Medical Organization and Installations of the Civil War: An Overview
written by historian Bill White
Only a few short months following the fall of Fort Sumter to a determine South Carolina militia, a great hue and cry was raised by the general public in the North. The people of the North demanded action from their president, swift and effective action, to end the rebellion in the South. No one wanted a lengthy, drawn out war and the public felt that immediate action was in order. The North sought to end the impending conflict decisively with an attack against the Confederate capital of Richmond, Virginia. Under the intense political pressure of the citizens of the
North and a strong republican congress, President Lincoln ordered Brigadier General (BG) Irvin McDowell to advance his forces Southward across Bull Run, a small creek in Northern Virginia, destroy the Confederate fortifications there and thrust toward the Confederate capital.
Confederate BG P.G.T. Beauregard, however, had his own ideas about the future of the Confederacy and met BG McDowell on 21 July 1861. When the dust raised by the two powerful, but untested, armies settled, the south had won her first great victory of the war. Known in the South as the First Battle of Manassas and to the North as the First Battle of Bull Run, the cost of the engagement measured in casualties suffered was astronomical. Union losses were close to 3,000 (460 killed, 1,124 wounded, and 1,312 missing or captured.) while Confederate casualties approached 2,000 ( 387 killed, 1,582 wounded, and 13 missing.) But the real tragedy was that the medical services of both armies were so ill prepared, poorly organized and sadly managed that the wounded lay suffering on the battlefield for days, some reports say as much as a week, before all were recovered and treated.
In the wake of this tragedy, Union Major General (MG) George B. McClellan appointed a thirty-eight year old, recently promoted Major (MAJ) named Jonathan Letterman to overhaul the methods and practices used in military medicine and to reorganize the medical services of the Federal Army of the Potomac. Letterman was about to step onto the pages of military medical history. Because of his great success in reforming military medical practices, he eventually became known as the "Father of Battlefield Medicine" and developed practices that are still in use today, practices that would save countless lives and be adopted by both Union and Confederate forces alike.
Under Letterman's plan there were to be three treatment echelons. First the wounded were carried to forward area first aid stations. Known to the troops simply as Aid Stations, here soldiers were triaged, segregated by the nature and severity of their injuries, and stabilized. Of necessity, these were small, lightly staffed and extremely mobile treatment areas, usually manned by a single assistant surgeon who held the rank of captain, and worked with several enlisted aids. Aid stations were located within a mile of the battlefield or as close as possible where a sufficiently protected position was available.
Only the most necessary life-saving procedures were performed at these forward-most treatment centers. Here bleeding was stopped by all means necessary including the application of tourniquets, airways cleared and wounds were temporarily bandaged to stanch any bleeding that might recur in transport.
Also assigned to the aid stations, under Letterman's plan were mules, ambulances, drivers and assistant drivers, as well as litter bearers. These soldiers made up what we might call today "medical evacuation teams." Each team consisted of an ambulance wagon drawn by two horses, a driver, an assistant driver and two litter bearers. These teams would move into the area of the conflict, recover casualties and transport them to the aid stations. The only identifying marking for these brave men was a one inch wide green band around their caps.
From the forward aid station, casualties were quickly moved to mobile field hospitals. Predecessor of the more modern Mobile Army Surgical Hospital (MASH) units, field hospitals were equipped for more in depth treatment of soldiers. Nevertheless, their mission, brought forward from the aid stations, continued to be the temporary treatment of soldiers, stabilizing them until they could be evacuated to more permanent general hospital installations.
Major surgeries, amputations and extraction of shrapnel and mini balls were the order of the day for these installations. Once the surgery was complete and the patient stabilized, the soldier was moved farther to the rear. As noted, these facilities were designed to be mobile in nature and could be set up in a minimum amount time in tents relatively near to the skirmishing troops, but more often and whenever possible, high visibility buildings in the local area were used for this purpose. Often school houses, warehouses, even barns and other large structures in the general area of the engagement were pressed into service. A field hospital was generally located within a few miles of the site of the battle; they were seldom located more than five miles from the battlefield.
