tive insignia on their uniforms. Ambulances were to move at the head of all wagon trains, not the rear. Only medical corpsmen were to be allowed to remove the wounded from the battlefield. Although ambulances, horses, and harnesses were to be under division control, all ambulance drivers were to be under Medical Department control, trained for their work, and not allowed to assume other duties such as assisting surgeons in the field hospitals. They were also expected to be of proven good character. In March 1864 President Lincoln approved a congressional act creating a uniformed Ambulance Corps, based on Letterman's plan, for the entire Army of the United States. Although the Ambulance Corps was disbanded at the end of the war, it had served remarkably well when it was needed. The Medical Department during the war had never overcome serious problems in the supply of medicine and the construction of field hospitals. But its numerous horse-drawn ambulances had effectively removed the wounded from the battlefields, even during the massive conflict at Gettysburg.

In the Spanish-American War and World War I, the U.S. Army had to relearn many of the medical lessons of the Civil War. By World War I ground evacuation of casualties could be accomplished by motor-driven ambulances, but the increased speed was offset to some degree by limited road access to the widely dispersed front lines in France and the Low Countries. World Wars I and II showed that automotive transport, while effective for backhauls from clearing stations to field hospitals and evacuation hospitals, was of limited value in evacuating casualties from the spot where they fell.

Early Aeromedical Evacuation

The first aeromedical evacuation occurred in the Franco-Prussian War of 1870-71. During the German siege of Paris, observation balloons flew out of the city with many bags of mail, a few high-ranking officials, and 160 casualties. Thirty-three years later at Kitty Hawk, North Carolina, Wilbur and Orville Wright proved that manned, engine-powered flight in heavier-than-air craft was actually possible. In 1908 the War Department awarded a contract to the Wright Brothers for the Army's first airplane, and in July 1909 accepted their product.

Two enterprising Army officers quickly noted the medical potential of such aircraft. At Pensacola, Florida, in the autumn of 1909, Capt. George H. R. Gosman, Medical Corps, and Lt. Albert L. Rhoades, Coast Artillery Corps, used their own money to construct a strange-looking craft in which the pilot, who was also to be a doctor, sat beside the patient. On its first powered flight the plane crashed into a tree. Lacking the funds to continue the project, Captain Gosman