Dr. Jonathan Letterman and CW Medicine

From: featherfoster.wordpress.com

Evacuating the wounded from the battlefield could take days at the start of the American Civil War.

Dr. Jonathan Letterman is usually considered the Father of Battlefield Medicine.

Dr. Jonathan Letterman (1824-72) was an army surgeon who came from a distinguished medical family. During the 1850s, he was deployed at various locations “out west,” and learned firsthand the needs as well as the limitations of his profession. It also gave him ample time and opportunity to rethink a good many military medical procedures that had been entrenched since the Napoleonic Wars a half-century earlier.

At the beginning of the American Civil War, Dr. Letterman was appointed by the Surgeon General as the Medical Director of the Army of the Potomac. He was given the rank of Major. It was a fortuitous appointment. Jonathan Letterman was now in a position to put several of his unconventional (for the times) ideas into practice.

The Ambulance Corps Is Created

General George McClellan was an early and ardent advocate of Dr. Letterman ‘s approach to evacuation of casualties.

In 1861, the start of the Civil War, the system of retrieving wounded soldiers from the battlefield was inefficient at best. The army surgeons were in charge of the ambulances. The drivers and stretcher bearers were a motley assortment of non-combatants, i.e. buglers, drummers, cooks, etc. They were untrained, and in many cases, little more than children who would and did cave in under pressure and run from the field. It did not take very long before the army surgeons realized that they were overwhelmed with casualties and had neither the time nor facility to train their support underlings.

Special ambulance wagons were refitted with supplies and equipment to transport the wounded from the battlefield.

After the battle of Second Manassas (Bull Run) in midsummer, 1862, it took a week to remove the wounded from the battlefield. Many soldiers died unnecessarily whose lives could have been saved with nothing more than prompt treatment. Recognizing this gross ineffectiveness, General George B. McClellan, an ardent supporter of methods and training procedures, gave Dr. Letterman a free hand to employ whatever means he thought necessary to improve such poor medical service. Dr. Letterman had been thinking and rethinking such matters for a decade, and had many systems and changes in mind.

He immediately began organizing a well-trained and equipped Ambulance Corps, as an entity of its own. He designed special insignias for its members, which provided quick on-field recognition. It also gave the corps a sense of camaraderie amongst themselves and amongst the troops.

The Ambulance Corps was composed of non-medical personnel, but they would be trained and supervised by the army doctors. A chain of command was set in place to insure order rather than chaos. Each corps had a captain; each division a first lieutenant; each brigade a second lieutenant; and each regiment a sergeant. They would oversee all aspects of recovery from the field – including the care and maintenance of the ambulance wagons themselves.

The newly-created Ambulance Corp proved its value within months after it was established. Quick response likely saved hundreds of lives.

New ambulance wagons were properly equipped for the immediate care and transport of the wounded. It was a modified wagon well supplied with stretchers, kettles, lanterns, beef stock, bed sacks, and emergency medical supplies. The ambulance staff was recruited among rank and file soldiers.

Under Dr. Letterman’s system, ambulance personnel were specifically trained to lift and carry the wounded, and provide certain immediate treatment, such as applying tourniquets. They were also charged with cleaning, refitting and resupplying the ambulance wagons after a battle.

With proper training, a sense of its huge value and importance to the war effort, and most of all, lives saved by the timely removal of the wounded from the battlefield, the Ambulance Corps was able to provide quantifiable results in short order.

The Results of the Letterman System

When the Civil War began in 1861, no one was prepared for the horrendous number of casualties, both North and South. The original slap-dash measures of finding and evacuating casualties proved to be inefficient and humiliating to the army in general. Immediately after the Second Battle of Bull Run in the summer of 1862, (which took a week to remove the casualties) Dr. Jonathan Letterman was put in charge and in addition to organizing his Ambulance Corps, he also instituted a system for providing actual statistics regarding the evacuation of casualties.

The Battle of Antietam, September 17, 1862: 9500 casualties evacuated in twenty-four hours.

The Battle of Fredericksburg, December 13, 1862: 9000 casualties evacuated in twelve hours.

The Battle of Gettysburg, July 1-3, 1863: 14,000 casualties removed from the field by the morning of July 4.

So exceptional were the results of the Letterman System, that Congress mandated the system by law in 1864. Dr. Jonathan Letterman has rightly earned the title of “The Father of Battlefield Medicine.”

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Civil War Medicine: Dr. Letterman’s System Evolves

By Feather Schwartz Foster, 3-9-15

Dr. Jonathan Letterman had devised, implemented and had gained success with a well-trained ambulance corps.  Then he turned his attention to medical practices itself.

Civil War Doctors and their Equipment

By 1860s, medical practice in America had barely evolved since colonial times. In Europe, however, both Louis Pasteur and Joseph Lister were poised to revolutionize medicine with their concepts of bacteria, germs and antisepsis. Nevertheless it would be decades before those theories were accepted as science in the United States.

Dr. Jonathan Letterman, the Father of Battlefield Medicine, pioneered the Civil War Ambulance System and then turned his attention to arranging medical instrument kits and field hospitals.

During the Civil War, medical doctors with varying degrees of training and competency enlisted in the both North and South. In the South, which was desperately in need of any amount of medical expertise, all doctors were welcomed. In the North, however, there was a rigorous hierarchy of army surgeons, medical doctors, assistant doctors and even nurses. The animosity and friction it caused was understandable, but it was frustrating.

Dr. Jonathan Letterman, who had a decade of experience as an army surgeon out West, was not about to brave the shoals of in-fighting, especially since doctors were urgently needed. He was, however, prepared to implement two system to improve the mechanics of medical practice, both of which were readily executed and accepted enthusiastically by the Army itself as well as the doctors.

The Civil War Medical Kit

Dr. Letterman pioneered and devised a standardized medical kit of various instruments needed for immediate surgery. The instruments were interchangeable so they could be easily replaced due to loss or damage.

Most army doctors, whether from within the Army Corps itself or as private recruits, brought their own instruments at the start of the Civil War. Some of those instruments were antiquated. Some were in dire need of repair. Unsurprisingly, many were lost or damaged in transport and on the battlefield. A good many were inadequate to treat the types of wounds inflicted by the bone-shattering minie balls.

Most doctors brought their own instruments at the start of the Civil War. Many of them were antiquated, damaged or lost.

Dr. Letterman’s prior experience as an army surgeon had inspired him to develop a list of basic medical tools that he believed were necessary to treating battlefield casualties. He believed wholeheartedly that a standardized kit was essential, along with a fully equipped medical wagon-per-brigade. Then the instruments could easily be transported, and more importantly, replaced if and when needed. Every doctor would then be equipped with all the tools he needed to meet all possible situations.

These medical kits contained various sizes and shapes of knives, scalpels, forceps, bistouries (long, narrow knives for minor incisions), curettes for scraping and cleaning, and lancets for making punctures. In addition, there were tourniquets, bone saws, chain saws, sutures and bandages.

Each medical wagon was outfitted to contain seventy-six different medicines, dressings, medical books, and additional surgical instruments. They were further equipped with bedding, basins, vials, bedpans, basic food staples (hardtack and beef stock), kettles, plates, drinking vessels and spoons. When the extravagance of these supplies was raised, Letterman is said to have responded, “Lost supplies can be replaced, but lives lost are gone forever.”

Letterman’s Final Reform: The Field Hospital System

Shortly after the Second Battle of Bull Run (Manassas), Dr. Letterman introduced and implemented a system to provide a “dressing” station at the front, headed by one assistant surgeon from each regiment. Their purpose was to perform basic “triage”, and tend to immediate first aid and/or minor wounds.

