Military Medicine: Does Rank Matter?

Last week at Gazette665’s Fourth Annual Civil War History Conference – 1864: Fighting To Survive – I had the opportunity to teach about the ’64 Shenandoah Valley Campaign but with a twist. Militarily and medically! I’d been planning this presentation for a year and drawing on my studies of primary sources to build a new look at Civil War medical history.

This month on the blog for our Friday post I wanted to share some thoughts and research I’ve been doing “on the side” about Military Medicine across different eras. I promise not to get too “gory and gross” (as my mom would call it).

We’ll kick off the month with some thoughts about rank and if/when/how this has affected survival rates, digging back into medieval history and then moving forward on the timeline.

The Question

By the Civil War era did a soldier’s rank or social status affect his battlefield medical experience if he was sick or wounded? And – if it was a factor – when did the historic shift toward triage based on injury rather than status happen?

Medieval portrait of King Henry V; he is typically depicted in profile, possibly due to his facial injury.

The Wounded Prince

At the Battle of Shrewsbury in 1403, sixteen-year-old Prince Henry (later England’s King Henry V) got shot. An arrow pierced his face along the nose, blow his eye, embedding deep in his skull. The projectile’s shaft was either broken off or drawn out shortly after the wounding, but the arrow head remained, creating a situation that would have caused almost certain death from infection and other complication.

But – Henry was a prince, the heir to the English throne. While common soldiers and even lesser ranking nobles or knights might have been given comfort care, medical experimentation was tried on the prince in an attempt to save his life. I’ll spare you the details since it gets bad, but ultimately through a use of honey as an anteseptic and the creative genius of a medieval surgeon to invent a new device for extracting the arrow head, the metal got removed and Prince Henry survived.

Medieval and medical historians agree that the incident probably would not have happened if Henry had been a common soldier. Rank helped save Henry’s life. One of his warrior subjects probably would not have been so lucky.

Rise of the Common Man

Prince Henry lived in an era when importance was based on the feudal system. Guess what! When you’re part of the ruling family in that system, you definitely take priority over the lowly peasant soldier or common-man archer who might have just as good (or better) chance of survival.

Rank, status, nobility continued to impact battlefield survive for additional centuries. Then the Enlightenment Era comes while the medical field advanced a few paces and a philosophy started to gain traction that all men are created equal. Hmm…

The American War for Independence really starts to rock military medicine. Sure, there were important guys in the Continental Army who got well taken care of when they were injured, but you don’t find “nobility by birth” at play as the doctors try to tend to the badly injured. The common man philosophy was on the rise in western thinking and starting to translate into military medicine.

Dr. Dominique Jean Larrey

The Napoleonic Era starts putting the ideals to the test. Napoleon’s medical director – Dr. Dominique Jean Larrey – and others on the medical staff of The Grande Armee set up a type of triage system, trying to base their decisions on severity of injury and likelihood of survival. They pioneered the “flying ambulances” (still specially wagons) to haul the wounded quickly from the fighting field to field hospitals.

By The American Civil War…

The revolutionary steps for American military medicine tried to bring the battlefield operations under the guiding questions to save lives. It wasn’t supposed to matter if the man were an officer or a private, friend or foe, the decisions were supposed to be made based on possibly survival.

Did that really happen? To some extent, yes. But also, no. (Awfully confusing answer, I know.)

Here’s what I’m finding. It’s not social rank that’s influencing the field hospital decisions, but military rank and leadership status certainly does. On a Civil War battlefield, Prince Henry as just the prince might have had to wait his turn since his chance of survival wasn’t great. But…as an army commander, Prince Henry would have got more specialized care.


General T.J. Jackson

July 21, 1861: Confederate General “Stonewall” Jackson is slightly wounded in the hand. When he finally takes himself to a field hospital, he insists that the surgeon finish tending to the more badly injured first. (Quite a few other minorly-injured officers take this approach in Civil War accounts).

May 2, 1863: Confederate General “Stonewall” Jackson is wounded. His injuries were severe and he is rushed to a field hospital and operating tent; the triage system would have placed him high in importance, but his rank and leadership capability (corps commander) also ensure quick care from the medical director and staff.

July 1, 1863: Union General Francis Barlow is badly wounded, captured, and moved to a civilian home. Hours later some Confederate surgeons arrive and examine the injury; determining it is mortal, they make him comfortable and leave. There’s nothing else they think they can do and there are other patients with better survival odds who needed help. (He did survive the injury, by the way.)

July 2, 1863: Union Sergeant Charles A. Fuller of the 61st New York is wounded in the shoulder and leg. Though he had to wait for medical attention due to the overwhelming number of casualties, no one denied him medical attention based on his rank (or lack thereof). His injuries placed him in the category of those likely to survive with medical operation and high priority and that’s how the surgeons viewed him.

June 20, 1864: Union Colonel Joshua L. Chamberlain is badly wounded and finally rushed into a field hospital operating tent. He repeatedly protests as he is placed on the operating table in preference to a “common soldier” who needed a simpler procedure. In this case, rank is influencing, but the surgeon is not making a decision based on Chamberlains professorship vs the other man’s profession.

September 22, 1864: Lieutenant Colonel Alexander S. Pendleton is mortally wounded. Taken to a civilian home, he received medical care from the corps medical director. Realizing he would not survive, Pendleton himself insisted that the doctors return to the retreating army and ambulance wagons. No questions of rank or status (general’s son) seem to be raised.

Now, social status when it came to the more permanent hospital in cities, sometimes takes a different turn in the story. Particularly in the South, we can find examples of officers (usually the high social class ones) finding ways to get to a private home hospital or simply going home with much greater ease than lowly Private Smith. But that can be another discussion for another day since its multifaceted too.

Union Surgeon’s Coat (Photo by Miss Sarah, Prado Park 2015)


In past centuries of military medical history, feudal and social rank factored into the priority of surgical care. The Enlightenment ushered in a new way of thinking that solidified in the United States and through the advancements of military medicine during the Napoleonic Era. No longer would social status heavily factor into triage decisions.

However, military rank sometimes did ensure quicker medical care. Still, the decisions were based on injury severity, likelihood of survival, and leadership position – not on professional/governmental/social status.

The American Civil War marks a turning point in military medicine on multiple levels, but it also represents a culmination and takeover when medical decisions based on a person’s social status finally faded and decisions were based on their leadership role in the army and the severity of their injuries.

Your Historian,

Miss Sarah

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