Horse-drawn carrriages are positioned on a grassy expanse. Servicemen stand or sit on horses.

The Ambulances of Antietam

By Kenneth M. Koyle ~

In an earlier post Benjamin Forrest discussed the travails of the Union Army’s Ambulance Corps in the Civil War. This week as we approach the 160th anniversary of the Battle of Antietam, the first battle where the Ambulance Corps was tested, we take a closer look at the origins and implementation of the Ambulance Corps in the Army of the Potomac.

In the early morning haze of September 17, 1862, alongside the banks of Antietam Creek near Sharpsburg, Maryland, a brigade of Union soldiers began moving quietly through a cornfield toward a line of Confederate troops. Cannon fire signaled the start of the Battle of Antietam, destined to become the bloodiest single-day battle in American history. The Union’s Army of the Potomac was supported at Antietam by a new battlefield innovation—the medical evacuation system conceived by Jonathan Letterman and established by order of Major General George McClellan just a month earlier.

A group of white men in uniforms and long coats stand and sit outside of a tent under trees.
Jonathan Letterman, sitting in the foreground, with the medical staff of the Army of the Potomac
National Library of Medicine #101436488

Neither the Union nor the Confederacy had an organized system for medical evacuation when the war began. At the first Battle of Bull Run in July 1861 the task was left to contracted civilian ambulance drivers and military band members, none of whom had the necessary training or equipment to do the job successfully. Most of the approximately 1,100 wounded Union soldiers from that battle were not evacuated until a wagon train was assembled for the purpose several days later. Some were left on the battlefield for a full week before being loaded onto wagons or the bare floors of railroad cars for transport back to Washington. Some were even known to have limped or crawled the 20 miles back to Washington on their own. Stories of the suffering of wounded soldiers spread throughout the Union, affecting public opinion and the morale of soldiers. Volunteer organizations gathered medical supplies and recruited nurses and other caregivers in response, but their efforts focused on caring for the wounded after they had been evacuated from the battlefield. The grisly work of battlefield evacuation was typically managed ad hoc, using whatever resources could be assembled for the purpose. Letterman’s system changed that by dedicating resources to evacuate and care for casualties beginning at the point of injury.

McClellan issued the order establishing the Ambulance Corps on August 2, 1862. It provided two dedicated two-horse ambulances for each regiment, each ambulance crewed by a driver and two litter-bearers. These light ambulances would evacuate the wounded from the battlefield to the regimental headquarters area, where they would receive immediate care and be prepared for evacuation in larger ambulances to field hospitals or general hospitals further from the field. This plan may seem like common sense to a 21st-century reader, but it is hard to overstate how groundbreaking it was in 1862. The ambulances themselves were not particularly innovative—similar versions had been in use since the Napoleonic Wars 60 years earlier. But organizing them with dedicated crews in an echeloned system of evacuation from the point of injury to the general hospital was novel, and extremely effective. This approach had a cost though, both in terms of personnel and in fiscal expenditures for the ambulances and equipment, and it wasn’t immediately seen as a worthwhile investment by the Army’s top leadership.

Horse-drawn carrriages are positioned on a grassy expanse. Servicemen stand or sit on horses.
Ambulance drill of the 57th New York Infantry, 1864
National Library of Medicine #101442677

Both Secretary of War Edwin Stanton and Major General Henry Halleck, Commander in Chief of the Union Army, had rejected Army-wide implementation of the plan based on cost and concerns that it would reduce the army’s mobility. Stanton did, however, authorize implementation in the Army of the Potomac, so initially it was only established at that level. The Ambulance Corps was not yet fully organized and training had barely begun when forces convened at Antietam, but 300 ambulances were present and managed to clear the battlefield during the night following the battle. Their work was summarized in the Medical and Surgical History of the War of the Rebellion:

The train of ambulances plied incessantly between the battle-ground and the field hospital. During the night of the battle all of our wounded in the widely extended field were removed to shelter and received the necessary surgical attention. Different members of the corps behaved with the utmost gallantry, passing freely under fire in their search of the fallen, and advancing at times to the extreme verge of the enemy’s pickets.

Horse-drawn carrriages are positioned on a grassy expanse. Servicemen stand or sit on horses.

In his Recollections of the Army of the Potomac, published in 1866, Letterman criticized the performance of his fledgling new system at Antietam. The number of ambulances and tents was inadequate, and medical supplies that had been ordered from Baltimore never arrived because a railroad bridge had been destroyed by the enemy, leaving trains stranded on the other side of the Monocacy River four miles away. But despite these challenges he was pleased with the overall outcome:

Head and shoulders, right pose of a bearded white man; wearing uniform.“It gives me great pleasure to state that the wounded had every care bestowed upon them—that they were willingly, promptly, and efficiently attended—and I cannot refrain from mentioning here the untiring devotion shown to the wounded of that day.”

By the time of the Battle of Fredericksburg three months later Letterman had his Ambulance Corps fully operational, with nearly 1,000 ambulances evacuating over 9,600 wounded men from the battlefield in less than 12 hours. The new system had proven its worth. In March of 1863 General Ulysses S. Grant ordered the establishment of an Ambulance Corps in the Army of the Tennessee, and Congress finally adopted Letterman’s plan for the entire Union Army a year later.

Men carry stretchers to a horse drawn wagon, other men treat wounded lying on the ground.
Ambulance Drill in the Field—The Newly Organized Corps Soon after Antietam, 1911
National Library of Medicine #101435361

The Union would hold the field after that horrific day at Antietam, but with over 12,000 casualties it would be hard to say that they “won” the battle. What they did do was provide a brutal, merciless test of a new concept—echeloned battlefield medicine supported by dedicated evacuation assets. The concept was tested at Antietam, proven at Fredericksburg, and it remains at the heart of emergency medicine today. Whether on the battlefield or in civilian settings, when lives are at stake and medical care is urgently needed it is provided based on the principles first tested at Antietam 160 years ago.

Portrait of Kenneth M. KoyleKenneth M. Koyle is Deputy Chief of the History of Medicine Division at the National Library of Medicine.

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