I'm a Sr. Financial Analyst from Long Island, NY and am an American Civil War buff and Living Historian (Company H, 119th NY Volunteers).
If wounded, the first step was for the wounded soldier to get away from the immediate area of combat and get to medical aid.
To The Rear
If a soldier was wounded in such a way that he was not immobilized, he made for the rear, and medical attention, under his own power. If his wound made it difficult, but not impossible, to walk, he attempted to go to the rear via the employment of his firearm as a cane or a crutch to aid his movement. If medical aid was too far away, the wounded sought cover, in woods, behind structures, etc. from the battle and either waited for help or rested with the intent to make another attempt rearward later.
Many wounds, however, were more serious and debilitating. If a soldier was wounded in such a way as to severely impede movement he, if able, called for help and tried to crawl to cover as best as he could. If he was immobilized, and could not move to the rear at all, he was helpless to do more than just lay in place, slow the loss of blood (if possible and if conscious), and call for help.
Aid from Comrades
If the wounded soldier had friends and/or family in the same unit and they were aware of the soldier’s condition, there was a fair chance they would leave the line of battle and help the wounded soldier off the field. They might have offered their shoulders on which the wounded man could prop himself and hobble rearward. They might have lifted the soldier up in their arms and tried to carry him. They may have improvised a mobile hammock, with their firearms as side poles and blankets secured to the firearms, in which the wounded soldier was carried.
Officers and NCO’s often stopped soldiers that wanted to take wounded comrades to the rear as this practice further weakened the unit’s strength for continued combat. A unit could ill-afford to lose two healthy men, even temporarily, for every man wounded in the fight.
A soldier who, thus, needed help to get to the rear but whose fellow unit members were unable to render such aid, depended on the army’s ambulance “corps”. The ambulances, as already described in the article Order Of March Part I, were two-wheeled or four-wheeled, horse-drawn wagons with a driver and two litter-bearers. This corps was slow to develop as neither side originally expected a long, protracted conflict or many casualties. It was tasked with the responsibility to get seriously wounded men to medical care as soon as possible. However, many situations seriously hindered these efforts. The number of casualties in any engagement was often quite large in relation to the available ambulance personnel, and scattered over large areas. There were also dangers inherent when in close proximity to the enemy and/or the scenes of continued combat, so there was no real chance to work under these conditions. Therefore, despite all efforts, wounded men often laid untended for long stretches of time.
Battlefield Medical Care (Letterman System)
In the early days of the war, there were few provisions made for the wounded beyond the need to get them to hospitals that were located by major cities. As most combat occurred well outside these metropolitan areas, the wounded were often forced to wait for long periods of time before they received care. Hundreds of wounded men died while in transit to the hospitals.
As the war progressed, so did medical care. The practice, called the “Letterman System” after the name of the creator of this process, evolved to become one of depth. Instead of one very distant area for all treatment, there were multiple stations established at reasonable distances behind the front lines. This ensured that, at least, a modicum of treatment was available to the wounded in the time between the receipt of the wound and the arrival at the metropolitan hospital.
The first such station was a Regimental Aid Station, which was usually set up by the assistant regimental surgeon just beyond small arms range of the front lines (roughly 300 - 400 yards (275 – 365 meters) or so). It was manned by the assistant surgeon and those he organized as litter bearers: the already existent Ambulance Corps staff, medical staff, regimental bandsmen, etc, and was the first stop for a wounded man. Here, medical personnel staunched the bleeding and changed the bandage, which was usually just the man’s handkerchief at that point. They also gave the man a shot of whiskey, thought to bring wounded men out of shock, and made the man stable enough to walk or be carried to the field hospital further to the rear.
Aid stations were generally temporary in duration due to the often fluid conditions of combat, and were set up in tents or, if nearby, in structures like barns, churches, houses, etc.
The Regimental Field Hospital was the next stop. These hospitals were where immediate surgeries took place by the regimental surgeon and assistants.
Like Aid Stations, the Field Hospitals utilized tents or structures for shelter. They were normally set up beyond artillery fire, which was roughly 2 miles / 3.2 km behind the front lines, and stayed in place as long as there were patients incapable of further movement. The wounded were divided into three categories of surgical priority (a.k.a. “Triage”): mortally wounded, slightly wounded, and in need of surgery.
If wounds were judged to be fatal (commonly head, chest, and abdomen wounds), the affected men were moved to an isolated area of the hospital, made as comfortable as possible, and left to die.
For those wounds judged minor, one of the assistants, referred-to as the “dressing surgeon”, bandaged the wounds and administered pain killers in the forms of liquor or opiates.
For those that required surgery, each needed to wait for his turn on the operating table.
By mid-War, field hospitals were consolidated into Brigade, then Division, then finally Corps field hospitals.
Upon time for surgery, the wounded man was laid on the operating table, which was often a dining room table, a door off of its hinges and set upon improvised legs, or even a piano. If there was no exit wound, the surgeon probed into the wound for the projectile, often with his finger which, unknowingly at the time, often caused greater internal damage to the patient. If / When the object was located, it was then removed it with forceps. The surgeon also tried to control any hemorrhages, which are copious, and life-endangering, discharges of blood.
Most surgeries were amputations. Limb wounds were the most common wounds suffered and, as mentioned in Just Before The Battle Mother: The Battle Joined, Minie Balls were the most common cause of wounds. The bones, arteries, and veins in the limbs were often broken and ruptured beyond repair by these large, leaden bullets so that, even today, amputations are the only recourse.
