The American Civil War often gets credit for ending slavery and reshaping the federal government in this country. But the War Between the States has another, often overlooked legacy: It may have started a new era in modern medicine.
As soldiers fell in unprecedented numbers from both injuries and disease, anesthesia became a specialty. The fields of plastic and reconstructive surgery exploded. And doctors developed new ways to treat a surge in nerve injuries and chronic pain, marking the beginning of contemporary neurology.
At the same time, a visionary surgeon named Jonathan Letterman forever altered the flow of medical treatment from battlefield to hospital, said George Wunderlich, executive director of the National Museum of Civil War Medicine in Frederick, Md.
Now, 150 years later, Letterman's basic principles continue to affect medical care in a wide range of situations, from bombings in Afghanistan to heart attacks in American grocery stores.
"Civil War medicine was every bit as barbaric as it's made out to be, and surgeons weren't washing their hands," Wunderlich said. "But it was a million times more modern than almost anyone thinks. And there are a lot of lessons we can still learn from today."
Medically, the United States was woefully prepared when the Civil War began in the spring of 1861, said Michael Rhode, an archivist at the National Museum of Health and Medicine in Washington, D.C. Nearly 80 years had passed since the end of the American Revolution, the country's last major war. And the new conflict was happening on a much bigger scale.
Scientists, meanwhile, had yet to come up with the theory that germs cause diseases. Doctors didn't know that they should wash their hands before amputating limbs. As soldiers from small towns came together in large groups, they became newly exposed to pathogens that their bodies had never encountered before. But there were no antibiotics and no antiseptics.
As a result, for every Civil War soldier that died of an injury or gunshot wound, more than two died from dysentery, diarrhea or other infectious diseases.
"They had no idea what was causing it," Rhode said. "The theory was something called miasmas, or bad airs. But no, it's not a miasma when a guy is wiping his surgical knives on a bootstrap with horse dung on it."
Medicine has come a long way since then. Injuries that resulted in amputations 150 years ago now lead to X-rays, the setting of bones, and a four- to six-week recovery period before returning to battle.
Over the course of the war, doctors learned some lessons that forever changed the way medical care happens, both on the battlefield and beyond.
There was, for example, a growing sense that cleanliness reduced fatalities. Doctors who treated soldiers made leaps in understanding about neurology and other fields, and specialists continued their lines of research even after the war ended.
Then there was Letterman, who as medical director for the Union Army created a well-organized system of care that began with triage close to the source of harm and was followed by rapid transportation to a series of clinics, hospitals and specialists. Even though technological advances have replaced horse and carriages with helicopters and jets, Wunderlich said, those kinds of protocols continue to be essential today.
As the Civil War ended and soldiers returned home, they retained their expectations for quick and efficient treatment in all situations. If a wounded man could be picked up in the midst of the Battle of Gettysburg, after all, shouldn't everyone be able to get rapid help after falling off a ladder on the street?
As a result, the end of the war saw the beginning of ambulance systems in many major cities. Letterman's ideas also directly influence the way today's 911 call system works. And the National Museum of Civil War Medicine has used the surgeon's ideas to train hundreds of thousands of medical professionals who have been sent to Afghanistan.
The war "was a watershed that really changed all medicine to the point where it could never completely go back to the way it was before," Wunderlich said. "All these changes had come about, and people weren't willing to go back."