How the Civil War Changed Modern Medicine

- Despite its barbaric reputation, medical care during the Civil War helped dawn a new era of modern medicine.

- Techniques developed in response to sick and wounded soldiers led to advances in pain management.

- The Civil War saw the birth of organized triage, which directly influenced the modern ambulance system.

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."

A Civil War-era hospital filled with Union soldiers appears in the above photo.

Rare Civil War images of African American life and battlefield scenes appear in the new exhibit, “The Civil War in Photographs: New Perspectives from the Robin Sanford Collection.” The exhibit, at Southern Methodist University’s DeGolyer Library, runs through February, African American History month, and ends on March 15.

“Miss Major Pauline Cushman,” according to Peterson, was a federal scout and spy. “Pauline Cushman was an actress turned Union spy who was captured by Confederates and tried by General Braxton Bragg. Sentenced to death, she avoided hanging because of later Federal occupation of the area.”

“Photographs of Southern wartime regional life like this one are rare,” exhibit curator Anne Peterson, who is also in charge of photographs at the library, told Discovery News. She explained that this image shows “a group of African American women sitting on piles of cotton with two white male overseers.”

Churches on plantations were frequented by African Americans. This very rare photo shows one such church located on Wadmalaw Island in Charleston County, S.C.

“This is a casual view of Union Army camp life,” Peterson said. During free moments, the men would clean up and be shaved.

“Neither the North nor the South were prepared for war,” Peterson said. “There was a shortage of weapons, uniforms and trained officers on both sides. These young artillerymen are not even wearing uniforms yet.”

Three soldiers of the 22nd New York State Militia stand with a cannon at Harpers Ferry, West Virginia.

This photograph shows the interior of Fort Sumter on the day after General Robert Anderson left Charleston. The fort had suffered one and a half days of bombardment by Confederate troops.

Peterson said, “Union Major Robert Anderson surrendered the fort and evacuated. Note the Confederate soldiers in uniform in the photograph.”

“Photographer Thomas C. Roche took a number of early views of Union Army camp life,” Peterson said. Here, cooks prepare dinner for soldiers camped near the Potomac River.

This view, Peterson said, “shows a Union prison camp in upstate New York with Confederate prisoners lined up.” She added that “the overcrowded Elmira camp held more than 12,000 prisoners during the war; 25 percent died (2,963) primarily from malnutrition, poor sanitation, and exposure to harsh winters.”

“From November 1861 until the end of the war, the Union Army and Navy occupied a relatively small area around Beaufort and Hilton Head Island, S.C." Peterson said. "With the approach of Federal troops, planters there evacuated the area, leaving behind their slaves and plantations. As a result, there were thousands of abandoned slaves living in freedom for the first time.”

The U.S. Army's Camp Hamilton was organized on the site of what is now Phoebus, Va. This photo of the camp shows tents and soldiers, as well as a group of drummer boys and what were then known as “Zouaves.” This title referred to certain light infantry regiments in the French Army, but the term was also adopted during the Civil War. The Zouave uniform included short open-fronted jackets, baggy trousers and often sashes and headgear.

Texas wartime photographs like this one, showing Pontoon Bridge over the Rio Grande River, are extremely rare, according to Peterson. “Photographer Louis de Planque opened photography studios on both sides of the border between Mexico and the United States, in Matamoros, Mexico, and Brownsville, Texas,” she said. “Note the African American soldier on the bridge from the 114th U.S. Colored troops.”

"After learning of the fall of Vicksburg, the Confederates surrendered Port Hudson, La. on July 9, 1863," Peterson said. "New Hampshire photographer William McPherson and his partner, Mr. Oliver, documented the abandoned earthworks, ordnance and military equipment.”

“After the Confederates retreated from Petersburg, Va. just days before the surrender, photographer Thomas C. Roche and his assistant made a series of more than 20 views of dead Confederate soldiers,” Peterson said.