The remainder of the medical staff would be organized into teams, and divisional field hospitals would be set up a few miles behind the lines. While people today are appalled by the lack of sanitation, it was a huge improvement over previous conditions.   With hundreds, and frequently thousands of casualties brought to these makeshift facilities, only the most skilled physicians would be permitted to perform surgery. It would be left to the others to dress wounds, handle the record-keeping, supply maintenance, etc.

Throughout the North, the precursor to today’s VA Hospitals were established for long-term care, which included battlefield illnesses and/or providing prosthetic limbs, etc. These would be solid permanent structures, rather than tents or makeshift facilities at the front.

While some doctors groused and complained that their experience was being slighted, both the Army and the senior medical professionals agreed that it was “a brilliant achievement in hospital management,” despite the lack of sanitation. Countless lives were no doubt saved.

Dr. Letterman’s models for Ambulance Corps, a standardized medical kit and wagon, and field hospital management would be the model for armies throughout the world for the next half century.

Sources:

Henig, Gerald S. and Niderost, Eric – Civil War Firsts: The Legacies of America’s Bloodies Conflict, Stackpole Books, 2001

About Feather Schwartz Foster
Feather Schwartz Foster is an author-historian who has made more than 500 appearances discussing presidential history. She teaches adult education at the Christopher Wren Association (affiliated with William and; Mary College), and adult Education programs at Christopher Newport University. She has been a guest on the C-SPAN "First Ladies" program. She has written five books.

Image 1: Every Army Ambulance wagon was equipped with an array of medicines, vials and syringes for emergency treatment.

Image 2: To try to make some sense out of overcrowded, confused and often filthy field hospitals, Dr. Letterman organized a system to triage and treat casualties promptly and more efficiently.

From: featherfoster.wordpress.com

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Civil War Surgery

By Pvt. Hugh R Martyr, 20th Maine

The War broke out during a transition period in medical knowledge. Anaesthesia had been used since the 1840's and thus allowed operations to be performed that hitherto would have been impossible. However there was no knowledge or understanding about the spread of infection until the 1870's. Thus, able to carry out major surgery, medical staff unwittingly caused serious problems with infection.

By far, the most common of wounds to be dealt with, were caused by gunshot. The Minié Ball made a hideous wound, often changing shape as it entered the body and dragging in dirty clothing; upon hitting bone it caused shattering which in turn increased the severity of the damage. Approximately 71 per cent of gunshot wounds were on arms, legs, hands or feet.

There was a difference of opinion amongst Union surgeons about the need to amputate damaged limbs or attempt to repair and try to save them, however, for the staff at the field hospitals time was short. If in doubt the limb was removed. Abdominal wounds were far more serious and the percentage of soldiers surviving them was far less than those losing a limb; bowel and stomach wounds being the most serious.

One of the problems for the wounded was that the transportation from the primary care station to a general hospital was crude and unsanitary; if the wound had not been infected on the battlefield it was almost certainly contaminated en route in ambulance, train or boat. The transportation personnel were more interested in speed of delivery than the comfort of the soldiers in their care.

The officers in charge of advance field hospitals confined the treatment of the wounded to stopping haemorrhage and to bandaging. Tourniquets or compresses were applied, liquor in the form of whiskey or brandy given to counteract shock, and the patient was usually given an opium pill or a dose of morphine. Bandaging of wounds became less common as the war progressed as it was found that they became soiled and contaminated and were causing problems as they were cut away. Splints to be used on fractured limbs were usually cobbled together using fence rails or board, ambulances were furnished with "Smith's Anterior" a suspended splint in ambulances but many staff did not know how to use it correctly. One contribution to medical science was the Hodgen Splint, invented in 1863 by Surgeon J Hodgen. This was a splint that provided room for examination, prevented contraction and allowed drainage of the wounds without disturbing the break. The basic design is still in use today.

The wounded were brought to the field hospital and laid out on straw; the less serious cases would be dealt with by a "dressing surgeon" who together with a medical orderly would operate a triage system passing over the mortally wounded and getting the most needy to the operating table. Pressure of the work load and the primitive conditions of the field units often meant that recommended procedures often were by-passed. It was thought that it was important to operate before infection could set in, but to avoid work whilst the patient was in deep shock. However, there was not the luxury of time available to the surgeons, the operating table had hardly been swilled down after one case before the next was brought in.

The management of the cases after surgery was relatively simple and consisted of rest, the relief of pain by opiates, doses of liquor or quinine to "support the system" and the application of cold compresses to keep down inflammation.

These quick operations broke all the rules of modern asepsis, cleanliness was almost impossible and the field stations soon became a gruesome spectacle as the surgeons worked through the hundreds of cases brought to them. From a Spotsylvania hospital a surgeon wrote home to his wife that he had been steadily operating for four days and that his feet were badly swollen. "It does not seem as though I could take a knife in my hand today. Yet there are a hundred more cases waiting for me. The poor fellows beg for the chance to have an arm or leg taken off. It is a scene of horror as I ever saw."

Pain relief came in the form of opiates; in the state of shock and under the influence of the anaesthetic the pain of the initial surgery was mitigated. It was as shock subsided and infections took hold that the misery of pain was suffered. The poor handling and rough transportation did not help in any way to ease the wounded soldiers plight. Opium was administered in tablet form and often morphine was rubbed into the wound. The hypodermic syringe became more common in the later years of the war and morphine was then injected.

The problem of infection was never really solved; surgeons had little understanding of the healing process and thought that the pus-producing infections were the normal process of tissue repair. When wounds healed without this action as it is now expected to do so, it was thought unusual. Thus large amounts of fatalities occurred due to Septicaemia, Pyaemia and the now unknown "hospital gangrene". The doctors at the time expected this as they were common in the civilian hospitals at the time.

Surgeons reports and letters tell a dreadfully gruesome account of the work that they had to do, the lack of water, the untrained orderlies and the work load are all mentioned time and time again.

I would be wrong to dismiss the efforts of the doctors and medical staff as being poor, throughout the whole of the war huge resources and improvements were made. The medical budget of 1864 exceeded the total amount of money spent on the pre-war army. Medical knowledge was on the verge of major breakthroughs and I consider the numbers of wounded that survived horrific injuries that would even now cause major concern, a testament to the efforts of the Medical Staff and the Sanitary Commission.

Main Sources: Doctors in Blue, by George Washington Adams; Official Records of the Union and Confederate Armies Medical and Surgical History of the War of Rebellion; History of the United States Sanitary Commission.

Pvt. Hugh R Martyr, 20th Maine

The above article first appeared in the ACWS Newsletter, February 2001

SURGERY IN THE FIELD

The wounded soldier who received medical attention in the field (and base hospital) had still to run the considerable risk of surgery. After ambulance facilities were available, field hospitals were sometimes overwhelmed by major battle casualties. The limited number of surgeons worked around the clock and haste and neglect were unavoidable under such circumstances. Anaesthetics, generally chloroform, were available, but there was no notion of aseptic procedure. As W W Keen recalled some years later:

"We operated in old blood-stained and often pus-stained coats with undisinfected hands we used undisinfected instruments and marine sponges which had been used in prior pus cases and only washed in tap water."

Nearly all wounds became infected. In the case of chest or abdominal wounds, surgeons probed with their fingers, prescribed morphine and tried to stop external bleeding. Otherwise there was little that could be done. Death within three days from haemorrhage and/or infection was the normal result. The average Union mortality from gunshot wounds of the chest was 62 percent of cases and from wounds of the abdomen, no less than 87 percent. By way of contrast, only about 3 percent of all American wounded failed to survive in World War II.

The chances for survival following an injury to the extremities were better though not good. Joints were resected and limbs amputated with alarming frequency, often in an attempt to prevent the spread of infection. It was usually the ensuing infection, which caused death. The so-called "surgical fevers" included tetanus, erysipelas, hospital gangrene, and septicaemia.

