A Complete Transformation of Medicine: John Letterman’s Ambulance Corps

By Savannah Labbe ’19

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A Civil War Ambulance Corps (via Library of Congress)

At first glance, the photo above does not seem to really depict much of any importance. It simply seems to be a photo of soldiers transporting a wounded comrade into a wagon. While these men were doing important work and giving wounded soldiers the chance to live, it does not seem as if they are doing anything revolutionary. However, the picture actually shows a radical improvement in medical treatment brought about by the Civil War. Looking back on the practices of Civil War Americans, many people tend to believe the Civil War was a particularly dark time in medical history, a time when doctors sawed off limbs to solve any problems and often did it with dirty instruments and no anesthesia. This idea of Civil War medicine is a misconception because most amputations were, in fact, done with anesthesia and the Civil War did introduce many improvements in the medical field. In fact, the Civil War can be seen as a turning point from more ancient practices of medicine to more modern practices. The fact that the Civil War was a turning point in medical history is evident in the Union’s development of ambulances and the ambulance corps, one of which is depicted in the photo above. The Union’s ambulance corps radicalized battlefield medical treatment, allowing the majority of soldiers to receive care much more quickly and efficiently, something the South never accomplished.

While the Union Army eventually developed efficient battlefield treatment like what is being displayed in this photograph, at the beginning of the war the medical department was disorganized, chaotic, and in need of much improvement. After the First Battle of Bull Run, wounded soldiers were left scattered over the field and most of them were eventually captured by the enemy. Although there were only 1,011 Union wounded, much fewer than in later battles, many of these wounded remained on the field for days and some were forced to walk all the way back to Washington D.C. just to receive treatment. Those who were unable to walk had to face days of suffering, exposure, and thirst, that would eventually lead to their death. This disaster within the Union’s medical department and its failed care for soldiers was not limited simply to Bull Run, but continued throughout the entire first year of the war. Doctors lacked supplies, many soldiers suffered from scurvy, and the wounded piled up waiting for transportation to northern hospitals. In addition, doctors and quartermasters were responsible for the management of the ambulance teams, which was not practical during battles as doctors could not attend wounded men and supervise the ambulances at the same time. Also, the quartermasters were often more concerned with supplies or providing transportation for high-ranking officers than providing the ambulance corps with the necessary wagons and horses they needed to perform their job. The early ambulance teams would have been nowhere near as organized and efficient as the team pictured above.

The significantly improved orderliness depicted in the photo was largely due to Jonathan Letterman, who was appointed medical director of the Army of the Potomac on June 23, 1862. He realized that an efficient system of care was a matter of life and death for the soldiers. The men in the photograph above were key players in the crucial first step in this system, rescuing the soldiers from suffering in the field and bringing them to doctors. This task of putting the medical department in order was a hard one. Out of an army of 103,000 men, Letterman found that 29% were listed as ill or unable to fight, most due to easily treatable illnesses. Letterman started by asking General McClellan for more medical supplies for doctors and a greater variety of foods for soldiers in order to prevent malnutrition based illness, like scurvy. McClellan not only granted these requests, but also issued a general order dictating that the quartermasters keep the soldiers well supplied with vegetables. While this was an important first step in the right direction, Letterman would soon radicalize the entire system for treating wounded. He set up a triage system, started the ambulance corps, and instituted standard operating procedures. The men carrying the stretcher and driving the ambulance in the photo above were taking part in this ingenious system. They were not only a part of an important moment in medical history, but they also ensured the efficiency of Letterman’s system, giving wounded soldiers a greater chance at survival than ever before.

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Dr. Jonathan Letterman and his medical staff. Letterman seated furthest left. (via Library of Congress)

More soldiers were able to survive due to Letterman’s methods of organization, triage, and specialization. Once Letterman had obtained more supplies, he began reorganizing the ambulance corps to create teams such as the one in the photograph above that worked like a well-oiled machine. On August 6, 1862, he created an official ambulance corps in which the men therein were dedicated solely to ambulance work. Previously, soldiers just simply rotated through ambulance duty and were not specifically assigned to an ambulance team. Letterman structured the ambulance corps similarly to the army itself, with a captain as commandant of each of the infantry corps’ ambulance teams. A lieutenant would direct the ambulances for each division and brigade and a sergeant directed ambulances for each regiment. This organization solved the problem of who was in charge of the ambulances and allowed the doctors to focus on treating the wounded. Each regiment was allotted one transport cart and two ambulances and the officers of these ambulance crews were responsible for the training of crews, maintenance of vehicles and equipment, as well as the welfare of the horses. With the ambulances now under the sole control of the ambulance crews, the men in the photo above could focus on the most important part of their job: Healing the wounded and saving lives.

