The Photographic History of The Civil War: in ten volumes, Thousands of Scenes Photographed 1861-65, with Text by many Special Authorities, Volume 7: Prisons and Hospitals.
Francis Trevelyan Miller, Ed.

With the ambulance corps: transportation of Federal sick and wounded

Edward L. Munson, M. D., Major, Medical Department, United States Army

Well-equipped ambulance bearers of the army of the Potomac, 1862—drill in removing wounded

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Removing the wounded from Marye's heights, May 2, 1864: ambulance corps of the fifty-seventh New York infantry This spirited scene of mercy followed close on the assault and capture of the famous ‘Stone Wall’ at Fredericksburg, May 2, 1863. The ambulances belong to the Fifty-seventh New York, which suffered a terrible loss when it helped, as a part of Sedgwick's Corps, to carry Marye's Heights. Out of one hundred and ninety-two men engaged, eight were killed, seventy-eight were wounded, and one was reported missing, a loss of forty-five per cent. Then the ambulance train was rushed to the front. Within half an hour all the wounded were in the field hospitals. The corps still had many of the short, sharply tilting, jolting two-wheeled ambulances whose [299] rocking motion proved a torment to sufferers. Several four-wheeled ambulances appear, however, and later in the war the two-wheeled ambulances were entirely superseded. The long lines of infantry drawn up in battle array in the background are ready to repel any further assaults while the wounded are being removed on the litters. The one in the foreground (on the left) exhibits a device to elevate the patient's limbs. The medical officer is gazing anxiously at the wounded soldier, and an orderly is hurrying over with some bandaging. Directly behind the orderly, bearers are lifting another sufferer on a litter into the four-wheeled ambulance.

A few of the wounded at Gettysburg: second corps hospital, Union center, near Meade's headquarters To these rough tents, erected by the Second Federal Army Corps, the wounded have been rushed during the second and third days of the mightiest of all American battles, just decided at a cost of 6,664 dead and 27,206 wounded. Accommodations are simple. But cups hang at the front of the foremost tent wherewith to slake the sufferers' thirst, and at least one woman nurse is present to soothe their fevered brows with the touch of her cool hands. By this time the ambulance organization of the Union armies had been perfected. Such was the efficiency of its administration that on the early morning of the 4th of July, 1863, the day after the battle, not one wounded soldier of the thousands who had fallen was left on the field. The inspector-general of the army himself reported this [301] fact from personal investigation. During the Civil War, the number of battle casualties steadily increased, until in the year 1864 there were no less than 2,000 battles, actions, and skirmishes officially reported, and during the second quarter of that year more than 30,000 wounded were received in the Washington hospitals alone, while the total number of such admitted to all the hospitals during the same period exceeded 80,000. For the war period, May 1, 1861, to June 30, 1865, the cases admitted to hospitals for all surgical causes amounted to 408,072, with 37,531 deaths. Of this great number 235,585 were gunshot wounds, with 33,653 deaths. This gives a case-mortality among the wounded able to secure surgeon's care of 14.2 per cent., a terrible toll of the nation's young men.

The first removal of helpless wounded from the battlefield 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 travois, 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. [303]

Union hand-stretchers at work at Marye's heights in May, 1864 Over fifty thousand hand-stretchers of various patterns were issued by the Union Government during the war. It was by means of them that the removal of the helpless wounded from the battlefield was effected. The best pattern of hand-stretcher weighed twenty-four pounds, was quickly collapsible when not required, and possessed legs which made its temporary use as a cot readily possible. This photograph shows the wounded on Marye's Heights after the battle at Spotsylvania, May 12, 1864. The wounded man on the stretcher is gazing rather grimly at the camera. His hand is bound up, and his foot showing at the end of the stretcher is bare. The poor fellow in the foreground seems pretty far gone. His face is as pale as the blanket which covers him. The whole group of strong men struck down typifies the awful effects of war.