MEDICAMENTS

Medical supplies were transported to the battle areas as part of the general field train, and carried to the front lines in ambulances, or on pack mules, or on the shoulders of the regimental hospital stewards.

The major effective drugs in use were quinine and morphine. Whiskey was frequently administered to the wounded to induce "reaction", and as the solvent for quinine sometimes administered daily as a suppressant of malaria. Chloroform, sometimes mixed with small amounts of ether, served as an anaesthetic. Among other drugs used were opium, pepsin, various emetics and cathartics, iodine, and calomel.

Dysentery, one of the most important diseases from the viewpoint of both high morbidity and mortality, was treated with oil of turpentine, among many other substances, and ipecac was administered for enteritis; probably neither of these was very effective.

The paratyphoid fevers were not separately recognised and diagnosed; the term "typhomalarial fever" was used to describe debatable cases of prevalent remittent fever.

The lack of preventive measures and specific therapy for treatment of the various diseases became a major factor in the outcome of some battles, and at times, of entire campaigns.

AMBULANCE CORPS

The original organisation of the medical serve offered inadequate provision for the removal of the great numbers of casualties from collecting points to hospitals in rear echelon areas. On September 7, 1862, in a letter to Secretary of War Stanton, Surgeon General William A Hammond requested the formation of an ambulance corps. The corps, complete with animals, personnel, and supplies, was first established under the guidance of Dr Jonathan Letterman, Medical Director of the Army of the Potomac.

On the Confederate side, the task of transporting the wounded was complicated by the difficulty of running supplies and equipment through the northern blockade of southern Atlantic ports and the lower Mississippi River.

As in the North, the duties of Confederate surgeons included supervising the moving of the wounded from the battle lines to facilities in the rear. Toward the end of the war, the entire transportation system of the Confederacy, including their ambulance organisation, collapsed for want of the necessary equipment and supplies.

The above articles first appeared in the ACWS Newsletter, June 1999

Image: Left femur of a Confederate soldier with a gunshot fracture

From: acws.co.uk

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Jonathan Letterman, Doctor (1824–1872)

From: biography.com

QUICK FACTS

NAME: Jonathan Letterman
OCCUPATION: Doctor
BIRTH DATE: December 11, 1824
DEATH DATE: March 15, 1872
EDUCATION: Jefferson Medical College
PLACE OF BIRTH: Canonsburg, Pennsylvania
PLACE OF DEATH: San Francisco, California
NICKNAME: "Father of Battlefield Medicine"

Though not as well known as Ulysses S. Grant, Jonathan Letterman played an important role in winning the Civil War for the Union and is known today as the "Father of Battlefield Medicine."

Synopsis
Born in Canonsburg, Pennsylvania, Jonathan Letterman followed his father’s profession and became a doctor. During the American Civil War, he instituted several crucial medical procedures to efficiently remove battlefield casualties, immediately assess their condition and provide short- and long-term care, saving thousands of lives in the process. After the war, Letterman moved to San Francisco, California, where he practiced medicine and served as coroner. He died on March 15, 1872.

Early Life and Military Service
Jonathan Letterman was born in Canonsburg, Pennsylvania, on December 11, 1824. The son of a surgeon, Letterman followed in his father’s footsteps. He graduated from Jefferson Medical College in 1849, assuming the rank of assistant surgeon in the Army Medical Department that same year. From 1849 to 1861, he served in several military campaigns against Native American tribes in Florida, Minnesota, New Mexico and California.

Field Doctor in the Civil War
At the outbreak of the Civil War, Jonathan Letterman was assigned to the Army of the Potomac and was soon named medical director of the entire army, rising to the rank of major. Upon his first assignment, Letterman recognized that the typical field soldier was suffering from a number of health conditions, scurvy being one of them. He successfully addressed this problem by introducing fresh vegetables into their diet. But addressing the problems of battlefield casualties wasn’t going to be so easy.

During Civil War battles, Letterman and his fellow doctors had to deal with casualty levels far greater than expected. As an example, the Second Battle of Bull Run (Second Manassas, August 28–30, 1862) produced nearly as many U.S. casualties as the entire Revolutionary War. This was due, in part, to the combination of improved weaponry and outdated battle tactics. Another problem was the appalling inefficiency in dealing with casualties. Wounded men were left to fend for themselves unless carried off by a fellow soldier. Oftentimes, they would lie for days on the battlefield to suffer from exposure and thirst. It took more than a week to remove the wounded from the Second Bull Run battlefield.

Major Improvements in Medical Procedures
Jonathan Letterman made several changes to reduce the number of deaths after a battle. First, he established an ambulance corps with trained stretcher bearers to pick up the wounded and bring them to hospital clinics. He also instituted a triage system with prioritized treatment based on the degree of a soldier’s injury and likelihood of survival. Letterman developed a three-stage process for treating soldiers after evacuation with a field-dressing station next to the battlefield to quickly dress wounds and stop bleeding; a field hospital close by, usually in homes or barns, where emergency surgery could be performed; and a large hospital located away from the battlefield that would provide long-term treatment.

Proof of the effectiveness of these methods was made evident just two weeks after their implementation. The Battle of Antietam (Sharpsburg, September 17, 1862) is considered the bloodiest single-day battle in American history. There were more than 23,000 casualties, 12,000 of them Union soldiers. Under Letterman’s command, medical personnel were able to remove all wounded Union troops from the field within 24 hours, probably saving thousands of lives.

Later Life
During the remainder of the war, Jonathan Letterman served for a brief period as Inspector of Hospitals for the U.S. Army and then resigned in December 1864. He moved to San Francisco, where he continued to practice medicine and was elected coroner from 1867 to 1872. Upon the death of his wife, Letterman became severely depressed and died of intestinal disease on May 15, 1872, at age 47. He was buried at Arlington National Cemetery. In 1911, the Army hospital at the Presidio in San Francisco was named in his honor.

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Major Jonathan Letterman (December 11, 1824 - March 15, 1872)

From: civilwar.org

Dr. Jonathan Letterman may not be as well known as General Ulysses S. Grant, but he played just as important a role in winning the Civil War for the Union. Known as the “Father of Modern Battlefield Medicine,” Letterman’s work saved thousands of soldiers from dying horrible deaths on the battlefield.

Letterman was born in Canonsburg, Pennsylvania on December 11, 1824. His father was a surgeon, and Letterman followed in his footsteps, graduating from Jefferson Medical College in 1849 and assuming the rank of assistant surgeon in the Army Medical Department that same year. From 1849 until 1861, Letterman served on various military campaigns against Native American tribes in Florida, Minnesota, New Mexico, and California.

With the beginning of the Civil War in 1861, Letterman was assigned to the Army of the Potomac and was eventually named medical director of the entire army in June 1862, with the rank of major. After it took over a week to remove the wounded from the battlefield at Second Manassas, Letterman was given free range by General George McClellan to do whatever was needed to revamp the poor medical services that the men received in the field.

Before Letterman’s innovations, wounded men were often left to fend for themselves. Unless carried off the field by a comrade, or one of the regimental musicians doubling as a stretcher bearer, a wounded soldier could lie for days suffering from exposure and thirst. Letterman started the very first Ambulance Corps, training men to act as stretcher bearers and operate wagons to pick up the wounded and bring them to field dressing stations. He also instituted the concept of triage for treatment of the casualties.

Letterman developed an evacuation system that consisted of three stations:

1) A Field Dressing Station - located on or next to the battlefield where medical personnel would apply the initial dressings and tourniquets to wounds.

2) A Field Hospital – located close to the battlefield, usually in homes or barns, where emergency surgery could be performed and additional treatment given.

