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Determining the Facts

Reading 1: From Incompetence to Proficiency:
The Development of Union Medical Care

The North and the South had struggled through nearly four years of brutal fighting by the time the Battle of Bentonville erupted in the spring of 1865. By then, month after month of dead and wounded soldiers had drained away most, if not all, of the romance of war that had characterized the start of the conflict. Yet the seemingly endless flood of casualties had produced at least one encouraging development, better medical care on the battlefield.

For troops wounded in the early battles of the Civil War, the disorganization of the medical corps often proved disastrous. At the First Battle of Manassas (Bull Run) on July 21, 1861, for example, many Union surgeons refused to treat casualties from regiments other than their own, and civilian ambulance drivers fled from the field at the first sound of gunfire. As a result, some wounded were left lying on the battlefield for three or four days.

Assistant Surgeon John W. Foye of the Eleventh Massachusetts Infantry described one deplorable but typical scene:
The regiment was accompanied by one ambulance well provided with stimulants and surgical appliances, but without medicines or tents. The field hospital was established about a quarter of a mile from the front line when we engaged, but late in the day it was three-quarters of a mile in the rear. Up to two o'clock the Confederate wounded at the hospital nearly equaled our own. Until that time but few wounded were brought off by their comrades, but later it was not unusual to find a flesh wound escorted by half a dozen able men....At three a medical officer of rank visited the hospital on his way to the rear and left it optional with the medical officers at the hospital to join him or remain. Nearly all the surgeons left us about half-past three. Three ambulances went away at that time. The only remaining ambulance, belonging to my regiment, was captured about half-past five, within a hundred yards of the hospital. All the wounded capable of being moved had been sent off to the rear. I estimate the number left at one hundred and eighty. All of them fell into the hands of the enemy.¹

The horror and suffering at Manassas led administrators within the United States Army Medical Department to urge the formation of an ambulance corps and a formal system for establishing and operating field hospitals during battle. Many of the necessary improvements were provided by Surgeon Jonathan Letterman, Medical Director of the Union's Army of the Potomac. Part of the following reading comes from his "Field Hospital Order" of October 30, 1862; the rest appeared in guidelines given to the Medical Director of an Army Corps.

Previous to an engagement, there will be established in each Corps a hospital for each Division, the position of which will be selected by the Medical Director of the Corps. There will be selected from the Division, by the Surgeon-in-Chief...three Medical Officers, who will be the operating staff of the hospital, upon whom will rest the immediate responsibility of the performance of all important operations....

The remaining Medical Officers of the Division...who follow the regiments to the field will establish themselves, each one at a temporary depot, at such a distance or situation in the rear of his Regiment as will insure safety to the wounded, where they will give such aid as is immediately required....

The Surgeon-in-Chief of Division will exercise general supervision...over the medical affairs of his division. He will see that the officers are faithful in the performance of their duties in the hospital and upon the field, and that, by the ambulance corps...the wounded are removed from the field carefully and with dispatch.

During an engagement the duty devolving upon the Medical Director of a Corps to select a site for the different hospitals of the Corps is not always an easy one. As a general rule they should be placed near the most practicable roads, in rear of the center of the troops, and sufficiently to the rear to be out of the ordinary range of the enemy's guns; suitable ground, good water, and plenty of fuel must of course decide the choice of locality.²

This system, which became known as the Letterman Plan, was introduced first in the East. It became a crucial part of the North's gradual improvement of its logistics--its handling of military material, facilities, and men. In 1862 the South set up its equivalent of the Letterman Plan, an "infirmary corps." In Battle Cry of Freedom James McPherson points out that, "like everything else in the southern war effort, [the infirmary corps] did wonders with the resources available but did not have enough men, medicines, or ambulances to match the Union effort." As a result, he estimates, 14% of wounded Federal troops died versus 18% of wounded Confederates.³

The Letterman plan was still untried in the Union's western armies when General William T. Sherman commenced his Atlanta Campaign in the spring of 1864. But by the time Sherman began his "March to the Sea" in November 1864, it was working well and in many instances had even been refined.

Questions for Reading 1

1. What problems did the Union Army Medical Corps have during the First Battle of Manassas?

2. At that battle, what option did the ranking medical officer give the surgeons when he visited the field hospital? How did they react? Why do you think the surgeons made this decision? Why do you think "half a dozen able men" frequently chose to escort someone with a flesh wound to the hospital?

3. According to the Letterman Plan, what were the duties of the Medical Director of the Corps? The Surgeon-in-Chief? The medical officers assigned to regiments in the field?

4. Which problems apparent in the First Battle of Manassas did the Letterman Plan attempt to solve?

Compiled from Capt. Louis C. Duncan, The Medical Department of the United States Army in the Civil War (Washington, 191?) 29, 123-25; George A. Otis and D.L. Huntington,The Medical and Surgical History of the War of the Rebellion, Part III, Vol. II, "Surgical History," Washington: Government Printing Office, 1883, 905.

¹Quoted in Capt. Louis C. Duncan The Medical Department of the United States Army in the Civil War (Washington, 191?), 29.
²Duncan, 123-125; Otis George A., and D.L. Huntington. The Medical and Surgical History of the War of the Rebellion. Part III, Vol. II, "Surgical History." (Washington: Government Printing Office, 1883), 905.
³James McPherson, Battle Cry of Freedom: The Civil War Era (Oxford University Press: New York, 1988), 485.

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