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:

Surgeon-General's Office, September 7, 1862.
Hon. Edwin M. Stanton, 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 [305]

Ambulance drill in the field—the newly organized corps soon after Antietam This busy scene of 1862 reveals an ‘ambulance drill’ of the newly organized and wellequipped corps. On the left is a man on a litter with his arm thrown above his head. Another man on a litter with his leg encased in a sort of ready-made cast in just being loaded into the ambulance. On the right, near the drum, an orderly is presenting a cup of water to the ‘wounded’ man comfortably reposing on a blanket. Beside him is a medical officer majestically directing affairs. Another orderly in the background on the right is kneeling by another ‘wounded’ man, who is also gazing at the camera. The man in the foreground is playing his part well. He is lying on the bare ground, and his cap lies at a little distance from his head. This photograph would have comforted the anxious friends and relatives at home in 1862, from its portrayal of the efficiency of the organization.

[306] 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,

William A. Hammond, Surgeon-General.

 

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 [307]

Hospital boats.

These two photographs show boats used for transporting the sick and wounded in the West and in the East. The hospital steamer Red Rorer, shown in the upper picture, plied the Mississippi, while the steamer Argo and the schooner lying at her bow are two of the vessels that were used in bringing medical supplies to the Army of the Potomac in its operations near Petersburg. All transport boats were at first under control of the quartermaster's department, but later a number were placed under the exclusive control of the medical officers. These varied in type from the finest freight boats to the best types of speedy steamers.

United States hospital boat red rover at Vicksburg

Hospital wharf on the Appomattox river, near City Point

 

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 1 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. [309]

Ambulances going to the front—before the Wilderness campaign In the foreground of this photograph stand seven ambulances and two quartermasters' wagons, being prepared for active service in the field. The scene is the headquarters of Captain Bates, of the Third Army Corps, near Brandy Station. The following month (May, 1864) the Army of the Potomac moved to the front under General Grant in his decisive campaign from the Wilderness onward. A large quantity of stores lie upon the ground near the quartermasters' wagons ready for transportation to the front. As it became evident that any idea of providing each regiment with its individual hospital was impracticable in a large command, efforts were made to afford hospital facilities for each division at the front. As a result, the regimental medical supplies—the wagons containing which had usually been back with the field train when required during or after action—were largely called in and used to equip a single central hospital organization, which could be held intact and at once available to be brought forward in its wagons for use as needed. One of these hospitals was organized for each division, but sometimes the needs of the wounded in a given area would be such that several of these hospitals might be ordered to work near together.

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 fourwheeled. 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 [311]

Lessons in ambulances

It was only after a great deal of experimenting with vehicles of various types, both two and four-wheeled, that the ‘Rucker’ ambulance was accepted toward the end of the war as the final development. It gave complete satisfaction. In the accompanying photograph appear types of the two-and four-wheeled ambulances. The former were soon found intolerable; they transmitted every bump and depression in the road by a direct jolt to the suffering patient. One great fault of the four-wheeled ambulances was their excessive weight in relation to their transportation capacity. The vehicle finally developed was the prototype of the improved ambulance now used in our army. The lower photograph shows a section of a the vast system of repairs. The tremendous importance of general hospitals was recognized by Congress in February, 1865, in giving the rank of colonel to department surgeons having more than 4,000 hospital beds under their charge, and of lieutenantcolonel to those having less than that number.

The murderous two-wheeled and merciful four-wheeled ambulance

United States ambulance repair shop at Washington

 

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, [313]

Ambulances.

An ambulance train ‘parked’ at Harewood hospital, the month Gettysburg was fought

Ambulances and medical supply wagons ‘parked’—1864

A train of ambulances at City Point

 

Ambulance train.

This photograph shows to what a state of perfection, in drill and equipment, the ambulance service of the Union armies had been brought by April, 1863. The castle on the ambulance curtains indicates the Engineer Corps. The little vignette below the larger photograph shows the train unharnessed and at rest. Starting with a medical department scarcely adequate for eleven thousand men in time of peace, the ambulance service was ultimately increased, developed, and organized into a vast administrative medico-military machine, working smoothly in all its ramifications and meeting efficiently the needs of a force aggregating, at one time, nearly a million men, exposed to the fire of an able opponent, and very often compelled to operate under unfavorable conditions and amid unhealthful surroundings. The department brought order out of chaos, health from disease, and surcease from suffering, in a manner and to a degree previously unparalleled. Its achievements must challenge the admiration of medical men for all time.

Ambulance train of the engineer corps at Falmouth, Virginia 1863

Ambulance train of the engineer corps at Falmouth, Virginia 1863

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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.