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There was a major paradigm shift in medicine at the time of the US Civil war. Prior to the war, medicine was mostly considered to be an art, but after the war, it became a science. The gears for the shift came from outside the the medical profession.Anesthesia _ Surgery, especially amputation, causes the patient to go into shock if anesthesia is not administered. Even when the surgery was successful, often the patient died on the table. Doctors considered the speed in which the surgery was conducted, was of primary importance, to reduce the shock to the patient. Prior to the civil war, some in the medical profession, began to use chloroform and ether. In general, that worked, but it was hit and miss. Sometimes too much was administered, killing the patient, and sometimes too little. In the days when operating rooms were lit by candles, oil or gas lamps, chloroform, and especially ether were dangerous to all.A dentist, Horace Wells began experimenting with Nitrous Oxide as an anesthesia, along with chloroform and ether. Many in the medical profession, still artists, humiliated Wells with cat calls of “humbug,” and charlatanism. But there were enough younger physicians who were paying attention. Wells continued his experimentation, mostly on himself. Important was to determine the amount of substance to be administered, to get the desired results.Wells will become addicted, and then insane from the substances, and will commit suicide in 1857. His work will make it into the civil war. Best documented was the period between May, 1864 and May, 1865, by the Army (Union) medical corps. Of the 80,000+ operations conducted my Union medical doctors, only 254 were done without the benefit of chloroform, or ether.As the father of modern anesthesia, Horace Wells, a dentist, was recognized by the American Dental Association (ADA) in 1864, and by the American Medical Association (AMA) in 1870.Germs - The germ theory of disease was brought forth by a chemist, Louis Pasteur, in 1857. It explained so many things accurately, and testable. Maybe the most important result in medicine to Pasteur’s theory, was that it led to a huge leap in sanitation.Abraham Lincoln was absolutely aghast at large number of what they called, camp and hospital deaths, due to disease and dysentery. It was the nurses who were paying attention to Pasteur, and it was they, mostly raising their own money, who went to Lincoln to get the USSC (United States Sanitary Commission) formed. In many cases, it put the nurses, and (old school) doctors at snarling odds with each other. The results of the greatly increased sanitation, brought on by the ladies of USSC, were nothing short of profound.Besides Lincoln, the new General in Chief, Ulysses Grant, was doubly impressed, and he put out the word to all of his commanders on how he wanted the new USSC ladies to be treated, and obeyed. They saved his fighting troops. The list of these ladies is long, and has so many stars in it, is unfair to mention just a few; Barton, Alcott, Chappel-Porter, Wormeley, Dix, Bickerdyke.Mary Ann Bickerdyke, with her USSC credentials, and entourage, went all the way to Atlanta, Georgia, to catch up with General W. T. Sherman before he could get too far into his march to Savannah, and the sea. She was slowly passed from the picket (guard) to the lieutenant, captain, major, and eventually to a higher officer on Sherman’s staff. Very busy, and very often bothered by people wanting to speak with the general, the staff officer reluctantly went to Sherman’s tent to inform him of some lady, by the name of Mary Ann Bickerdyke, who wished to speak to him personally. To the entire staff’s surprise, Sherman bolted up, hiked up his trousers, buttoned his blouse, smoothed his hair back, put on is hat and rushed out of his tent to stand at attention in front of Mary Ann’s horse, with her on it.Asked later, by his staff, why he had such a sudden change in demeanor, Sherman raised his eyebrows, shook his head slightly, and said, “She ranks me.”Bickerdyke built hospitals all along Sherman’s path, including for wounded Confederate soldiers. The second most powerful general in the Union army didn’t mind, because she was saving the lives of so many of his soldiers.At the end of the war, they held a Grand Review of the Union Armies. With Lincoln and Grant in the reviewing stands, the Grand Army of the Potomac, with all of its corps passed in review, on 23 May, 1865. On the next day, Sherman’s army passed in review. At the head of the powerful XV corps, was Mary Ann Bickerdyke. There was no complaint from the actual Corps commander, or any of his men.A chemist, a dentist and a lot of nurses were the true inventors of modern medicine, which got kick started by the US Civil War.