The Union field hospitals were, when time permitted, marked with a flag bearing a green "H" in the center of a yellow field and having a green border. If there was time to prepare the hospital before the long lines of wounded began, the route from the battlefield to the field hospital was marked with small green flags.
During the early war, and even later in the conflict when time was short, a field hospital consisted of simply a single wall tent which was known to the troops as the regimental hospital tent. The staffing of the facility included a surgeon, assistant surgeon, steward, ward master, four nurses, two cooks and a casual duty private. The latter performed general, non-medical, labor associated with the maintenance and operation of the facility.
One of the chief differences in the implementation of Letterman's concept between the two opposing sides was that in the Union Army the field hospital activities were assigned at the regiment level; however, in the Confederate Army the same activities were moved to the brigade or division level, possibly because of the extreme staffing shortage of well qualified medical personnel in the southern armies. It is also possible that the change was implemented in this manner within the Confederate service because it permitted the regimental medical staff to establish and control more effectively, better staffed forward aid stations. Furthermore, the Confederate service never fully implemented the Ambulance Corps, the ambulances continuing under the control of the Quartermaster Corps.
Lastly, the soldier would be evacuated by wagon, rail, or waterway, to the more permanent general hospitals for continued treatment and recovery. These were usually located along the supply and communications lines of the army, well to the rear, in the larger cities or towns along the railroad.
Letterman was also responsible for the decentralization of the ambulance corps in the Union forces. Under his decentralized approach, each medical field entity had its own ambulance service under the immediate control of that specific unit. An aid station had, for example, its' own complement of ambulances, drivers and litter bears whose only job was to move the injured between the battlefield and the aid station and, subsequently, between the aid station and the field hospitals. This task completed, they would return to the aid stations, perhaps hoping that the station had not had to move in the interim, implementing, in military parlance, the time honored "skedaddle" maneuver, a term still in use today.
Field hospitals and general hospitals were also decentralized to the extent practicable. No longer would priorities at a higher command level take precedent over the evacuation and transport of battle casualties. Formerly, these Union ambulances had been under the control of the Quartermaster Corps where the transportation of "bombs and bullets" competed with the transportation of the sick and wounded both important activities.
The new ambulance corps was created in the Federal Army of the Potomac by Special Orders No. 147 at the command of MG McClellan. The orders assigned officers and noncommissioned officers to the Corps and specified the levels of command and the duties and responsibilities of the members of the corps. It also detached vehicles, horses and equipment from the Quartermaster Corps making them immediately available to the newly formed Ambulance Corps. So highly praised was Letterman's Ambulance Corps order that it was passed, completely intact, into law by an act of congress in 1864.
Further, Letterman transferred control of much needed medical supplies to the Medical corps and reorganized the distribution procedures for these valuable assets. On 4 October 1862, Letterman published a circular in which he documented the organization, equipment and supplies (what might be called, in a modern army, a Table of Organization and Equipment [TO&E]) for the general hospitals. The circular, published on that date, was entitled "Medical Supply Table for the Army of the Potomac for Field Service." It was released over Letterman's signature as the Medical Director, Army of the Potomac.
A few days after the publication of the original circular, on 30 October 1862, Letterman published the requirements, staffing and supplies for a field hospital in a subsequent document. Among other things, the instructions specified the medical supplies to be allowed per month of active field service at the brigade level.
As thorough and effective as Letterman's system was, there was nonetheless, some who felt that more could be done for their fallen heroes. To their great credit, the ladies of Columbia, South Carolina rallied to finalize the system. They created in 1861 what they initially called a Wayside Hospital, so called even though actual medical/hospital treatment was, at its creation, minimal. It was, in fact, not actually a "hospital" at all. This facility was located near a local railroad terminal, the railroad being the chief means of transport of the era, and provided care and nourishment to sick an injured soldiers waiting to begin their journeys, or to those already en route. To serve the soldiers already onboard transport, the ladies would go onto the trains that stopped to embark or disembark passengers on furlough or take on water and fuel. These southern bells would "visit with" the sick or injured soldiers, smiling and chatting, generally boosting moral, re-bandaging wounds and, if a doctor was present at their facility, removing individuals who needed more in depth medical care. During the first year of its existence, the wayside hospital at Columbia treated more than 1,000 soldiers.