3) A Large Hospital – Located away from the battlefield and providing facilities for the long term treatment of patients.

In addition to these improvements, Letterman arranged for an efficient distribution system for medical supplies.

The success of the Ambulance Corps was proven at the battle of Antietam on September 17, 1862. While there were over 23,000 casualties, medical personnel were able to remove all of the wounded from the field in just 24 hours. The battle of Fredericksburg, where the Union suffered an additional 12,000 casualties, and the battle of Gettysburg, with 14,000 Union wounded, both tested Letterman’s system to the extreme, but again, it proved a great success, saving thousands of soldiers’ lives. In March of 1864, the system was officially adopted for the U.S. Army by an Act of Congress.

With Letterman’s work with the Army Medical Corps completed, and after serving a brief period as Inspector of Hospitals, Letterman resigned from the army in December 1864. He moved to San Francisco where he served as coroner from 1867 to 1872, and published his memoirs, Medical Recollections of the Army of the Potomac.

In 1872, after the death of his wife, Letterman became severely depressed. Several illnesses followed and on March 15, he passed away. He was buried in Arlington National Cemetery where his gravestone honors the man “who brought order and efficiency in to the Medical Service and who was the originator of modern methods of medical organization in armies.”

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Regimental Dressing Stations

From: rochestergeneral.org

The initial treatment of wounded soldiers was usually administered at regimental dressing stations that were located close to the battle lines and protected by earthworks or other natural defenses. These stations were typically manned by one Regimental Assistant Surgeon and one or two medical attendants.

The wounded would either come to the dressing station or be helped there by comrades. Wounds were treated with rough dressings and whiskey and opium pills would be administered to ease pain. Ideally, each regiment was assigned six ambulances with six drivers and twelve stretcher bearers that would evacuate the wounded to the Division field hospital.

Image 1: Wounded Confederate soldiers seek shade in makeshift tents using blankets and sticks and rifles for tent poles at a Regimental Aid Station aided by Dr. Anson Hurd of the 14th Indiana Volunteers.

Image 2: A Zouave ambulance crew demonstrating the removal of wounded soldiers from the field.

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Jonathan Letterman, (1824-1872)

"Medical Recollections of the Army of the Potomac". New York: D. Appleton & Co., 1866

On November 13, 1911, a new government hospital located near San Francisco, California was named the Letterman General Hospital in honor of the man who was responsible for reorganizing the army medical department during the Civil War and creating an effective ambulance system still used today, relatively unchanged, by modern armies. As stated by biographer Dr. G. E. Dammann, who wrote the biographical introduction to the 1994 reprint of Letterman’s Medical Recollections…, “Jonathan Letterman is the person who could be named father of medical evacuation”.

A native of Canonsburg, Pennsylvania, Letterman received an M.D. from the Jefferson Medical College in 1849 and went almost immediately into army medical service. He worked as an army surgeon in several U.S. frontiers before reporting to duty with the Army of the Potomac in 1861. In 1862, Letterman’s friend, Surgeon General Hammond, named him medical director for the Potomac division, a post he held under the command of Major-General McClellan.

Prior to Letterman’s reorganization, the U. S. Army had only a few facilities in Washington, D. C. that operated as general hospitals. Regimental hospitals that followed their units were the primary medical caregivers. There was no ambulance corps, but only litter bearers who carried the wounded from the field. These were often regimental musicians with no medical training. And ambulances were “engaged in carrying everything but wounded soldiers”. Noticing the disorganization and inefficiency of the medical corps, Letterman set out to restructure the system. He established an ambulance corps under the command of the medical director instead of regimental officers, and he made the transportation of the wounded their sole responsibility (Dammann iii). The new ambulances more than adequately proved their effectiveness, and Congress institutionalized them for all Union divisions in 1864.

As a part of Letterman’s reorganization, he also standardized medical supply wagons for each regiment and bulk supply wagons for the brigades. In addition, he consolidated the hospitals into a three-tiered system, consisting of field hospitals for immediate care of units, post hospitals for the sick and wounded of each garrison, and general hospitals that received patients from throughout the army. All these measures allowed the medical department to efficiently face the many difficult battles still ahead, and they became the basis for military medical administration for the rest of the Civil War.

In January of 1864, Letterman left the army (around the same time Hammond was replaced as Surgeon General). Shortly thereafter, he moved to San Francisco, where he served two terms as coroner and remained in that position until his death in 1872. Letterman’s memoirs as medical director during the war were published in 1866 as Medical recollections of the Army of the Potomac. Some of the original army orders and reports quoted within this book concern Letterman’s change of command order, the placement of ambulances under the medical department, and other medical reorganization and standardization orders. The Reynolds-Finley Historical Library has a first edition copy of this work.

Image: Jonathan Letterman and his staff. Letterman is seated on the left.

From: uab.edu

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Ambulance

From: collections.countway.harvard.edu

Ambulance, built at the Gov. Repair Shops, Washington, D.C., under the direction of Brevet Major General, D. H. Rucker, Quartermaster, U.S. Army.

From Reports on the extent and nature of the materials available for the preparation of a medical and surgical history of the rebellion (Philadelphia, 1865).

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Evacuation and Hospitalization: "Some on the Bare Ground, Some on Planks and Stretchers"

From: medicalmuseum.mil

The first battles revealed gaping holes in the capabilities of the medical commands to evacuate wounded men from the battlefield, render immediate care, and arrange long-term hospitalization. Outdated military regulations relied on regimental musicians to remove the wounded. Surgeons were required to treat only men from their assigned regiment, but even then they were soon overwhelmed by the chaos of battle. In some cases, days passed before men were removed from the battlefields. Townspeople became nurses. Their carts and wagons served as ambulances and their homes were outfitted into makeshift hospitals.

The public and military medical personnel grew outraged by these conditions. Their reactions forced significant changes in evacuation and hospital systems. Troops were organized and trained to recover and transport wounded men in ambulances. New types of ambulances were designed and built. Railcars and ships were outfitted to move the wounded from field hospitals to general hospitals. Large general hospitals holding thousands of patients and hospitals specializing in particular diseases and medical conditions were built. Surgeons planned the location of evacuation points and field hospitals before battles commenced. The procedures developed during the Civil War-rapid evacuation, assessment in the field, and transportation to a hospital far from the battle lines-are still in use by the American military.

HOSPITALIZATION
Once evacuated from the battlefield, wounded soldiers were evaluated at the field hospital. Three categories were used- the walking wounded, the wounded requiring immediate care, and the wounded beyond help. The walking wounded were given opium for pain and their wounds were cleaned and dressed. Immediate care usually involved amputation or bullet extraction. Morphine and opium were given to the fatally wounded. Once treated, the wounded were then evacuated to larger division and general hospitals.

Field hospitals were established in tents, barns, houses, or other protected locations with access to water. Hastily erected rows of tents also served this purpose. The usual means of evacuation to a field hospital were stretchers, two-wheeled ambulances, or on the shoulder of a fellow soldier.

With the influx of large numbers of sick and wounded soldiers, the cities of the eastern and southern coasts became centers for large general hospitals. New hospitals were designed and built. Others were created from existing buildings. A belief that "bad air" caused certain diseases suggested that increased airflow would reduce sickness. As a result, new hospitals maximized the ventilation of the wards.

Some hospitals specialized in the care of certain injuries or medical conditions. For example, Turner's Lane Hospital in Philadelphia became the Union Army's hospital for the care of neurological disorders. The Confederate medical command favored the construction of very large hospitals. With 8,000 beds and 250 surgeons, Chimborazo Hospital in Richmond was one of the largest.