MedicineWhen the Civil War began the medical services of the armed forces were almost nonexistent, but there were US medical schools, and doctors could and did receive medical training and degrees. In America, the Pennsylvania Hospital was opened in 1751 through the cooperation of Benjamin Franklin and Thomas Bond, a physician, but there were no schools of medicine in the colonies before the opening of the Medical College of Philadelphia in 1765. Thereafter, in 1767 a department of medicine was founded at Kings College in New York, which awarded the first American medical degree in 1770.Ironically, warfare allowed many doctors to gain surgical experience that never would have been available to them in general practice. This circumstance probably saved many lives in the post-war decades. Hippocrates is quoted as saying that war is the only proper school for a surgeon, yet prior to the Civil War physicians were loathed to undertake extensive procedures — often putting off surgery until the case was all but hopeless.The first battle of Bull Run left 1000 of the 2600 wounded stranded on the field with no efficient means of rendering them aid or removing them to hospital. Ironically, the war provided a unique opportunity to advance medical science and technology. By the end of the war, the manufacture of superior medical instruments and devices had shifted from Europe to the US, and more than 15,000 medical doctors had received on-the-job surgical experience not available to their predecessors.The Federal government began the war with fewer than 130 surgeons and assistant surgeons scattered among its many forts and military posts. Medical officers and their assistants were commonly assigned to individual regiments, and musicians served as stretcher bearers and orderlies. The ships of the navy each had a surgeon, but the smaller vessels often had only medical orderlies assigned to their compliment.Some of the medical personnel working for the federal government were dismissed for suspected disloyalty in 1860, and many of them served with the Confederate forces. The Federal Army in January 1861 counted only 98 surgeons, and the Confederates a mere 24. With time the lack of physicians corrected itself somewhat as medical men volunteered or contracted for service. A total of 17,000 doctors served on the battlefields and in the hospitals of the Civil War from 1861 through 1865. Only 4,000 of these served the South. At the Battle of Gettysburg, the Army of the Potomac had 650 doctors attached to it to serve over 90,000+ men. The 14,000 Union wounded had a mere 105 doctors to care for them once the bulk of the Federal Army, and 85 percent of its doctors, moved on. The Army of Northern Virginia (70,000+) had a less determinate, but certainly smaller, number of physicians to deal with the seriously wounded left behind in its retreat. It was not unusual after a battle to find a mingling of medical personnel–friend and foe, blue and gray–busily tending the wounded.There were a large number of so-called “contract surgeons” serving with the federal army. These doctors had been recommended by the Sanitary Commission and served in military facilities during the emergency. These private physicians were described as a “spoiled lot with little tolerance for personal discomfort and a distaste for sustained labor in the field.” The regular army doctors quickly tired of the complaints, and found that private physicians were of little benefit. For their part, the private physicians tended to look down upon the military doctors as second class practitioners incapable of sustaining themselves in general practice. Nonetheless, most of the physicians who volunteered or enlisted in the army (or navy) during the war had little or no surgical expertise. In the antebellum period, surgery was often dangerous or ineffective. Few practicing physicians attempted surgical procedures except for the most minor ailments. Medical colleges offered two-year programs leading to a medical degree, but there were few, if any, organizations overseeing the medical practice. The American Medical Association—the first of its kind to monitor its members—would not be founded for a decade after the Civil War.A number of surgical manuals were produced through the auspices of the federal government as a temporary solution to the lack of surgical knowledge. Among these were three by Dr. Frank H. Hamilton, professor of military surgery at Bellevue Hospital Medical Center (New York): A Practical Treatise on Fractures and Dislocations (1860); Practical Treatise on Military Surgery (1861); and Amputations in Gunshot Fractures of the Femur (1863). In addition Dr. Samuel D. Gross (Jefferson Medical College of Philadelphia) wrote A Manual of Military Surgery (1861); Dr. Joseph Javier Woodward wrote the Hospital Steward’s Manual (1862) adopted by the army for its hospitals; and Dr. Stephen Smith authored Gray’s Anatomy, Descriptive and Surgical (1862). Many other works were available, but all these titles were available in the Surgeon General’s Office throughout the war.Many Civil War surgeons lived to see these developments and, reminiscing long after the war, lamented their own lack of preparation for the difficulties of treating large numbers of severely wounded men. Opening the abdomen or chest was rare even under hospital conditions. “Many of our surgeons had never seen the inside of the abdomen in a living subject,” one physician wrote, adding, “Many of the surgeons of the Civil War had never witnessed a major amputation when they joined their regiments; very few of them had treated gunshot wounds. … The surgery of these battlefields has been pronounced butchery. Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon.” During the course of the war, formal and informal surgical training programs were begun for newly enlisted surgeons, and special courses on treating gunshot wounds were given. Surgeons on both sides rapidly developed skills and knowledge that improved the treatment of wounds, and they devised many new surgical procedures in desperate attempts to save lives. Improved medical devices and procedures saved many lives that would otherwise have been lost. Evacuation and transportation of the wounded got better, as did the establishment and management of hospitals. The percentage of the wounded that died after treatment dropped dramatically as the war progressed. After Antietam (September 1862), for example, 22 percent of the 8,112 wounded treated in hospitals died; but after Gettysburg (July 1863) less than one year later, only 9 percent of 10,569 wounded died.