The Civil War produced casualties on a scale never seen in American history up to that time. Out of necessity, great improvements in the treatment of the wounded were made during the war, and as time went on, more and more of these wounded men survived. Though there were many who contributed to these advancements in medicine during the Civil War, one of the leading innovators was U.S. Army physician Dr. Jonathan Letterman. Letterman’s most significant contribution was the establishment of the Union Army’s ambulance corps and hospital system.
Letterman first gained some notoriety in army medical circles early in the war when he constructed the first general hospitals of the type that became standard throughout the army. On June 23, 1862, Letterman was named Medical Director of the Army of the Potomac. He immediately began to institute sweeping changes. Up to this time, the evacuation of wounded from the battlefield had been performed by musicians and others who were not trained in proper procedures for the handling of wounded soldiers. Often, the personnel assigned to this duty were shirkers or downright incompetent. To make matters worse, there were no set procedures in place and no chain of command. Officers often commandeered ambulances for their own uses. The system was nearly useless.
With the support of the Army of the Potomac commander, Major General George McClellan, and Surgeon General William A. Hammond, Letterman changed all that. On August 2nd, 1862, McClellan issued Special Orders No. 147 establishing a dedicated army ambulance corps based on Dr. Letterman’s design. The ambulance corps would have a set command structure of Medical Corps officers with trained soldiers assigned to the corps to carry out specific tasks. The corps would be properly equipped for its duties, and would be solely responsible for the removal of the wounded. The ambulances were to be used for the transport of the wounded, and the practice of officers using them for their own purposes would end.
Letterman also established field hospitals for treatment of the wounded near the battlefield, often just outside of the range of enemy artillery. These hospitals were established at the division level, and would provide care for the wounded until they could be sent to a general hospital away from the battle zones. Letterman instituted a supply system to make sure the hospitals and ambulances were furnished with all the medical supplies they needed.
The new system had begun to be put in place at the Battle of Antietam in September of 1862, and first went into full use at the Battle of Fredericksburg in December. The result was a resounding success. The wounded were quickly and efficiently removed from the battlefield and treated, resulting in many more lives saved. McClellan’s order covered only the Army of the Potomac, but Letterman’s system was adapted by other Union commands as time went on. Finally, an Act of U.S. Congress in March 1864 established a uniform system of ambulances for use in all United States armies, based on Letterman’s system.
Letterman stepped down from the army in 1864. The procedures that he developed lasted long past his death in 1872, and form the basis for the modern system of evacuation and treatment of battlefield casualties.
Hardtack and Coffee or the Unwritten Story of Army Life by John D. Billings. Reprint. Bowie, Maryland, Heritage Books, Inc. 1990.
Life of Billy Yank: The Common Soldier of the Union
by Bell Irvin Wiley. Baton Rouge, Louisiana: Louisiana State University Press, 1971.
Medical Recollections of the Army of the Potomac by Jonathan Letterman M.D. New York: D. Appleton and Co. 1866