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During the Civil War, the Union Army often used ships to move sick and wounded soldiers from distant battlefields to general hospitals in Northern cities. Initially, government-run hospital transport ships suffered from lack of planning as did military operations on land. The need for improvement was especially demonstrated during the 1862 Peninsula Campaign when well-run volunteer hospital transport ships assisted the government ships to evacuate patients.
In April 1862 the Quartermaster General granted permission for the U.S. Sanitary Commission Hospital Transport Service to use some idle government transport steamboats to care for sick and wounded soldiers at no cost to the government.
On Sanitary Commission hospital transports, a doctor had charge of the wounded as they arrived at the dock by rail or ambulance. He determined the order of loading based on the severity of the cases. The most seriously ill were loaded in the lower saloon of the ship and tended by the ship's surgeons. The moderately ill were loaded into the upper saloon of the ship, and the least ill were temporarily held in tents on land. The "Women's Department" of the ship took charge of the patients' comfort and welfare. Several women worked on each ship feeding the patients, dressing wounds, and ensuring that all had clean beds and clothing. Supplies were loaded in order to provide basic medical care while on route.
The orderly loading of the volunteer ships contrasted dramatically with the confused loading of government hospital transport ships in 1862. Sanitary Commission volunteers noted that no one person received the wounded as they arrived, had charge of loading the patients, or was responsible for properly supplying the ship. The Sanitary Commission rendered whatever aid they could to the government ships, providing medical care, supplies, and food, but lacked the authority to take charge of the situation.
The Peninsula Campaign of 1862 ended in a Union retreat. One of the last duties of the U.S. Sanitary Commission Hospital Transport Service was when three of their ships were permitted to return to City Point, Virginia, under a flag of truce to load about eight hundred wounded men who were taken prisoner in Richmond. Afterward, the Quartermaster Corps reclaimed the ships loaned to the Sanitary Commission. Improvements were made in the functioning of the government hospital transports, providing more care and comfort to the soldiers. Female nurses and volunteers served on government hospital transports until the end of the war, sometimes at great personal risk.