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Hospital Flags (U.S.)

Last modified: 2015-04-04 by rick wyatt
Keywords: united states | ambulance | hospital | h |
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[Hospital flag]             [Hospital flag]
Hospital Flag
image by Randy Young, 20 November 1998
  "Signal For Ambulance" Guidon
image by Peter Krembs, 1 April 2001

See also:

Flags Description

At the time of the Civil War, there was no prescribed design, size, or material for hospital flags. At first, both sides used simple red or yellow rectangles. A yellow flag had been used prior to the war to denote places of quarantine, so this might have been a simple evolution. Red just seems to have been "logical". Red also was used to identify places where they collected the wounded for triage, and used to identify "ambulances" - wagons used to collect and carry the wounded.

Even ambulances weren't specifically designed prior to the war; but as time went on, the North set up designs and other specifications for ambulances. The one thing about medicine during this war was that "wartime" or "military" medicine wasn't anywhere near as "formal" as it is today, and the services used whatever they could to satisfy the demand at the time. This is especially true of "hospitals"... that was anyplace where they could treat the wounded and perform surgeries. Often barns and farmhouses were commandeered for this purpose. One reason for the high degree of infections in the wounded was the use of open fields and pastures (which had a lot of manure from the herds there) and the close proximity of barns. (Did you ever wonder why so many Civil War battles were fought on the open grass of National Parks?)

As the war progressed, the Northern side began the switch to yellow flags and added the letter "H" to the center. There were regulations about sizes, but not about materials. The South never got that organized; they ran out of time. But as a battle would rage, the participants would use whatever they could find, of almost any color - including tablecloths and bed sheets - and the opponents often would not recognize the "flag" as being official or as relating to a "hospital", and would fire their cannon at the site.
Bob Hunt, 11 January 2008

The yellow flag with the green H was adopted as a hospital flag by the U.S. Army under a General Order issued on 4 January 1864. Prior to that, as far as I can determine, the only flag used was a plain yellow flag. I don't believe that the CS Army ever used anything other than the unmarked yellow flag as a hospital flag.
Randy Young and Devereaux Cannon, 10 October 1998

The regulations for the Medical Guidon specified that was to be 14 inches wide and 28 inches long, i.e., proportioned 1:2. The color illustrations in my book, Flags of the Union, correctly illustrates the guidon having its one inch green border on only the 3 outside edges. However, in the black and white line drawing the illustration erroneously shows the border on the hoist edge as well.
Devereaux D. Cannon, Jr., 2 April 2001

Regulations for Union and Confederate Armies

The Ambulance Department and Hospital Department were separate departments in the U.S. Army until 1864. (General Orders No. 9 Adjutant General's Office, War Department and Public 22-Act of Congress and General Orders No. 106 War Department, Adjutant General's Office). The Ambulance under the Quartermaster General and Hospital under the Surgeon General, U.S. Medical Service, War Department. It is not clear but it is probable the same system was used in the Confederate Army, except the Confederate had a Chief Surgeon over the Medical Service not a Surgeon General. (The Army Medical Department 1818-1865 CMH Pub 30-8, GPO S/N 008-029-00152-7)

U.S. Ambulance Department:
U.S. Army Revised Regulations 1861 (P 736) " The ambulance depot, to which the wounded are carried or directed for immediate treatment, is generally established at the most convenient building nearest the field of battle. A red flag marks its place, or the way to it, and the conductors of the ambulance and to the wounded who can walk"

U.S. Hospital Department / Medical Service:
Army of the Potomac March 24, 1862 General Orders No. 102 " The Hospitals will be distinguished by a yellow flag" Department of the Rappahannock June 19, 1863 General Orders No. 53 repeated General Orders No. 102 Army of the Potomac. Army of the Cumberland/Department of the Cumberland December 19, 1862 General Orders No. 91 "Hospital and Ambulance depots will be distinguished by a yellow flag, 3 feet square for the hospitals and for the principle ambulance depot on the field of battle; 2 feet square for the lesser ones" The same order was repeated on April 25, 1863 Department of the Cumberland. Adjutant General's Office, War Department January 4, 1864 General Orders No. 9 "Hospitals will be distinguished by yellow flags with a green "H" in their centers, larger for General Hospitals, smaller for Field Hospitals, a smaller yellow flag bordered with green for ambulances". Army of the Cumberland/ Department of the Gulf April 26, 1864 "Field and General Hospitals flags will conform to the General Orders No. 62 announced by the War Department.