The sanitary conditions in some wards often led to "hospital gangrene." Sergeant G.W. Gardner, age 29, Company A, 12th Illinois Cavalry, was shot through the leg with a conoidal carbine ball at Mitchell's Ford, Va., on Oct. 11, 1863. The ball, which did not strike bone, was removed, and Gardner was sent by train to Emory Hospital in Washington. Following treatments of hot water, oxygen gas, and cotton packing, gangrene of the foot set in and spread rapidly up the leg. The leg was amputated on Oct. 29. Gardner contracted diarrhea soon after the amputation and died on Dec. 5, 1863.

HAREWOOD HOSPITAL
As the war progressed, Washington became home to several hospitals. Some were new constructions while others were in renovated buildings. Harewood Hospital was located on 7th Street, NW, near the Soldiers Home. Harewood was supervised by Surgeon Reed Bontecou. It held 2,000 beds in the permanent wards. At one time 312 hospital tents holding 1,872 beds were also on the grounds.

TRANSPORTATION OF THE WOUNDED
Staged photograph showing troops loading an ambulance. Two military physicians were largely responsible for the changes in evacuation procedures and the system of hospital care during the war. Union surgeon Jonathan Letterman, medical director for the Army of the Potomac, was instrumental in establishing regimental aid stations, field hospitals, and division level hospitals. He also authorized training for ambulance companies responsible for moving wounded men from the battlefield to the field hospital. Dr. Samuel Stout, of the Confederate medical service, established aid stations, devised mobile field and general hospitals (the origins of the MASH unit), and championed hospitals with large, open wards. He also organized effective evacuation systems for wounded Confederates. The changes instituted by Stout and Letterman-rapid evacuation, assessment in the field, and transportation to a hospital far from the battle lines-provided sick and wounded soldiers a process of care still used by the American military.

Once evaluated and cared for at the field hospital, wounded men were transported to general hospitals in trains and hospital ships. Large numbers of wounded men could be loaded on these trains and ships, given care, and transported directly to general hospitals. Hospital trains could carry hundreds of patients. Many contained kitchens and well-spaced bunks to provide better patient care. Ships transported soldiers to general hospitals and also served as floating hospitals. Later in the war, Union ships stopped at Southern ports to pick up wounded and transport them up the Atlantic coast to hospitals in Washington, Philadelphia, and New York.

 A model of the DA January The U.S. Army Hospital Steamer DA January was a side-wheel steamer that served as a floating hospital. Outfitted to allow for the best in patient care, it contained a surgical suite, baths, a kitchen, nurses quarters, hot and cold running water, and an ice water cooler. Windows circulated air through the wards, which held nearly 450 beds. During its four years of service, the DA January transported and cared for more than 23,000 wounded men. It regularly visited the cities along the Mississippi and Ohio rivers.

Image 1: The Rucker ambulance could carry men in both the sitting and lying position.

Image 2: Diagram of Harewood Hospital shows the V-shaped arrangement of the wards, the separate quarters for nurses, an ice-house and other outbuildings. 'Medical and Surgical History of the War of the Rebellion.'

Image 3: Trains were used to evacuate more than 25,000 men to hospitals in the North. This railcar used by the Army of the Cumberland featured a bunk system allowing easier access to a patient.

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A Brief Plea for an Ambulance System for the Army of the United States, as Drawn from the Extra Sufferings of the Late Lieut. Bowditch and a Wounded Comrade

From: collections.countway.harvard.edu

Dr. Henry I. Bowditch (1808-1892), delivered a baccalaureate address to Harvard Medical School graduates on March 11, 1863, and then revised and printed it following the death of his son, Nathaniel, in Virginia, adding an impassioned plea for an ambulance service to assist the wounded in the field.

That appendix, made all the more powerful by his personal grief, was then reprinted separately.
The first ambulance corps was organized in the Army of the Potomac in August, 1862, and in the following year a standard number of ambulances for each regiment was mandated.

Image: Henry Ingersoll Bowditch: A brief plea for an ambulance system for the army of the United States, as drawn from the extra sufferings of the late Lieut. Bowditch and a wounded comrade
(Boston : Ticknor and Fields, 1863). Gift of J. Collins Warren, M.D., to the Library of Harvard Medical School, 1916.

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Toward an Ambulance Corps

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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Private William McCarter of the Irish Brigade Hospitalized After Fredericksburg

by Patrick Young, Esq., 1-4-2013

Private William McCarter was badly wounded during the Irish Brigade’s disastrous attack on the stone wall during the Battle of Fredericksburg in Virginia. He lay bleeding on the field for hours before nightfall made possible his still-dangerous escape to the rear.

The Northern army had a medical corps consisting of doctors and assistants, but most of the wounded were brought off the field by members of their own regiments who went back to try to collect friends. These Union soldiers would often pass by other wounded men, reserving their aid for men of their own units alone. McCarter was helped by two Irish Brigade comrades who recognized him in the dark. They put him on a horse-drawn ambulance. The ambulance was overloaded with twelve men when it took off to try to find medical care. The men were offered no first aid and two of them died before the vehicle reached the city of Fredericksburg, a short ways away.

Private McCarter says his ambulance carried twelve wounded men.

When McCarter got to Fredericksburg, Union soldiers were wandering about aimlessly in the streets. Some broke into houses and looted them. A number were getting drunk on whiskey they had stolen. McCarter was dropped off at a house that served as a make-shift hospital. More than fifty “mangled victims” of the fighting were in the one room. The men did not see a doctor until the next morning. By then, a wounded man lying near McCarter had died.

A severely overworked doctor was finally able to see McCarter. He dug the bullet out of the soldier’s shoulder, but first he had to cut away much of McCarter’s uniform to get at his wound. When McCarter had to evacuate north by foot the next day, he did so with his wounded arm naked and exposed to December’s cold. He and thousands of other wounded men walked to a rail depot where they waited hours without shelter for a train to take them north. “[T]he wounded men crouched and huddled together and…some of them died from the exposure,” he recalled.

McCarter next went to a makeshift hospital made up of a collection of tents. There was so much blood and so many severed body parts that he later described it as looking like a “village of butcher shops.”  The surgical tent left a lasting impression:

"Lying around were cases of ugly looking surgical tools, including the saw and the knife. In the back end of each tent a hole was made. Through it amputated arms or legs were thrown out upon the ground outside."

When trains finally arrived, the wounded rushed to get on. There was no order to the loading and the healthier men shoved aside the severely wounded. “It was simply every man for himself,” McCarter wrote, “I saw three men killed by falling under the car wheels as a locomotive began to move.” When McCarter was finally evacuated he was taken by a four hour train ride to Aquia Creek. Along the way, nine of McCarter’s wounded comrades died.

McCarter and hundreds of other wounded men on the train were taken off and hauled onto a steamship that was to take them to Washington. Few comforts were provided the suffering men and McCarter was forced to rest on the cold floor of the ship, when an unexpected source of comfort came to him. A woman, a Catholic nun, a Sister of Mercy comforted him, fed him and found him a warm place to sleep. This was McCarter’s first experience with these women, many of whom were immigrants like himself.

As he soon found out, the Sisters of Mercy had volunteered to take over the care of the men on the ship. McCarter remembered that during the trip they did “everything in their power to alleviate the terrible sufferings of the cargo of our wounded, sick and dying soldiers.” Over the coming weeks he would be cared for by many Sisters of Mercy. Their ministrations would be offered to native-born and immigrant soldiers alike of all religious backgrounds.  In coming articles, we’ll look at how these immigrant religious women helped create the nursing profession in the United States and changed attitudes about women in medicine.

From: longislandwins.com

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Private Bruce Shipman and the Ambulance Corps of the 76th New York

By Robert Moore, Jr.

