Wednesday, August 13, 2014

Transportation of Federal Sick and Wounded


        The first removal of helpless wounded from the battle-field was usually effected by hand-litters, of which the number issued during the war exceeded fifty thousand. There were a number of patterns used, of which the best weighed twenty-four pounds, was quickly collapsible when not required, and possessed legs, which made its temporary use as a cot readily possible. Many wounded were also removed by their comrades on extemporized litters made by passing poles or muskets through the sleeves of coats which were then buttoned over them; or these supports were rolled in the edges of blankets, and litters thus formed. Hurdles, gates, window shutters, and ladders, with brush and hay thrown over them, were also used. Poles interlaced with rope or wire were employed. Hammock litters were made by swinging the wounded man in a blanket with its ends lashed to a single pole. The Indian travels, a frame on two long poles dragged after a horse, their front ends being supported by the saddle and tied together with a breast-strap, was also used. The ordinary "chair seat," as made by children at play, was frequently employed to remove wounded over shorter distances. Mule-litters and cacolets, the latter chairlike affairs swung on each side of the mule's back, were suggested and some were provided, but seem to have been little used. They were specially intended for rough country where wheeled vehicles could not readily go. Wounded able to walk were expected to make their own way back to the surgeon, with or without assistance.

But the transportation results achieved in these ways were usually possible only over short distances. The organization of the medical service made no provision for removal of the wounded from the regimental collecting-points to hospital facilities further to the rear. There were no sanitary organizations in reserve, available to assist near the firing-line where their service might be needed, or to bridge with their succor, care, and transportation, the often tremendous gap between the relief stations of the regimental surgeons and the general hospitals, usually far in rear. Frequently surgeons with some regiments in action were overwhelmed by the number of casualties in their organizations, while others might be idly waiting with commands held in reserve. The need for organizations to play the part of intermediaries was obvious, but for some occult reason failed to appeal at first to those who had the direction of general military affairs in charge. The lack of such specially equipped and trained organizations resulted in a vast amount of suffering during the first eighteen months of the war, and gave rise to much criticism of the Medical Department which the latter in nowise deserved.

A carefully matured plan for the organization of a hospital corps, to belong to the Medical Department and take over work which was at that time being inefficiently done by some sixteen thousand enlisted men detailed from the line of the army, was submitted to the Secretary of War on August 21, 1862, but failed of adoption as a result of the opposition of General Halleck, general-in-chief. An appeal was then made as follows:

September 7,1862.

Secretary of War.

        SIR : I have the honor to ask your attention to the frightful state of disorder existing in the arrangement for removing the wounded from the field of battle. The scarcity of ambulances, the want of organization, the drunkenness and incompetency of the drivers, the total absence of ambulance attendants are now working their legitimate results-results which I feel I have no right to keep from the knowledge of the department. The whole system should be under the charge of the Medical Department. An ambulance corps should be organized and set in instant operation. . . . Up to this date six hundred wounded still remain on the battlefield, in consequence of an insufficiency of ambulances and the want of a proper system for regulating their removal in the Army of Virginia. Many have died of starvation ; many more will die in consequence of exhaustion, and all have endured torments which might have been avoided. I ask, sir, that you will give me your aid in this matter ; that you will interpose to prevent a recurrence of such consequences as have followed the recent battle-consequences which will inevitably ensue on the next important engagement if nothing is done to obviate them.

I am, sir, very respectfully, your obedient servant,

This letter was returned with an endorsement from General Halleck, reiterating his continued disapproval of the whole plan of medical organization, in the face of which opposition in high places, no further steps at army headquarters could, for the time, be taken.

But in the mean time, medical officers of independent commands had been endeavoring to improve conditions within the immediate jurisdiction of their commanders, and in the Army of the Potomac, Medical Director Letterman had convinced General McClellan, perhaps the ablest organizer in the Northern forces, of the need for some special provision for the first aid and transportation of wounded. On August 2, 1862, General McClellan issued an order embodying Medical Director Letterman's plan, which was not only the first of its kind but so complete and practical as to have since served as the basis for the organization of the medical service in the field in all the armies of the world. The order need not be here further discussed than to mention that it organized an ambulance corps with animals, transportation, personnel, and supplies complete, to be used for succoring and transporting sick and wounded men, " and for nothing else."

The advantages of this organization became speedily manifest, and at the battle of Antietam, in the following month, it gave admirable service. Of its operation in the battle of Fredericksburg, Surgeon Charles O'Leary, medical director of the Sixth Corps, said in his official report:

" During the engagements of the 13th, the ambulances being guided and governed with perfect control and with a precision rare even in military organizations, the wounded were brought without any delay or confusion to the hospitals of their respective divisions. Not a single item provided for the organization of the field-hospitals suffered the slightest derangement, and the celerity with which the wounded were treated, and the system pervading the whole Medical Department, from the stations in the field selected by the assistant surgeons with the regiments to the wards where the wounded were transferred from the hands of the surgeons to be attended by the nurses, afforded the most pleasing contrast to what we had hitherto seen during the war. . . ."

