need was felt in other theaters as well. In Missouri, Surgeon John H. Brinton reported that the lack of adequate evacuation capability had caused abandonment of the wounded. Those who were able crawled to whatever cover they could reach; many were captured.
The absence of personnel dedicated to the evacuation mission required commanders to use combat soldiers to remove the wounded from the battlefield, further reducing the Army's fighting strength. Not surprisingly, the speedy return of soldiers who left the battlefield to assist the wounded was problematic. A Confederate report echoed the universal complaint of line commanders: "If any from the ranks are drawn from the fight to carry off the wounded, they never return until the fight is over, and thus three are lost to the company instead of one wounded."
Confederate Army medical organization mirrored the Union's, as leadership of the Southern medical department was in the hands of former Union medical officers, including Confederate Surgeon General Samuel Preston Moore. While the Confederate medical manual was based on U.S. Army regulations, its field medical doctrine included the European concept of a sanitary corps with officers and soldiers designated for evacuating the wounded. Those soldiers would serve in the front lines, where "not infrequently they lose their lives in accomplishing their benevolent tasks."
A variety of ideas for an ambulance system surfaced in the Union Army. One was for an ambulance company of two lieutenants and sixty-seven soldiers for each corps, with the entire ambulance organization under command of a medical officer. A variation of that idea was an ambulance company for each division. The Sanitary Commission proposed an ambulance regiment for the Army of the Potomac.53 Some medical officers adopted partial remedies. The Army of the Potomac published an order written by Surgeon Charles S. Tripler, the medical director, detailing twenty-five soldiers per regiment as an ambulance corps under the supervision of the brigade surgeon. Tripler required the medical officers to train the medical soldiers on a daily basis and sent his medical inspectors out to check on the instruction. The inspectors also checked the number and kind of ambulances, their condition, and whether the soldiers and vehicles were employed solely in medical evacuation.54 In the West, Surgeon Brinton organized the regimental ambulances into ambulance trains, each under a noncommissioned officer "whose business it was to see that a continuous line of wagons should ply between the scene of conflict and the general hospitals."
Brig. Gen. William A. Hammond, a 34-year-old officer, replaced General Finley as surgeon general in April 1862. Hammond, at six feet, two inches in height, 250 pounds, possessing a booming voice and an aggressive and abrasive personality, was by no means a shrinking violet. Backed by the Sanitary Commission, he had been appointed by President Lincoln over Secretary of War Stanton's objections and immediately incurred the wrath of that powerful man. But at first inertia rather than hostility was Hammond's chief problem. Hammond quickly focused on the need for a coordinated evacuation and treatment capability and recommended establishment of an ambulance corps. However, Maj. Gen. Henry W. Halleck, the Army's general-in-chief, rejected the proposal, declaring that ambulances would add to the problem of large combat trains, the ever-present "tooth-to-tail" argument. Halleck also feared that the presence of medical personnel on the battlefield would spread panic among soldiers who might view them as harbingers of suffering and death. Hammond tried again in September, pleading: "I only ask that some system may be adopted." He lamented that 600 wounded soldiers still lay unattended on the battlefield of Second Bull Run, dying of starvation and neglect. His pleas were again rejected.
The surgeon general persisted, making the establishment of a permanent hospital and ambulance corps the highest priority in his annual report for 1862. He argued that it would enable the Medical Department to enlist soldiers specifically for hospital nursing duties and for the operation of field ambulances, rather than having to depend on the unreliable practice of detailing soldiers from other branches. However, he was unable to get War Department support for his proposal that year.
The Letterman Plan
That same year, however, Hammond selected Maj. Jonathan Letterman as medical director for the Army of the Potomac. What the surgeon general was blocked from doing for the Army, the 38-year-old Major Letterman was able to do for the Army's largest combat formation by putting together an ambulance corps as part of a unitary medical support system. Letterman, a veteran officer with thirteen years in the Army and field medical experience in the campaigns against the Seminole, Navajo, Apache, and Ute Nations, reported on 1 July 1862 to Maj. Gen. George McClellan in Virginia at Harrison's Landing on the James River. Here the Seven Days Battle was in progress and casualties were mounting. Letterman inherited what McClellan described as a collapsed situation: "Supplies had been almost exhausted or necessarily abandoned or destroyed, and the medical officers [were] deficient in numbers or broken down by fatigue."
Letterman, a man of "remarkable energy and ability," moved quickly to establish an integrated medical capability based on three principal elements: a coordinated system of casualty evacuation from the point of wounding back through the division rear; organization of medical logistics, including supply tables and transportation; and establishment of division field hospitals as part of the evacuation chain. Supported by his commander, he set forth his plan in Army of the Potomac General Orders 147, 2 August 1862, which placed all ambulances under the control of the medical director. Captains commanded the corps-level ambulance organization, first lieutenants commanded at the division level, second lieutenants led at the brigade level, and sergeants at the regimental level. Those ambulance officers were progenitors of present-day Medical Service Corps ground and air ambulance officers.
Letterman's use of nonphysician officers to command ambulance units represented a significant shift in Army Medical Department policy. He intended to relieve the physicians from duties that distracted them from their primary mission of patient care, especially in combat. Letterman knew that at such times the needs of the wounded "prevented any supervision [of ambulances], when supervision was, more than at any other time, required."
Another important feature of Letterman's plan was the assignment of vehicles to the direct control of the medical director. Two-patient ambulances, each with two privates and a driver, were allocated on the basis of three for each infantry regiment, two for each cavalry regiment, and one for each artillery battery. Two supply wagons were assigned to each division's ambulance corps. The use of those vehicles was strictly restricted to the Medical Department. Only medical personnel were permitted to accompany the sick and wounded to the rear, and only bona fide patients were allowed to ride in the ambulances. A Union chaplain described Letterman as "virtually a medical dictator."