It is also prudent to note, at this point, that the Columbia, South Carolina ladies were not without other civilian competition in the establishment of the Wayside Hospitals. There were other Wayside Hospitals established about this same time. Charleston, also in South Carolina and Kingston, Georgia also assert that they established the "first" Wayside Hospital.
Following the creation of these early organizations, Wayside Hospitals began to spring up across the Confederacy, usually created, funded, and staffed by the various Ladies Aid Societies popular during the era, initially not military but civilian organizations.
The Confederate Army, perhaps not wanting to be out done by the ladies auxiliary, immediately embraced the wayside hospital concept and commended the ladies and good-hearted, loyal southerners on their spirit. However, at all levels of command the military medical organization was geared to support the soldier injured on the battlefield and the "wayside" concept was not worked into the army model until somewhat later in the conflict. Frequently these new organizations, if they were staffed by trained personnel at all, were staffed by civilian doctors, either under contract to the army or simply supporting the cause by donating their services. Repeating, it is important to understand that originally these hospitals were the creation of civilian authorities. The buildings, where they existed, were constructed and funded by the city or county governments and through donations from the patriotic citizenry of the south. They were not yet, in the black and white world of the army, officially military organizations, with, perhaps, a very few exceptions, until later in the hostilities.
Similar organizations were present in the North. However, these organizations were called "Soldiers Homes" and were never quite the same in their implementation as their southern counterparts.
Once the Wayside hospital concept had been established, this freed the South Carolina ladies to move to what was considered more appropriate care. Leaving portions of the wayside hospital projects to more appropriately trained medical personnel; the ladies next organized what they called "Wayside Homes." These were places where weary, but healthy soldiers, discharged because of injuries or on furlough, could stop and relax, be entertained and fed while the kind ladies talked with them about their homes and families or wrote letters to their loved ones for them, not unlike today's USOs. Ministers visited the homes on a regular basis counseling and praying with the soldiers and often preaching sermons for those who gathered.
Sometimes separate, sometimes combined the homes and hospitals were called "Wayside" simply because they were designed to be located beside the railroad right-of-way. The name was often abbreviated from "wayside" to, simply, "way".
When combat units at the brigade level and larger were stationed in a town, small general hospitals would co-locate in the building provided for the Wayside Hospital or set up a field hospital in an adjacent location. When a brigade or division field hospital was establish in this manner, the wayside hospital would be identified by both the name "Wayside" and the name of the senior surgeon of the field hospital. When this occurred, the surgeon's name was associated with the name of the hospital. Therefore, if Doctor Smith (for example) was the senior surgeon for a brigade stationed in or near Selma, Alabama and chose to set up his field hospital in the facility used by the Wayside Hospital there, that hospital may become known as the "Way and Smith Hospital." This was also common practice for the regimental, brigade and division hospitals. It was in this manner that Wayside Hospitals gradually became part of the official military medical treatment model and began to generate the posting and treatment records upon which we rely for information today.
By late 1862, Wayside Hospitals and Homes sprang up all along the railways across the eastern theater of the war and soon spread to the west. Eventually they could be found at every major rail intersection from Virginia to Texas and, while there were fewer Wayside Homes, they also served a valuable purpose where they existed.
Even though Jonathan Letterman fought his battles with disease and trauma in a blue uniform, both sides, blue and gray alike, owe a great debt to the practices and organization put into effect by him. Further, the fine southern ladies of the great and sovereign state of South Carolina made a gallant contribution to the war effort of which they can be eternally proud.