In the operations at the time of the battle of Chancellorsville in the following May, the Sixth Corps charged and took Marye's Heights behind the town of Fredericksburg. The medical director of the corps, in his report, says : " The charge was made at I P. M.. ; the heights were taken, and in less than half an hour we had over eight hundred wounded. Two hours after the engagement, such was the celerity and system with which the ambulances worked, the whole number of wounded were within the hospitals under the care of nurses."

In the battle of Gettysburg the ambulance organization was intact, and such was the perfection of its administration, that, on the early morning of the 4th of July, the day after the battle ended, not one wounded man of the great number who had fallen was left on the ground. The inspector-general of the army himself reported this interesting fact from personal examination.

The success of the plan under McClellan induced Grant to adopt it in the Army of the Tennessee, in an order dated March 30, 1863. Finally, Congress tardily passed an act, approved by the President on March 11, 1864, establishing a uniform system of ambulance service throughout the military forces. After it was once established, the value of this ambulance organization in the saving of life, suffering, and tears cannot be overestimated.

The ambulances were of a number of types, two- and four-wheeled. The former were soon found intolerable from their incessant rocking motion. The four-wheeled type was issued in various forms, successive models designed to avoid the demonstrated defects of their predecessors being issued. The Rucker ambulance was the final development toward the end of the war and gave much satisfaction. In a general way, it was the prototype of the improved ambulance now used in our army. One great fault of all these four-wheeled ambulances was their excessive weight in relation to their transportation capacity. After every great battle, any available supply wagons were used to supplement the ambulances. These were springless, but, with their floors well bedded with brush and hay, were made very comfortable for the wounded placed in them, while their canvas tilts served admirably to screen against rain and sun.

The medical-transport service in battle, as finally perfected, worked about as follows: The medical officers of regiments accompanied their organizations into action and established stations as near the firing-line as possible and usually at a sheltered point, with ready access from both front and rear. Hither the wounded resorted or were conveyed as the situation permitted, had their wounds dressed, and were set aside or started for the field hospital, if able to walk.

As soon as possible the ambulance corps came up and took over the helpless wounded, freeing the regimental surgeons and enabling them to accompany their organizations to the front or rear. If the ambulance train could not reach the places where the wounded were lying, it was halted at the nearest practicable point, and the ambulance corps went forward and removed the wounded to the ambulances by means of litters.

The ambulance train then removed the wounded to the field-hospitals, the service of which is later discussed and of which there was one to each division, where more elaborate professional treatment was received. These field-hospitals were usually located just beyond the range of artillery fire. Sometimes several of them were established close together, and if tactical conditions permitted, they would be brought up and established on an occupied battlefield, thereby saving the time and suffering incident to removal of the wounded therefrom.

After reaching the field-hospitals and receiving the necessary attention to fit them for further transportation, the wounded were removed as soon as possible to the great base and general hospitals, which at one time aggregated two hundred and five in number.

In continuance of the work of the ambulance service, the railroads and steamships were brought into use. Sometimes conditions permitted trains to be run close to the scene of action and to receive wounded almost on the battlefield itself. This was the first war of great magnitude in which railroads were so employed.

The hospital trains were under the control of the Medical Department. The surgeon in charge was the sole head. Some were made up of passenger-cars which were regularly equipped or constructed by the railroad companies for the better care of wounded; some were hastily improvised at the front from ordinary freight-cars, merely emptied of the supplies which they had brought up and in which the wounded were merely laid on beds of boughs, hay, or straw. Between the two extremes there were all varieties of arrangements. Some cars were fitted with bunks; others with stanchions and supports, upon which litters were laid or suspended, jarring being taken by springs or rubber. These trains often included special cars arranged and used as kitchens, storerooms, dispensaries, and surgeries. From the completeness of their resources, the better type of them was practically a hospital on wheels.

Frequently the sick and wounded were easiest and best removed by water, particularly in the vicinity of the Atlantic coast and in sections of the Mississippi watershed. But all transport vessels were under control of the Quartermaster's Department, which ordinarily gave the greatest preference and importance to its own duties, until higher authority, roused by the justice of the appeals, ordered a number of steamers placed under the exclusive control of the medical officers. These varied in type from ordinary freight-boats and transports returning empty, to the finest type of speedy, capacious steamers, completely remodeled into floating hospitals. Some of these hospital boats were planned for the care of four hundred or more patients. One old hulk was fitted up after the battle of Shiloh, with accommodations for a thousand men, and used as a receiving and forwarding hospital for the fleet of river hospital steamers. The latter were kept continually on the move, and a single such steamer is recorded to have removed 12,299 sick and wounded in the space of seventeen months. This steamer hospital service was a new departure in military affairs and was a matter of gradual development to the end of the war, when it had become most complete as to equipment and administrative efficiency. All the boats used for hospital purposes were ultimately assigned officially to the use of the Medical Department, either for the trip or-in the case of specially equipped steamers-indefinitely. The surgeon in charge was in complete control of the boat and its movements, except in respect to the details of navigation. The system worked so successfully as to be continued during the Spanish War, and is part of the regulations at the present time.

Source: "Photographic History of the Civil War" Volume IV, Article By Edward L. Munson, M.D., Major, Med United States Army.


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