Letterman implemented his plan later in the year as the Army of the Potomac fought in Virginia and then moved north into Maryland. It was only partially in place for the Battle of Antietam in September 1862, where, during twelve hours of combat, casualties from both sides rose to over 22,700. McClellan's casualties mounted to 25 percent of the soldiers who went into action. On the Union right wing, where Letterman's plan was in place, casualties were rapidly evacuated and all wounded within the Union lines were removed during the night. Casualties on the left, where the new evacuation plan was not in place, were not removed until the following night.
Full implementation of Letterman's plan occurred three months later, at Fredericksburg. There, Letterman reported that the ambulance corps had begun to evacuate the wounded after dark on 13 December and by daylight had removed all the casualties except some twenty soldiers who were within the Confederate lines. Surgeon General Hammond, visiting the Army of the Potomac, was pleased with the results; even more important, commanders began to recognize the advantages of a system that reduced straggling as it saved the wounded.
General McClellan wrote that Letterman's ambulance corps decreased the number of combat soldiers pulled from the battlefield, "one of the great desiderata for our armies." The Army of the Potomac continued to benefit from its unified medical support capability in battles after Antietam. There were 14,193 wounded Union soldiers at Gettysburg, 1-3 July 1863, yet there were no wounded left on the battlefield within Union lines by early morning the day after the battle. Letterman reported: "I know of no battlefield from which wounded men have been so speedily and so carefully removed." By the summer of 1864 the Army of the Potomac's ambulance corps numbered 800 ambulances with 66 officers and 2,600 enlisted soldiers. The medical director's central control provided the flexibility necessary to tailor the medical system to meet changing requirements. Capt. J. G. Pelton, chief of II Corps ambulances, said he could easily shift vehicles and medical soldiers throughout his corps area of operations so as to place the evacuation capability where it was most needed.
Union Army units that failed to adopt Letterman's innovations continued to experience difficulty in battlefield evacuation. Surgeon Glover Perin, upon becoming medical director of the Army of the Cumberland in February 1863, found an inefficient ambulance service. He attributed this to the absence of commissioned ambulance corps officers, the lack of attendants, and the control of ambulances by the Quartermaster Department. He adopted a modified Letterman plan, but even with that in place the Army of the Cumberland left behind an estimated twenty-five hundred of its wounded at Chickamauga in September 1863. Surgeon Thomas A. McParlin, then medical director of the Army of Virginia, received a copy of Letterman's plan and submitted it to his commander, Brig. Gen. John Pope, but there was not enough time to implement it before Second Manassas. McParlin believed that Pope's army would greatly benefit from an ambulance corps. "The lessons of experience should not be disregarded, especially in matters of such transcendant importance. At such a time, a well organized, regularly established ambulance corps would have been a blessing."
Other armies agreed. The South was never able to field an evacuation and treatment system as sophisticated as the North's, but in Europe, French Army surgeons applauded the American innovation of placing the treatment and evacuation systems under complete medical control. As knowledge of Letterman's innovation spread, European armies proceeded to adopt his system.
A by-product of these innovations was the emergence of a small cadre of junior officers who understood the problems of medical evacuation. Those ambulance corps officers were often recognized for their achievements and valor. Letterman cited Capt. J. M. Garland for outstanding service in equipping the II Corps ambulance organization and for the care and diligence with which his soldiers removed the wounded at Antietam. Surgeon Henry S. Hewitt recognized Capt. S. Windecker, 103d Ohio Volunteers, for managing the Army of the Ohio evacuation system "in the most systematic and praiseworthy manner." Windecker's leadership had enabled Hewitt to keep just one physician with each regiment, while moving the others to the field hospitals where their medical talents could be pooled.
Lt. Henry Knight was cited for his courage under fire during the Union Army's disastrous assault at Fredericksburg in 1862. Capts. W. F. Drum, B. W. Baldwin, and J. G. Pelton of the Army of the Potomac won commendations for ambulance operations that were "well and gallantly performed." Lt. Joseph C. Ayer, chief of the 1st Division ambulances, estimated that his unit evacuated nearly six hundred soldiers during Fredericksburg, and in 1863 he reported that his ambulances evacuated 1,157 casualties in the Battle of Gettysburg. Letterman commended the ambulance corps for performing in a "commendable and efficient manner" at Gettysburg, on a day in which one ambulance corps officer and four privates were killed.
On 11 March 1864, Hammond's efforts and the success of Letterman's plan, backed by petitions and lobbying efforts, resulted in congressional action that established a permanent ambulance corps. The law authorized corps commanders to detail officers and enlisted soldiers to form their ambulance organizations and provided for the examination of candidates by boards of medical officers. As one citizens' committee put it, the Army should carefully screen the officer candidates because of the special trust it placed in them, and they should "at least equal the best of the fighting-men in gallantry." The War Department implemented the law in General Orders No. 106, 16 March 1864, a directive that also gave commanders the authority to create a distinctive uniform for members of the Ambulance Corps.
Despite his success, Letterman had grown tired. In December 1863 he asked for relief from "18 months of arduous and eventful duty." He was reassigned as Medical Inspector of Hospitals, Department of the Susquehanna. General Hammond, while successful in obtaining the Ambulance Corps legislation, had become further alienated from Secretary of War Stanton. In May 1864 he was dismissed from the service by a court-martial on charges trumped up by Stanton. Letterman resigned from the service at the end of the same year. The achievements of both lived on after them.
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