[i][i] Alfred J. Bollet, Civil War Times (June 2006). URL: The Truth About Civil War SurgeryWhen compared to what is known today, medicine was mired in an intellectual wasteland in the Antebellum Period. A form of vaccination against smallpox (known as variolation) had been pioneered by Edward Jenner in the eighteenth century and used by the army of the American Revolution. Eventually, this saved all but one in 50 soldiers who contracted the illness. As it turns out, the first vaccinations took place in America more than 50 years before those at Valley Forge. They were pioneered by Cotton Mather, who vaccinated two slaves and his own 6-year old son against smallpox. Each of them was mildly sick, but none died, nor did any of the three ever come down with smallpox again. The idea of inoculation or vaccination was new and untested. People were as afraid of the vaccine as they were of the disease. Yet the true causes of epidemic disease, general infections, and gangrene (putrefaction) were largely unknown. These were the great killers in warfare, particularly among the wounded.Louis Pasteur had proposed germ theory in France as early as 1856, but the medical and scientific establishment generally ridiculed it as unproven and speculative. With sober sincerity, many doctors assigned the cause of infection and epidemic disease to bad odors and miasmic mists. It would take additional research by men like Pasteur and British surgeon Joseph Lister for modern theories to be accepted.See Robert E. Denny, Civil War Medicine: Care and Comfort for the Wounded (New York: Sterling, 1995).See also:Amazon.com: Civil War Tech: How Simple It Is After All (Traditional American History Series Book 15) eBook: James M Volo: Kindle Store

Short Answer: The American Civil WarHippocrates is quoted as saying that war is the only proper school for a surgeon, yet prior to the Civil War physicians were loathed to undertake extensive procedures — often putting off surgery until the case was all but hopeless. The Civil War lives on in America’s collective consciousness as one of the bloodiest conflicts in its history, yet more men died of disease than bullets. Death and hardship have sometimes overwhelmed the histories of technological advances made during the war. This was particularly true of the wars of the mid-nineteenth century.Although the influence war and medicine have had on each other is debatable, in some cases war moves medical practices and innovation forward, or refocuses research into specific conditions. In the Crimean War (1853-56) 16,000 British soldiers died of sickness and only 2600 were killed in battle, but this circumstance influenced the development of field hospitals, professional nursing, and the improved transportation of wounded patients. The discovery of general anesthetics and their subsequent applications to surgery revolutionized medicine in the United States and throughout the world. Surgical tools and medical equipment were usually made of the newly discovered stainless steel, because of its durability and ability to be sterilized.When the American Civil War began the medical services of the armed forces were almost nonexistent. The Federal government began the war with fewer than 130 surgeons and assistant surgeons scattered among its many forts and military posts. Medical officers and their assistants were commonly assigned to individual regiments, and musicians served as stretcher bearers and orderlies. The ships of the navy each had a surgeon, but the smaller vessels often had only medical orderlies assigned to their compliment.Some of the medical personnel working for the federal government were dismissed for suspected disloyalty in 1860, and many of them served with the Confederate forces. The Federal Army in January 1861 counted only 98 surgeons, and the Confederates a mere 24. With time the lack of physicians corrected itself somewhat as medical men volunteered or contracted for service. A total of 17,000 doctors served on the battlefields and in the hospitals of the Civil War from 1861 through 1865. Only 4,000 of these served the South. At the Battle of Gettysburg, the Army of the Potomac had 650 doctors attached to it to serve over 90,000+ men. The 14,000 Union wounded had a mere 105 doctors to care for them once the bulk of the Federal Army, and 85 percent of its doctors, moved on. The Army of Northern Virginia (70,000+) had a less determinate, but certainly smaller, number of physicians to deal with the seriously wounded left behind in its retreat. It was not unusual after a battle to find a mingling of medical personnel–friend and foe, blue and gray–busily tending the wounded.There were a large number of so-called “contract surgeons” serving with the federal army. These doctors had been recommended by the Sanitary Commission and served in military facilities during the emergency. These private physicians were described as a “spoiled lot with little tolerance for personal discomfort and a distaste for sustained labor in the field.” The regular army doctors quickly tired of the complaints, and found that private physicians were of little benefit. For their part, the private physicians tended to look down upon the military doctors as second-class practitioners incapable of sustaining themselves in general practice. Nonetheless, most of the physicians who volunteered or enlisted in the army (or navy) during the war had little or no surgical expertise. In the antebellum period, surgery was often dangerous or ineffective. Few practicing physicians attempted surgical procedures except for the most minor ailments. Medical colleges offered two-year programs leading to a medical degree, but there were few, if any, organizations overseeing the medical practice. The American Medical Association—the first of its kind to monitor its members—would not be founded for a decade