I take great pride in writing this story of my great-great grandfather, Bruce Shipman, for your journal, and I know that he would be very pleased to be included. He considered his service in the Civil War with the 76th New York as the greatest single event of his life. I literally would not exist if not for certain twists of fate involving the Civil War, foremost among them Shipman's capture at the Battle of Gettysburg in 1863 — more about that later. But I think the most compelling aspect of the story is that Bruce was such an ordinary guy. He was of average height and build, came from obscurity, did his duty during the war and went back to obscurity afterwards, like thousands of other men. The most unusual thing about his Civil War experience was his participation in the ambulance corps, a very small group of men who had an affect on nearly every man in the regiment at one time or another.

Bruce Shipman was born in 1839 in Springfield, New York, not far from Cooperstown and Cherry Valley. By the age of 16, he was living with a family named Cooper, working for them as a hired hand on their farm. In 1860, he married Nancy Keller, the daughter of a lockkeeper on the Erie Canal, and soon their first child, Ruby, was born.

In April 1861, South Carolina forces fired on Federal Fort Sumter in Charleston Harbor, but as far as I can tell, Bruce Shipman knew little of politics. He lived with his wife and baby daughter on another man's land, tending fields and livestock which were not his own. He probably read about slavery, states' rights and secession, but what impact these issues made on him remain unknown. Life in Springfield, New York, went on, as a nation was split in two and went to war.

The Union loss at Manassas, Virginia in July 1861 signaled the beginning of a much longer war than anyone had expected. The people of Bruce Shipman's community began to raise a group of soldiers to go and fight. However, the community was small, and as related in the official history of the 76th New York, the Cherry Valley recruits were consolidated with a much larger group of soldiers from the Cortland area into the 76th. The Cherry Valley group composed companies H,I and K; Bruce Shipman served in Company K.

It would be difficult to discover why Shipman decided to join the army. Patriotism, perhaps. It is doubtful that he was an abolitionist or felt strongly about the slavery issue. He enlisted on November 1, 1861, for a period of three years. He was 22 years old, stood 5' 8 1/2" tall, and listed his profession as "farmer." As of November 6, he put on the uniform of a private in the 76th New York Regiment.

Bruce Shipman drilled throughout November and December. On January 17, 1862, the regiment marched to Albany, where they presented their colors before the state Assembly. The troops were then marched across the frozen Hudson River to the Railroad depot at Renssalaer. They arrived in New York City the following day at noon. By the end of January they were on their way to Washington, D.C., where they served in Fort Massachusetts. During the peninsula campaign in the spring of 1862, the 76th stayed in Fredericksburg, Virginia, repairing railroads.

Bruce Shipman got his first taste of battle with the regiment on August 21st, as the unit was held in reserve while an artillery duel was waged over their heads. A week later, the 76th came under heavy shell fire for the first time at Gainesville, Virginia. Shipman fought as a line soldier at Gainesville and South Mountain, Maryland. But by September 17, 1862, at Antietam, Shipman had been detailed to serve in the newly created ambulance corps. It is difficult to imagine today, but at the onset of the Civil War, there was no system in place for the evacuation of the wounded from the battlefield. Ambulances and their hired drivers were under the command of the Quartermaster's Department; stretcher-bearers, consisting of the regimental band and misfit soldiers, were answerable to the regimental surgeons, with no coordination between the two groups.

Union surgeon Jonathan Letterman, Medical Director of the Army of the Potomac, changed this by establishing an ambulance corps in an order dated August 2, 1862. Under the Letterman system, three ambulances under the command of a sergeant were assigned to each regiment of infantry, two to a troop of cavalry, and one to each artillery battery. Ideally, each ambulance was a four wheeled wagon pulled by four horses, attended by a driver and two privates to act as stretcher-bearers. Each ambulance could carry four wounded men at a time. A second Lieutenant commanded the ambulances of the brigade. By the time of the battle of Antietam, the 76th New York had a sergeant and nine responsible privates detailed to man its three regimental ambulances. Each of these men carried a colt army revolver as a sidearm. The ambulances were gathered and parked by brigade; since the 76th New York was in the Second Brigade, First Corps (composed of six regiments), the brigade ambulance park would have had 18 ambulances attended by 180 men. A medicine wagon and driver, two medical officers, and a hospital steward accompanied each division (composed of two brigades). The Army of the Potomac had an average total of 650 medical officers. Letterman insisted on daily inspections of the ambulances, horses, stretchers, water kegs and other equipment.

The men selected for duty in the ambulance corps were detached from their regiments as a result of their interest, efficiency, and good moral character. No man could be removed from this duty unless relieved by the medical director of his corps. A man found to be unfit for ambulance corps duty would be put back into the ranks immediately. Ambulance corpsman were distinguished in the field by a 2" green stripe around the hat, and a 2" green half-chevron on each sleeve. Soldiers not in the ambulance corps were forbidden to leave the ranks of their units to carry wounded men to the rear. No officer or enlisted man was allowed to use the ambulances for transportation, for themselves or their belongings (this is one reason why the ambulance corpsmen carried sidearms).

Letterman's system was first tested at Antietam, where it functioned well. In battle after battle thereafter, the efficient ambulance corps evacuated thousands of wounded men from harm's way. Sometimes the wounded men were moved while still under enemy fire, but most of the time a lull, truce, nightfall, or the end of a battle was when the bulk of the evacuations were performed. The battles became progressively more brutal each time the armies clashed. Bruce Shipman picked barely living men up off the fields of Fredericksburg and Chancellorsville. By the end of 1862 just 225 of the original 1,000 men of the 76th New York were still in the ranks.

On July 1, 1863, the 348 men and 27 officers of the 76th New York entered the little town of Gettysburg, Pennsylvania, along with the First Army Corps under General Reynolds. Within a half hour of fighting, 27 men were dead, including Major Grover, and 124 were wounded. The work of the ambulance corps was interrupted, however, as Confederate forces overwhelmed the Union troops, driving them back through the town. Many men were captured, including Bruce Shipman. Held prisoner during the remainder of the battle, Shipman was lucky, for he was not taken south with the retreating army of General Lee on July 4. Instead, he went along with the other prisoners captured on July 1 to a "parole camp" in Baltimore, Maryland. Most Union soldiers taken on subsequent days of the Gettysburg battle were forced to accompany the Confederate Army in their retreat, and eventually ended up at Andersonville.

Bruce Shipman, however, was somehow able to get a furlough from the Baltimore parole camp before his exchange came through, and in August 1863, he went home to upstate New York. His reunion with his wife Nancy and daughter Ruby must have been bittersweet, for his duty would be to return to the army and complete his three-year enlistment, only about half over. The importance of this visit home to me is inestimable, however, since my great grandmother was conceived during the autumn of 1863. In early October, Bruce Shipman returned to the parole camp, was exchanged, and returned to the 76th New York, encamped at Culpepper, Virginia. He witnessed the battle of Mine Run, and the execution of Private Winslow Allen for desertion in December 1863. Pvt. Shipman was given several special duties when active fighting tapered off each winter. At various times he served as the regimental mail carrier, pioneer, and the Major's orderly. Perhaps he was good with horses due to his years as a farm laborer.

On May 5, 1864, Bruce Shipman was lucky once more, as the armies clashed in the Battle of the Wilderness. Because he was detailed to the ambulance corps, he was not in the advanced position of the 76th, which was surrounded by Confederate forces. Nearly half the regiment was captured and sent to southern prisons; enlisted men went to Andersonville.

As Lee's troops dug in for the final act of the war at Petersburg, members of the ambulance corps, including Bruce Shipman, were assigned to the stationary hospitals constructed at City Point, Virginia. An efficient evacuation system for the wounded was instituted, with trains bringing casualties to the James River, where they were loaded on steam hospital vessels for the short trip to City Point. As soon as the army had settled into the routine of Petersburg, Bruce Shipman went AWOL. I believe that he somehow made his way home to Springfield, New York to see his new baby daughter, Jennie, my great grandmother. Perhaps there were complications with the birth, or trouble on the farm. Perhaps his commanding officers even turned a blind eye, or gave him a pass. Officially, he was listed as being AWOL, the only instance of this serious infraction in his entire war record. Within a month he returned to camp at City Point, now with only six months left to go on his enlistment.