Not only were the ambulance crews better led, they also practiced improved care techniques, like the new triage system. Letterman designed this system to be three-tiered. First, a wounded soldier would be removed from the field on a stretcher and then loaded onto a wagon, as shown in the photo above. The soldier would then be brought to a field station close to the battlefield to receive initial treatment, which would be very simple, akin to first-aid treatment today. If the wound was not very severe, the soldier would just be administered to here and then sent back to his regiment. If a soldier needed more advanced treatment, he would be transported to a divisional hospital at the rear of the lines, which was the second phase of treatment. At this stage of the system, doctors would perform surgeries, extract bullets, amputate limbs, and anything else that the soldier needed, depending on the wound. The final stage was recovery, and many soldiers stayed at divisional hospitals for short-term rehabilitation. However, if the soldier’s recovery was going to be long-term and they needed more intense care, they would be moved to a general hospital in a nearby town or city. Patients could rest and recuperate in these hospitals that had more resources and better ensured the soldier’s recovery than a divisional hospital that was always swamped with critical injuries.

In conjunction with this system of care, particularly the second stage, Letterman also began the practice of medical specialization by mandating that only highly qualified and experienced doctors could perform amputations and surgeries. This specialization was important, as no matter how hard the ambulance crew in the photo above worked, it meant nothing if the doctor was not experienced enough to actually treat the wounded. Letterman’s new system of specialization and organization was first tested in 1862, after the Battle of Antietam. The system functioned well despite the vast amount of casualties. Ambulance teams cleared 12,410 casualties in less than 48 hours, which was a drastic improvement from Bull Run, when many wounded remained on the field days later even though there were fewer wounded. By the Battle of Gettysburg, the system was perfected and the Union ambulance corps was able to evacuate 14,193 Union and 6,802 Confederate wounded, providing treatment for them within three days of being wounded. Not one wounded soldier remained on the battlefield the morning after the battle concluded. This system’s success is evident in the fact that the Union Army’s mortality rate for those who died of wounds reduced drastically from 25.6% in the first year of the war to 13.3% after Letterman’s changes. This system was so much more effective that it was soon adopted by all Union armies as well as some European armies. In March 1864, Congress passed a law that officially established Letterman’s system for all Union armies.

War often has a significant impact on medicine, and the Civil War was no exception. With Letterman’s guidance, an efficient practice of battlefield care was established for the first time in the Civil War and the basic principles of this system would be used in many wars to come. For example, Letterman’s three-tiered system of field treatment, divisional hospital, and then general hospital was used extensively in World War II, with soldiers who were most seriously injured often being transported to Great Britain or even the United States to recover. The men in the photograph helped ensure the success of this system, and the actions they are performing are still performed today: Wounded soldiers are still removed from the battlefield on stretchers with critical efficiency and transported to hospitals for better, and often times life-saving, treatment. John Letterman revolutionized the field of medicine, and soldiers of the Civil War and all wars after are indebted to him. Letterman’s innovation is why this photo is so important. It shows the successful working of that system as well as an important moment in the history of medicine. The photo is also important for its multi-dimensional meanings and the many different feelings it evokes. The photo displays the inherent suffering and pain of the wounded soldier, surrounded by the chaos and confusion of the battlefield. However, the photo also symbolizes hope and healing; the opportunity for a wounded soldier to live another day. It is a testament to the efficiency and innovation of Letterman’s system, and the evolution of medical practice as a whole, ironically borne out of the widespread death and unnecessary sufferings inflicted by war on a nation unprepared for such brutality, that has come to save thousands of lives around the world since its inception.


Sources:

“EMTs, Civil-War Style.” Civil War Times 45, no. 1 (February 2006): 74. Accessed November 8, 2018.

Place, Ronald J. “The Strategic Genius of Jonathan Letterman: The Relevancy of the American Civil War to Current Health Care Policy Makers.” Military Medicine 180, no. 3 (March 2015): 259–62. Accessed November 8, 2018.

Smith, Dale C. “Military Medical History: The American Civil War.” OAH Magazine of History 19, no. 5 (September 2005): 17–19. Accessed November 8, 2018.

Weirt, Jeffry D. “Dr. Letterman’s War.” Civil War Times 45, no. 7 (September 2006): 7–8. Accessed November 8, 2018.