Evacuating the wounded from the battlefield could take days at the start of the American Civil War.
The Letterman System
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
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.
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.
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.”
Henig, Gerald S. and Niderost, Eric – Civil War Firsts: The Legacies of America’s Bloodies Conflict, Stackpole Books, 2001