C.S. Ambulance Department:
Although most of the Hospital Department and Ambulance Department records were destroyed by fire in Richmond Virginia in 1865, I have found that the same U.S. Army regulations of 1861 were adopted by the Confederate Armies: Army of the Potomac/Army of Northern Virginia, Army of the Mississippi, Department of South Carolina, Georgia & Florida. Army of the Mississippi March 14, 1862 General Orders No. 3 copied nearly verbatim the Revised Regulations of the U.S. Army of 1861 for ambulance flags. Department of South Carolina, Georgia & Florida April 5 1863 General Orders No. 53 same as General Orders No. 3 Since General Beauregard issued both General Orders above, he was probably also responsible for starting the same system of flags in the Confederate Army of the Potomac/Northern Virginia in 1861 (War Department Register of Captured Flags No. 253,258,250,257,312 and 328)

C.S. Medical Department/Medical Service:
The organization of the Confederate Medical Department/Medical Service was identical to that of the United States Medical Department in 1861. It is probable that the same system, use of yellow flags to mark the location of hospitals. (The Army Medical Department 1818-1865). Confederate Veteran XIX, reunion announcement "Medical Officers Army and Navy, C.S.A. - Our place of meeting will be the chapel of the First Presbyterian Church, centrally located and easily accessible by the display from the front of a yellow flag, the hospital insignia of the Confederate Army". Confederate Veteran XXII " Dr. Simon Baruch, remembers the day of His capture at the Black Horse Tavern Field Hospital on the Hagerstown Road, I directed the Union Adjutant General's attention to the yellow rag on the lightning rod and said; you fired five shells after that hospital flag was hoisted"

The use of the yellow flag in the U.S. dates back to 1700's. The flag was used as a quarantine flag for ships suspected of carrying contagious disease. "An act to prevent Sickly Vessels from Coming into this Government" City of Philadelphia 1699. A yellow flag was also used to mark the location of hospitals in the "Marine Hospital Service" July 16, 1798 Federal Public Health Law "An act for the relief of sick and disabled seamen" signed by President John Adams. The hospitals of the "Marine Hospital Service" was under the Department of the Treasury at that time. At the start of the Civil War (War of Northern Aggression) as a Federal enterprise, "Marine Hospital Service" operated 27 hospitals. By comparison, the U.S. Army had 98 medical officers, 20 thermometers, 6 stethoscopes and a few medical text books. The Confederate Medical Department had 24 medical officers. In 1864 the "United States Marine Hospital Service" only had 8 hospitals in service, the others had been transferred to the U.S. Army Medical Service and the southern hospitals were taken over for military use by the Confederate Medical Service.

Except for the Federal Armies listed it is probable that the other Armies (Army of Ohio, Army of the West, etc.....) used the system of red flags to mark ambulance depots and yellow for hospitals until 1864 ( General Orders No. 106)

The Act of Congress of 1778 "Establishment of the American Army" and the Act of Congress 1778 & 1780 'Regulating the Hospitals of the United States of America" establish that each battalion of infantry (infantry regiment) of the Army have a Surgeon and a Surgeons Mate. It is probable that from 1818 to 1860 or 61, the regimental surgeon and/or brigade surgeons had a flag with a green or yellow device ( Corps Badge etc...) to mark his position in the field. ( U.S. Army Medical Department Museum has a pre or early Civil War Medical Flag - white field with a green shamrock in the center and a green border similar to 2nd U.S. Army Corps Division Headquarters Flags)

(Note: the National Archives has artwork of a yellow flag with a green "H" in the center on the hoist upper and lower corners a small red cross, Petersburg, Virginia Field Hospital 1864)

I hope you find this of interest, any additions or corrections will be appreciated, Again, Thanks.
Tom Martin, 17 December 1998

A solid red flag was used to designate the "forward aid station" that was set up by the Assistant Surgeon and Steward and located a few hundred yards behind the battle line.

As you stated, prior to General Order No. 9 of January 4, 1864, a solid yellow flag was used to designate the hospitals. With GO 9, the following sizes were established:

  • General Hospital Flag: 9 ft X 5 ft with a 24 inch tall green "H".
  • Post and Field Hospital Flag: 6 ft X 4 ft with a 24 inch tall green "H".
  • Ambulance and Guidon Flags: 14 inches X 28 inches with a 1 inch green border. The guidon flags "lead" the way to the field hospitals. Prior to GO 9, a solid red flag with no border was used for both ambulances and guidons.
The Confederate Medical Service patterned itself after the Union Medical Service. However, they did have a Surgeon General, Samuel Preston Moore. Moore was actually the 2nd SG for the Confederates (the 1st, DeLeon, served only a couple of month at the very beginning of the conflict)and served in that capacity for all but the first few months of the war.
Peter J. D'Onofrio, 30 April 2002