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Battlefield Medicine Battlefield Medicine BATTLEFIELD MEDICINE z A History of the Military Ambulance from the Napoleonic Wars through World War I z WItH Az NeW PrefAce John S. Haller Jr. Southern Illinois University Press Carbondale and Edwardville Copyright © 1992 and new preface copyright © 2011 by the Board of Trustees, Southern Illinois University All rights reserved Paperback edition 2011 Printed in the United States of America 14 13 12 11 4 3 2 1 Library of Congress Cataloging-in-Publication Data Haller, John S. Battlefield medicine : a history of the military ambulance from the Napoleonic Wars through World War I / John S. Haller, Jr. — Pbk. ed. p. cm. Prev. ed.: Carbondale : Southern Illinois University Press, c1992, under title Farmcarts to Fords : a history of the military ambulance, 1790–1925. Includes bibliographical references and index. ISBN-13: 978-0-8093-3040-9 (pbk. : alk. paper) ISBN-10: 0-8093-3040-7 (pbk. : alk. paper) ISBN-13: 978-0-8093-8787-8 (ebook) ISBN-10: 0-8093-8787-5 (ebook) 1. Transport of sick and wounded—History. 2. Transportation, Military—History. 3. Ambulances—History. I. Haller, John S. Farmcarts to Fords. II. Title. UH500.H35 2011 355.3'45—dc22 2010046493 Printed on recycled paper. The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI Z39.48-1992. FOR John) lea)) Nonie) and Lee No spectacle is more painful than that of the carriage of the wounded, the sick, and the dying in the midst of a campaign. It is the blackest page of war. The triumphs of the battlefield are all dimmed in looking at this inevitable sequel. It is needful to have seen it to comprehend it, for official dispatches and history tell but little of the reality. -Sir Henry Holland, Recollections ofPast Lift, 1872 Contents Plates ix Preface xi Acknowledgments xiii Introduction 1 part one. Early History 1. Beginnings of a System 7 2. Early Ambulance Technology 40 part two. Consolidation 3. A World in Transition 61 4. Old and New Thinking 90 part three. The Great War 5. New Challenges 145 6. Trials of Evacuation 163 7. Lessons Learned 184 Notes 205 Selected Bibliography 235 Index 257 Plates Fol/owing page 110 I. Larrey's two-wheeled ambulance 2. Percy's surgical wagon 3. Percy's stretcher-bearers in marching order 4. Percy's stretcher fined for carrying wounded men 5. Squire's organi~..ational model for a division hospital 6. The common dandy and Barcill y dandy 7. A convoy of sick in camel kujjawas and a camel dhoolie 8. Mule cacolcrs or chairs 9. A freight car fined with eight spring-bed stretchers 10. The China wheelbarrow ambulance 11. Neuclorfer's two-wheeled liner, open for wounded transport, packed for carriage 12. Ncuss's two-wheeled litter 13. The Moses ambulance wagon and tent 14. The Coolidge ambulance wagon 15. The TripIer ambulance wagon 16. The Wheeling or Rosecrans ambulance wagon 17. The Rucker ambulance wagon 18. An 3mlY wagon fitted up as a Langer ambulance wagon 19. TIle interior of an improvised hospital railcar 20. A Dakota Indian tr:l.vois 21. A wounded soldier conveyed on a double-mule litter 22. McElderry's single-mule liner 23. The Rooker saddle attachment packed to a McClellan saddle x PLATES 24. The Rooker saddle attachment for support of a wounded soldier 25. The Autenrieth medicine wagon 26. Medical supplies carried on a two-pack mule 27. The U.S. Army medical transport cart 28. The British army sick-transport wagon 29. The Hamburg system of stretcher suspension in an improvised railcar 30. A saddle support for wounded calvary 31. A bicycle ambulance 32. Carter's "simplex" ambulance 33. Apparatus for carrying a wounded man on a soldier's back 34. Diagram of the British army evacuation organization 35. Diagram of the U.S. Army evacuation organization 36. Two-wheeled farmcart 37. Stretchers slung between two wheels, leaving the trenches 38. Stretcher-bearers returning from no-man's-land, S0111111e,1916 39. German prisoners carrying wounded men in a waterproof sheet 40. Colt trench stretcher, Willis stretcher, Victor stretcher carrier, and Blackham stretcher carrier 41. An overhead trench railway ambulance trolley 42. Ambulance cars on a temporary railway 43. Decauville light-railway system fitted for carrying wounded soldiers 44. A camel cacolet for recumbent patients 45. A German streetcar commandeered for transport of wounded 46. Ambulances for carrying mustard gas patients 47. The Belgian field ambulance motorcar 48. A Hampshire Automobile Club ambulance motorcar 49. An advertisement for volunteer American ambulance drivers 50. A Ford ambulance motorcar in the American Field Service 51. Transferring wounded men to a railway train 52. A ward railcar arranged for recumbent cases in a British ambulance train 53. Loading a patient into the fuselage of an aeroambulance 54. The aero ambulance designed by Major S. M. Strong Preface Unfortunately for the earth's