The wounded continued to pour into the hospitals. The 76th N.Y. lost 341 men during the war; 175 in combat, 166 of disease. During the course of the war, 110,070 Union troops died in battle, and 94,000 Confederates. The total number of deaths from all causes was approximately 258,000, or 1/10th of the U.S. population at that time.

On November 5, 1864, after three years of service, Bruce Shipman's tour of duty was legally over. He had done his duty to his country, and the end of the war was in sight. He was at home in Springfield, New York when Lee surrendered to Grant five months later. He left the army to return to his family in New York State, and was given his $100 bounty. Perhaps he used it to move his family from the Cooper farm to a farm of their own. By 1865, state census records show that the Shipmans owned their own 200 acre spread. Bruce and Nancy Shipman went on to have five more children, for a total of seven.

Bruce Shipman was returned to obscurity. He died in 1927 at age 88 in Richfield Springs, 20 miles from where he was born. The Civil War, and his role in it, would remain the single most exciting event of his life. The same was true for literally thousands of men, north and south. All returned to the struggles of day to day life after the war. Bruce was luckier than many. He survived the war without a serious mishap, unwounded, un-mutilated, and able to work until the day he died.

I have spent many years researching this story, which was compiled from the official history of the 76th New York, Bruce Shipman's war record and pension papers from the National Archives, census data, the family Bible, and books and articles about the U.S. Army medical department and Civil War ambulance corps. It was my privilege in the late 1980s to work for the National Park Service at the Gettysburg battlefield, and live in a pre-Civil War home in the town. Although my major historical interest is not the Civil War, my ancestor's participation in that conflict makes the war seem very real, and not so distant, to me.

Image: Ambulance corps of the 57th New York - National Archives photo

From: bpmlegal.com

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About the Ambulance Corps

From: fisher.k12.il.us

The Medical Director of the Army of the Potomac was Jonathan Letterman. Jonathan Letterman made a plan called the ambulance plan, which had two stretchers- and one driver. They brought the wounded to places called dressing stations, then they were transferred to a field hospital.

The plan was implemented in August 1862 when McClellan issued General Orders No.147 creating the Ambulance Corps for the Army of the Potomac under the control of the Medical Director.

In March 1864, Congress published the Act Public 22 to create an Ambulance Corps for all of the Union Armies. The most unfit soldiers were detailed prior to the Ambulance Corps.

Many horse-drawn ambulances were first used in the 1850’s in the Crimean War. Standardized horse-drawn military ambulances were introduced in the U.S. During the Civil War. The first U.S. motorized ambulance unit operated in Mexico 1916 during the American punitive expedition against the Mexican Revolutionary general Panache Villa.

1. The ambulance corps was organized on the basis of the captain to each army corps as the commandant of the ambulance corps.

2. There were only two men and one driver to each ambulance and one driver to each transport cart.

3. The captain is the commander of all ambulances and transport carts in the army corps. He would make a personal inspection once a week of all the ambulances, transport carts, horses and their harness.

4. The first lieutenant was assigned to the ambulance corps of a division and would have complete control. He would receive a daily inspection report of all the ambulances and horses.

5. The sergeant in charged of the ambulance corps for a regiment and would conduct the drills and inspections.

6. Two medical officers from the reserve corps of surgeons of each division, and a hospital steward would be detailed by the medical of the army corps to accompany the ambulance train when on the march.

7. Commanders of the ambulance corps would report with out delay to the medical director.

8. No person would be allowed to be carried from the battlefield any wounded or sick except these corps.

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Ambulance Trains

Excerpted from: "Ambulance Trains" by Addeane S. Caelleigh

Just as the horse-drawn ambulance had been originally developed by military medicine, so were ambulance trains. Evacuating, distributing, and treating the wounded during modern war requires mass transportation, which by the 1850s meant the railroad and steamship. In the United States, both were used in the Civil War (1861-65), and rail evacuation was important in the treatment of sick and wounded soldiers for almost the next hundred years.

In the Civil War, the wounded were at first carried away from battles in empty freight and passenger cars, which were not well suited to the needs of the patients or the medical corps. A system of rubber slings was fitted into some cars to hold litters and act as shock absorbers. Others were outfitted fully as hospital cars, with facilities for staff, apothecaries, dressing stations, and kitchens.

Hospital railway cars were not needed again until World War I, when they were used in both the United States and Europe. In Europe, railroads were an integral part of war planning by all belligerent countries, to move men and equipment both to and from areas of fighting. Although there were specifically outfitted ambulance trains or hospital trains, at the front during combat the common pattern was for freight cars to carry equipment and soldiers up to the front and to take away the wounded to the rear areas. In the United States, rail cars were used to move the wounded from East Coast ports, where they had been delivered from Europe by ship, to hospitals throughout the rest of the country. In the early months after America entered the war in 1916, these cars were converted civilian rail cars, but later special hospital cars were used. These hospital cars and trains continued to be used for many months after the November 1918 Armistice that ended the war, because the U.S. wounded remained in hospitals throughout Europe for many months, returning home or to U.S. hospitals only as they improved enough to be moved.

Author: I gratefully acknowledge information gained from visiting the U.S. Army Medical Department Museum, Fort Sam Houston, Texas (near San Antonio), which has a 1953 ambulance car as part of its excellent collections.
© 2001 Association of American Medical Colleges

From: journals.lww.com

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Ambulance Trains

From: replications.com

Immediately prior to the break out of hostilities between the National Government and the Confederate States, the U.S. Army had developed and built a quantity of ambulances.  Up to that time, there was no purpose built ambulance in government service.  In previous wars, various wagons were pressed into service for the transporting the sick and wounded.  Most were found unsuitable.

The commission that developed the specifications for the first U.S. Army ambulances examined European designs and those submitted by American sources.  It was decided that a light, single horse, two-wheeled cart and a heavier, two (sometimes four) horse, four-wheeled wagon be built.   A Battalion of Infantry was to receive an allotment of one two-wheeled cart per company plus one more two-wheeled cart and a four-wheeled wagon per battalion.  Later, men were drafted from regiments to form an Ambulance Corps.  An innovation of Jonathan Letterman, the Ambulance Corps first officially appears in the Army of the Potomac (1862).  Congress would later make the institution a mandated part of the establishment (1864).

The two photographs on this page illustrate the usage of the three most common ambulances used during the war.  The first photograph shows the 2 wheeled ("Coolidge") and 4 wheeled ("Tripler") approved for use in  1859.  The second photograph shows the lighter 4 wheel pattern ("Roscrans/Wheeling") that begins to appear in numbers about the time of Fredericksburg and will generally replace the earlier models by the end of 1863.

Medical Inspector Frank Hamilton noted that the two wheeled variety continued in use through the end of the war where the roads were smooth.

Near the end of the war, an improved 4 wheeled ambulance ("Rucker") was adopted and was the standard Army pattern ambulance for the post war Indian campaigns.

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Civil War Ambulance

From: nps.gov

A recent exhibit addition at Fort Scott National Historic Site is truly one of a kind and will enhance visitor understanding of Fort Scott's role in the Civil War. In April 2012, the Fort received a hand crafted reproduction ambulance wagon which historically was used to transport wounded soldiers to hospitals. The ambulance, designed by Charles Tripler, who became the first medical director for the Army of the Potomac, accommodates four patients on stretchers and up to six seated in front and back. On exhibit alongside a reproduction freight wagon in one of FOSC's stone carriage houses, an informational sign will provide visitors insight on Civil War transportation.

