Times of dramatic trauma — war being chief among them — often contribute to significant innovation. This holds true for the Civil War, when trauma and tragedy on the battlefield contributed much to advances in medical care.
Beginning with the first battles of the war in 1861, the casualties mounted fast. Makeshift field hospitals were first to be overwhelmed. As the wounded were moved off the lines, they overran the hospitals, schools and any other available facilities in the communities near the battlefield.
The brutal nature of soldiers' wounds and unsanitary conditions, both on the battlefield and off, made disease and infection major threats. In fact, two-thirds of the more than 620,000 people who perished in the Civil War died of disease.
Eventually, from the chaos of war came a strict organization. What worked and what didn't work in both field hospitals and in new facilities behind the lines were examined. These more organized systems were developed through the work of a few influential figures.
Jonathan Letterman, medical director of the Army of the Potomac, would come to be known as the father of American military medicine for his structured "Letterman Plan." By pioneering the process of evacuating the battlefield, he ushered in the use of ambulances and advanced the science of field dressing. Letterman and U.S. Surgeon General William Hammond codified the mobile hospital organization under the 1864 Act to Establish a Uniform System of Ambulances in the Armies of the United States. Hammond also established hospital inspections and helped to standardize the organization of hospitals, including their proper layout. Clara Barton, who founded the American Red Cross, was instrumental in bringing professionalism, documentation and efficiency to battlefield medicine.
A conventional misperception about the Civil War was that the treatment of casualties shined a light on how barbaric the practice of surgery was in those days. The derisive moniker "sawbones" emerged from the prevalence of field hospital amputations. In reality, the reason so many soldiers lost limbs was the shear violence of their wounds. Most Civil War wounds came from Minié balls — .58 caliber, soft-lead bullets that would flatten on impact, shattering and splintering bone. Add to that the likelihood of infections setting in, and amputations were seen as a necessity and actually saved many soldiers' lives.
Another misconception was that anesthesia was not readily available, so soldiers' only recourse was to "bite the bullet" to endure excruciating pain. On the contrary, anesthetics were used in 95 percent of procedures, even in the more poorly supplied Confederacy, according to the National Museum of Civil War Medicine.
What physicians learned from all the bone sawing and field medicine was significant. While "germ theory" and an understanding of the importance of disinfection still had decades to come, observational science told doctors, nurses and other caregivers that soldiers often fared better in the field hospital than back in the wards of regular hospitals off the front.
"Ventilation theory" predated "germ theory," increasing the use of sunlight, airflow and clean sheets as aids to recovery. Before that, windows and drapes were closed to avoid "noxious vapors"; that practice helped to make the hospital a breeding ground for diseases like dysentery, typhoid fever, tuberculosis and pneumonia.
The price paid by the casualties of the Civil War was brutal, but out of this brutality came more infection control and increasingly systematic practice of medicine.