fragile ecosystem, war remains the policy of choice among feuding nations and peoples, wreaking havoc not only on fellow human beings but on all living species. One of the few positive outcomes to emerge from this man-made trauma was the effort, begun by Dominique-Jean Larrey during the Napoleonic Wars, to bring orga­ nized medical support and transport to the soldier wounded on the field of battle. Elements of Larrey's support system were later introduced into the Crimean War, the American Civil War, the Franco-Prussian War, various fin de siecle wars and hotspots, the Philippine Insurrection, and finally the trenches of World War I-all of which are traced in the pages of this book. We know, of course, that the military ambulance continued to respond to innovations in military tactics and technology. Examples were appar­ ent with the development of the Echelon II hospital units situated close to unit-level aid stations in World War II, and later, with the U.S. Mobile Army Surgical Hospital (MASH) units located minutes from the battle­ field in Korea. The proximity of these mobile units to the battlefield con­ tinued into Vietnam and the first Gulf War, providing an exceptionally high survival rate for tlle seriously wounded soldier. The last of these units, the 212th MASH, was established in Iraq in 2003 before being transferred to Pakistan to serve earthquake victims. Along with these organization­ al changes came improved ground and air transportation. While the first medevac helicopter was employed in April 1944 in Burma, not until the Korean War did the Bell 47, with its external basket stretchers, become the mainstay of air medical evacuation. Following that were the Bell UH-1 (Huey) during the Vietnam War, which allowed for treatment during flight, and the UH-60 Blackhawk in Iraq and Afghanistan. xi xii PREFACE More recently, the emergence of asymmetrical threats and insurgencies, often by nonstate combatants, have forced paradigmatic changes to existing support systems. Today, due in no small measure to improvised explosive devices and other unconventional weaponry, the military has responded with mobile forward surgical teams to provide basic advanced-trauma life support to stabilize seriously wounded soldiers unable to survive medevac care. These units, organized around advanced-trauma life support, operat­ ing room, and recovery components, are intended to treat combat casual­ ties within the "golden hour" following injury before transferring them to hospitals for further care. This book is dedicated to the men and women of m)' father's generation who fought in World War II and Korea, to those of my own generation who fought and died in Vietnam, and to those before and since who put their lives at risk in support of our nation's values and purposes. To them I tender my profound respect and humble thanks. February 2011 J.S.H. Acknowledgments During the course of writing this book, many colleagucs,librarians, archivists, and friends provided suppOrt, suggestions, criticism, and encouragement. In this regard, I am especially indebted to David L. Wilsoll, colleague in the Department of History; to Pascal James Imper­ ato, M.D., at the Medical Society for the State ofNcw York and editor of the New YorkStattJournal ofMtdicine; and to Glen W. Davidson, chairof the Department of Medical Humanities at the Southern Illinois Univer­ sity School of Medicine in Springfield, for their timely counsel, sugges­ tions, and assistance. Also important are those reviewers whose evalua­ tions-both supportive and critical-caused me to adjust my sights, correct mistakes, clarify concepts, and explo re new areas and connections. For their comments I am deeply appreciative. I want to give special thanks to Richard D. DeBacher, editoria l dircccorofSouthern Illinois University Press, fo r his advocacy on behalf of the manuscript; and to Susan Wilson and Kathryn Koldchoff, whose editorial support added measurably CO the final product. In addition, I appreciate the encouragement and advice given by colleagues Mark S. Foster, David P. Werlich, Donald S. Detwiler, John Y. Simon, Robert L. Hohlfdder, Glendon E Drake, Gilbert Schmidt, David C. Hood, T homas J. Noel, Mary S. Conroy, Dorothy Abrahamse, Stephen Horn, Karen Fawson, and Barbara Parker. Finally, I should like to thank my wife, Robin, who, as with all of my research, offered inspiration, encouragement, criticism, and substantial assistance, includ­ ing the proofing of numerous drafts and indexing the finished manu­ script. Like most authors of historical works, l alll\cspccially obligated co the historian-collector-librarians and their profcssional staffs. It was their generosity of time and experienced assistance that made it possible for me xU> XIV ACKNOWLEDGMENTS to enrich my understanding of the subject matter and to carry out the necessary research.
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