The opening months of the Civil War went on in the midst of confusion and improvisation. This was especially true of the field medical services of both armies which were disorganized and understaffed-and hence not in position to cope with the vast number of wounded soldiers nor treat them properly. Moreover, the ambulance services were woefully inadequate, and the wounded men had to find their way back to the hospitals where overworked surgeons operated around the clock under extraordinarily trying conditions. After the first battle of Bull Run both sides made attempts to reorganize their medical staffs, and after the second battle at Manassas it was obvious that further improvements were necessary. The Union army set about creating a medical service which could cope with a long war, but the Confederacy failed to foresee a similar need, having just won a major victory. In comparing the efforts of both armies to establish efficient medical services, Horace C. Cunningham brings to light an important aspect of this war of attrition.