During the Civil War, the town of Fort Scott housed one of five US Army General Hospitals west of the Mississippi River. Contemporary local newspapers referenced the sick and wounded being conveyed to the Fort Scott military hospital by ambulance wagon. Since there was not a standardized Civil War era US Army ambulance wagon design, park staff chose the Tripler Wagon. The Tripler, a type used at Fort Leavenworth as early as 1859, was very likely the typical ambulance variant used at Fort Scott during the war.

Werner Wagonworks of Horton, Kansas, was awarded the contract to construct the ambulance. A nationwide search failed to locate an existing original or reproduction Tripler, or even measured drawings, to guide construction. Hence, the contractor relied on limited photographic evidence, written references, and his decades of experience building other period wagons in order to craft the ambulance. Fort Scott National Historic Site therefore has the honor of providing the visiting public with the nation's only example of a Tripler ambulance. It will offer a unique interpretive display that coincides with the Civil War sesquicentennial.

Image: Civil War Ambulance at Fort Scott NHS, NPS Photo

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The Army of the Potomac's Ambulance Corp Organization Order of 1862

General Orders 147 - Organization of the Ambulance Corps

GENERAL ORDERS No. 147.
HEADQUARTERS ARMY OF THE POTOMAC;
Camp near Harrison's Landing, Va., August 2,1862.

The following regulations for the organization of the ambulance corps and the management of ambulance trains are published for the information and government of all concerned. Commanders of army corps will see that they are carried into effect without delay:

1. The ambulance corps will be organized on the basis of a captain to each army corps as the commandant of the ambulance corps, a first lieutenant for a division, second lieutenant for a brigade, and a sergeant for each regiment.

2. The allowance of ambulances and transport carts will be 1 transport cart, 1 four-horse and 2 two-horse ambulances for a regiment; 1 two-horse ambulance for each battery of artillery, and 2 two-horse ambulances for the headquarters of each army corps. Each ambulance will be provided with two stretchers.

3. The privates of the ambulance corps will consist of two men and a driver to each ambulance and one driver to each transport cart.

4. The captain is the commander of all the ambulances and transport carts in the army corps, under the direction of the medical director. He will pay special attention to the condition of the ambulances, horses, harness, &c., requiring daily inspections to be made by the commanders of division ambulances, and reports thereof to be made to him by these officers. He will make a personal inspection once a week of all the ambulances, transport carts, horses, harness, &c., whether they have been used for any other purpose than the transportation of the sick and wounded and medical supplies; reports of which will be transmitted through the medical director of the army corps to the medical director of the army every Sunday morning. He will institute a drill in his corps, instructing his men in the most easy and expeditious method of putting men in and taking them out of the ambulance, taking men from the ground and placing and carrying them on stretchers, observing that the front man steps off with the left, foot and the rear man with the right, &c. He will be especially careful that the ambulance and transport carts are at all times in order, provided with attendants, drivers, horses, &c., and the kegs rinsed and filled daily with fresh water, that he may be able to move at any moment. Previous to and in time of action he will receive from the medical director of the army corps his orders for the distribution of the ambulances and the points to which he will carry the wounded, using the light two-horse ambulances for bringing men from the field and the four-horse ones for carrying those already attended to farther to the rear, if the medical director considers it necessary. He will give his personal attention to the removal of the sick and wounded from the field and to and from the hospitals, going from point to point to ascertain what may be wanted, and to see that his subordinates (for whose conduct he will be responsible) at tend to their duties in taking care of the wounded, treating them with gentleness and care, and removing them as quickly as possible to the places pointed out, and that the ambulances reach their destination. He will make a full and detailed report after every action and march of the operations of the ambulance corps.

5. The first lieutenant assigned to the ambulance corps of a division will have complete control, under the commander of the whole corps and the medical director, of all the ambulances, transport carts, ambulance horses, &c., in the division. He will be the acting assistant quartermaster for the division ambulance corps, and will receipt and be responsible for the property belonging to it, and be held responsible for any deficiency in ambulances, transport carts, horses, harness, &c., pertaining to the ambulance corps of the division. He will have a traveling cavalry forge, a blacksmith, and a saddler, who will be under his orders, to enable him to keep his train in order. He will receive a daily inspection report of all the ambulances, horses, &c., under his charge from the officers in charge of brigade ambulance corps, will see that the subordinates attend strictly to their duties at all times, and will inspect the corps under his charge once a week; a report of which inspection he will transmit to the commander of the ambulance corps.

6. The second lieutenant in command of the ambulances of a brigade will be under the immediate orders of the commander of the ambulance corps for the division and have superintendence of the ambulance corps for the brigade.

7. The sergeant in charge of the ambulance corps for a regiment will conduct the drills, inspection, &c., under the orders of the commander of the brigade ambulance corps, and will be particular in enforcing rigidly all orders he may receive from his superior officers. The officers and non-commissioned officers of this corps will be mounted.

8. The detail for this corps will be made with care by commanders of army corps, and no officer or man will be selected for this duty except those known to be active and efficient, and no man will be relieved except by orders from these headquarters. Should any officer or man detailed for this duty be found not fitted for it, representations of the fact will be made by the medical director of the army corps to the medical director of this army.

9. Two medical officers from the reserve corps of surgeons of each division, and a hospital steward, who will be with the medicine wagon, will be detailed by the medical director of the army corps to accompany the ambulance train when on the march, the train of each division being kept together, and will see that the sick and wounded are properly attended to. A medicine wagon will accompany each train.

10. The officers connected with the corps must be with the trains on a march, observing that no one rides in the ambulances without the authority of the medical officers, except in urgent cases; but men must not be allowed to suffer, and the officers will, when the medical officers cannot be found, use a sound discretion in this matter, and be especially careful that the men and drivers are in their proper places. The place for the ambulances is in front of all wagon trains.

11. When in camp, the ambulances, transport carts, and ambulance corps will be parked with the brigade, under the supervision of the commander of the corps for the brigade. They will he used, on the requisition of the regimental medical officers, transmitted to the commander of the brigade ambulance corps, for transporting the sick to various points and procuring medical supplies, and for nothing else. The noncommissioned officer in charge will always accompany the ambulances or transport carts when on this or any other duty, and he will be held responsible that they are used for none other than their legitimate purposes. Should any officer infringe upon this order regarding the uses of ambulances, &c., he will be reported by the officer in charge to the commander of the train, all the particulars being given.

12. The officer in charge of a train will at once remove anything not legitimate, and if there be not room for it in the baggage wagons of the regiment will leave it on the road. Any attempt by a superior officer to prevent him from doing his duty in this or any other instance he will promptly report to the medical director of the army corps, who will lay the matter before the commander of that corps. The latter will at the earliest possible moment place the officer offending in arrest for trial for disobedience of orders.

13. Good serviceable horses will be used for the ambulances and transport carts, and will not be taken for any other purpose except by orders from these headquarters.

14. The uniform for this corps is: For privates, a green band 2 inches broad around the cap, a green half chevron 2 inches broad on each arm above the elbow, and to be armed with revolvers; non-commissioned officers to wear the same band around the cap as a private, chevrons 2 inches broad and green, with the point toward the shoulder, on each arm above the elbow.

15. No person will be allowed to carry from the field any wounded or sick except this corps.

16. The commanders of the ambulance corps on being detailed will report without delay to the medical director at these headquarters for instructions. All division, brigade, or regimental quartermasters having any ambulances, transport carts, ambulance horses, or harness, &c., in their possession will turn them in at once to the commander of the division ambulance corps. By command of Major-General McClellan:

S. WILLIAMS,
Assistant Adjutant-General.

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