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How to collect and transport the wounded was a major problem during the first part of the Civil War. The failure of the medical services to provide for moving the wounded from regimental aid stations to large hospitals set up in the rear of the battlefields caused unnecessary suffering and death.

On July 4, 1862 Dr. Jonathan Letterman replaced Surgeon General Charles S. Tripler, commander of the Army of the Potomac Medical Department. Letterman organized ambulance service into corps and division units, staffed by soldiers chosen by Medical Department officers. Drills were intensified and done more frequently. By the Battle of Antietam on September 17, 1862, the performance of Letterman's ambulance corps had improved significantly. Stretcher-bearers first carried the wounded to primary stations, then loaded them into ambulances to be transported to the field hospitals on a fixed schedule with regular stops en route.

After several attempts, the Ambulance Corps Act was finally passed on March 11, 1864. It established the corps as a regular army unit and gave the Medical Department the right to train and examine men for duty.