As the war moved forward, there were several efforts by the Confederate Congress to standardize and improve the medical treatment provided to wounded and sick soldiers. The first of these was legislation passed by the congress on September 27, 1862. The act was entitled "An Act to better provide for the Sick and Wounded of the Army in Hospital." Among other things, the act provided for the eventual transfer of the sick and wounded to general hospitals in their home states.
While there were several other acts of legislation passed with a similar goal, the most significant to Wayside Hospitals was passed by the Confederate Congress on May 1, 1863. This statue amended the original legislation "to establish... a number of "Way Hospitals... located along the routes of important Railroads." The legislation went on to provide food and beds of soldiers who were sick, wounded, furloughed and discharged "...during the course of their journeys home."
It took some time for the will of the congress to become disseminated across the Confederacy, so it was that government supported Wayside hospital weren't in the mainstream until later in 1863. Most government Wayside Hospitals were created in the following year.
As the Confederate Wayside hospitals began to assume the load of treatment, they were generally known simply by their locations as Wayside Hospital, Birmingham or Wayside Hospital, Atlanta. In the military medical support model, these were all (technically) general hospitals, capable of providing long-term care for the sick and injured In Richmond, Virginia, for example, and other large treatment areas, there were also medical organizations called Wayside and Receiving Hospitals (if located near the railroad) or, otherwise, simply "Receiving Hospitals". These "receiving" hospitals took in all casualties from the field and dispersed them to the other general hospitals located around the area.
After the creation of the Wayside hospital legislation by the Confederacy, the transition from private to military hospital was generally a smooth one. However, one fine example of southern dedication to its soldiers occurred early in the war effort, in fact, just 10 days after the first battle of Manassas mentioned above on 30 July 1861. Miss Sally L. Tompkins, had created, wholly at her own expense, the Robertson Hospital in Richmond. This was a private hospital that had served more than fourteen hundred soldiers during the early years of the war. All were treated exceptionally well and the institution became a great asset to the Confederacy.
When the law was passed establishing the Confederate hospitals, it also discontinued the use of private hospitals. Ms. Tompkins protested and appealed to the Secretary of War. The language of the law specified that all hospitals receiving Confederate casualties must be in the charge of a commissioned officer with a rank not lower than captain, the rank of an assistant surgeon. Miss Sally, as she was known, was a civilian, and certainly had no aspirations to a captaincy in the Confederate forces; therefore, she and her hospital were legally excluded from receiving patients.
Although she appealed the ruling to the Secretary of War, he did not have the authority to override an act of the Confederate congress granting her an exception. However, the Secretary, James A. Seddon, appealed to Jefferson Davis, the president of the Confederacy. He showed the president her hospital register and noted that the death rate was very small while the number of men returned to the army was very large. These numbers far exceeded that of any other hospital in Richmond. He appealed to the president for an exception.
On hearing of the record of the Robertson Hospital, President Davis immediately commissioned Ms. Tompkins a captain in the Confederate Army - not exactly what Miss Sally had in mind but, nevertheless allowing her hospital to continue receiving patients.
Clearly, at the onset of hostilities, neither side was well prepared for the volume or the degree of causalities that would be received during the war. However, because of the efforts of the military authorities of both sides and the kindness and devotion of the citizens, an unexpected and difficult situation was bettered. Although the care and treatment of battlefield causalities was primitive at best, it was, nevertheless, the finest ever provided during the era. Furthermore, it established methods and procedures that would be improved upon and enhanced over the years placing the United States in the forefront of modern military medical care.
Barely six years before the beginning of the Civil War the poet laureate of the United Kingdom, Alfred, Lord Tennyson defined the perceived mission of the soldier in his poem The Charge of the Light Brigade as "Theirs not to make reply, Theirs not to reason why, Theirs but to do and die…" Some eighty eight years later an American General, George S. Patton, offered his contribution to the soldiers' mission: "The object of war is not to die for your country but to make the other bastard die for his." It is because of the efforts of MAJ Jonathan Letterman and many others like him that our modern day warriors fight and fall but live to fight again.