Chloroform was administered via a cloth over the man’s nose and mouth to render him unconscious, though the cloth was periodically removed to allow air for the unconscious man. A tourniquet was then tightened on the limb above the portion to be removed, and the amputation began. Arteries and veins were tied-off with thread, as soon as they were severed, to stop the blood loss, and some skin on the underside of the limb was retained to wrap over the stump after the amputation was completed. The severed limb was then often thrown out of the nearest window or doorway, which piled up with other severed limbs and made for a ghastly sight to anyone who walked by. Meanwhile, the still-unconscious soldier was carried away to some other portion of the field hospital area and laid down, usually on a blanket on the ground, perhaps with some covering overhead. The surgeon, without pause to wash his hands or medical instruments, then repeated the process with other amputation cases, sometimes over the course of several consecutive days.
After surgery, and when the wounded were judged sound enough to move, the next stop was the General Hospital. This hospital had no regimental affiliation and consisted of wounded men from all units of the army, along with the medical staff. General Hospitals were located away from the battlefield, in major towns and cities in the regions where the armies fought, like Washington DC for the eastern theatre of combat, or Nashville, TN for the western theatre. These hospitals were permanently located, and were long, large hospital wall tents, or former barracks, or converted schools, hotels, factories, homes, railroad stations, or newly constructed buildings. These hospitals also had their own kitchens and sometimes even bakeries. The wounded were sent here, via ambulance, railroad, boat, etc. to recover from surgeries or to undergo additional surgeries if needed. No real system of accountability was in place in these hospitals so men, if fully recovered and not yet ordered back to their units, often took the opportunity to desert or otherwise be absent for lengths of time.
Recovery was anything but a certainty. Rates of post-surgery fevers and infections were high, due to the lack of sanitation in the field hospitals, and diseases ran rampant through the crowded wards. Gangrene often set in on wounds and amputations. Through trial and error, more plentiful nursing staff, cleanliness, and ventilation were eventually practiced so that mortality rates declined. Still, medical care in the American Civil War, even if plentiful enough (which it was not), was little better than that in the Middle Ages. Thousands died from the very medical care that was in place to save them.
Those that did recover, but were maimed for life, were often discharged from the hospitals, and thus from the army. They were sent to soldier convalescent homes or camps, either in the home states or nearby the general hospitals. In these facilities, generally run by private relief agencies funded by donations, former soldiers enjoyed relaxation and a few recreational activities while they learned to acclimate back to civilian life. However, not every facility was so inviting. Due to the huge numbers of maimed soldiers and the rate at which they were discharged, convalescent facilities often became little better than barracks for the crippled.
At about the midway point of the war, tens of thousands of troops were disabled due to wounds or disease. In general, these disabled troops were categorized into two classes: The first Class was of partially-disabled soldiers, no longer fit for field duty, whose periods of service did not yet expire and, thus, were not to be discharged. The second Class was composed of former soldiers who were discharged from the service due to wounds, disease, or other disabilities, but who were still able to perform light military duty and desired to do so.
Veteran Reserve Corps
A reserve force, originally called the Invalid Corps, then a year later became the Veteran Reserve Corps, was created by the War Department. It was composed of the afore-mentioned two classes of disabled troops.
Those in the First Class of Disability were transferred directly to the Veteran Reserve Corps to complete their terms of enlistment. Those in the Second Class of Disability enlisted directly into the VRC.
The VRC was infantry only, with no artillery units and no sailing vessels, and was organized into two Battalions, each based on level of physical disability.
The First Battalion comprised troops whose disabilities were comparatively slight and who were still able to handle a musket and do some marching. They were also able to perform guard or provost duty (such as guard prisoners, prevent desertion or unauthorized forage sorties, etc). The Second Battalion was made up of men whose disabilities were more serious, who perhaps lost limbs or suffered some other grave injury. These troops were commonly employed as cooks, orderlies, nurses, or guards in public buildings.
|Disability Class||Soldier Description|
Partially disabled, not fit for field duty, still within term of enlistment
Discharged due to wounds, disease, or otherwise disabled, but can perform light duty
Troops can handle shouldered firearms and can perform limited marches
Guard or Provost duty
Troops with more serious / grave disabilities (ie. amputated limbs)
Administerial (ie. cooks, nurses, orderlies)
VRC uniforms were sky-blue short jackets and forage caps to match their already issued kersey trousers.
The units of the Corps were Regiments, similar in organization to their field counterparts. Each Regiment was designed to comprise six Companies of troops from the First Battalion and four Companies from the Second Battalion. In actual practice, however, this design was not strictly followed, either in total number of Companies per Regiment or in how many Companies from each Battalion served in the Regiment.
As the war went on, troops in the VRC, found to be incapable of even light duty, were discharged at a rapid rate. It was then ordered that men, who were previously discharged and compiled two years of honorable service in the Union Army or Marine Corps, could enlist into the VRC without regard to disability. This helped to keep the strength of the VRC at more acceptable levels for the duties they were assigned
More than 60,000 men served in the VRC during the war, and their service freed hundreds of healthy troops to go to the front instead of remain in rear regions and perform these mundane duties. Some VRC units even engaged in combat in extreme situations.
Many improvements were made in military medical care during the War. However, a large number of lives were lost, many perhaps needlessly, before the need for such medical improvements was recognized.
The next article in this series is called American Civil War Life: Union Infantryman - Life On Campaign XVI.