after the Civil War.An ambulance from the American Civil War period.When compared to what is known today, medicine was mired in an intellectual wasteland in the Antebellum Period. A form of vaccination against smallpox (known as variolation) had been pioneered by Edward Jenner in the eighteenth century and used by the army of the American Revolution. Eventually, this saved all but one in 50 soldiers from contracting the illness (2%). Each of them was mildly sick, but none died, nor did any of them ever come down with smallpox again. The idea of inoculation or vaccination was new and untested. People were as afraid of the vaccine as they were of the disease. Yet the true causes of epidemic disease, general infections, and gangrene (putrefaction) were largely unknown. These were the great killers in warfare, particularly among the wounded.Louis Pasteur had proposed germ theory in France as early as 1856, but the medical and scientific establishment generally ridiculed it as unproven and speculative. With sober sincerity, many doctors assigned the cause of infection and epidemic disease to bad odors and miasmic mists. It would take additional research by men like Pasteur and British surgeon Joseph Lister for modern theories to be accepted.Few soldiers die instantly in battle. Most bleed out or die some considerable time after receiving their wounds — most from infection or complication. Wounded men sometimes went days without any care. The first battle of Bull Run in the American Civil War left 1000 of the 2600 wounded stranded on the field with no efficient means of rendering them aid or removing them to hospital. With some 70% of Civil War wounds affecting the limbs, amputation quickly became the treatment of choice in battlefield surgery. Ironically, the war provided a unique opportunity to advance medical science and technology. By the end of the war, the manufacture of superior medical instruments had shifted from Europe to the US, and more than 15,000 medical doctors had received on-the-job surgical experience not available to their predecessors.At the time of America’s Civil War, battlefield surgeons often worked under appalling conditions, wore previously bloodstained garments while operating, and failed to wash their hands or instruments between procedures. They often amputated limbs that appeared susceptible to putrefaction even before the infection had appeared as a prophylactic procedure. Postoperative patients often rested in beds with dirty linens that were not changed between occupants, or they were deposited in the fields surrounding the aid stations along with the rows of dead and piles of severed limbs.The false image that surgery during the Civil War consisted of amputations, amputations, and more amputations, many done unnecessarily, developed early in the war. Soldiers’ letters and hometown newspapers were filled with such accusations, and the notion stuck. Amputation often saved a soldier’s life, and a healed stump with a prosthetic limb was better than a painful, virtually useless limb, that chronically drained pus. Wounds of the chest, abdomen, and head were often fatal on the battlefield. Soldiers with these more serious wounds were often given morphine and water and made as comfortable as possible as they awaited death, while men with treatable wounds, such as injured limbs, were given evacuation priority.Besides “hospital gangrene” the most deadly infection was probably pyemia, literally, pus in the blood. It is a form of blood poisoning. Nothing seemed to halt pyemia, and it had a mortality rate of over 90%. Other surgical diseases included tetanus (with a mortality rate of 87%), erysepilas (a skin infection) and osteomyelitis (an inflammation of the bone). By way of contrast, the mortality of primary amputations was 28 %, of secondary amputations 52 %. The closer to the body the amputation was done, the more the increase in the wound being mortal. Hip amputations, like that of John Bell Hood, had mortality rates of around 83%. An upper arm amputation, as was done on Stonewall Jackson or General Oliver O. Howard had a mortality rate of about 24%. Hood and Howard survived, while Jackson withstood the surgery only to succumb to pneumonia.Many Civil War surgeons lived to see these developments and, reminiscing long after the war, lamented their own lack of preparation for the difficulties of treating large numbers of severely wounded men. Opening the abdomen or chest was rare even under hospital conditions. “Many of our surgeons had never seen the inside of the abdomen in a living subject,” one physician wrote, adding, “Many of the surgeons of the Civil War had never witnessed a major amputation when they joined their regiments; very few of them had treated gunshot wounds. … The surgery of these battlefields has been pronounced butchery. Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon.”During the course of the war, formal and informal surgical training programs were begun for newly enlisted surgeons, and special courses on treating gunshot wounds were given. Surgeons on both sides rapidly developed skills and knowledge that improved the treatment of wounds, and they devised many new surgical procedures in desperate attempts to save lives. Improved medical devices and procedures saved many lives that would otherwise have been lost. Evacuation and transportation of the wounded got better, as did the establishment and management of hospitals. The percentage of the wounded that died after treatment dropped dramatically as the war progressed. After Antietam (September 1862), for example, 22 percent of the 8,112 wounded treated in hospitals died; but after Gettysburg (July 1863) less than one year later, only 9 percent of 10,569 wounded died.[i]The ghastly nature of the condition of many wounded amputees returning from the conflict led to the federal government taking action in the form of its “Great Civil War Benefaction” program that made a commitment to provide prosthetic devices to every soldier who needed one. Tens of thousands of men maimed by the improved arsenals of both armies inspired entrepreneurs to design new and improved prosthetics. More than 30,000 Union soldiers and 40,000 Confederate soldiers lost limbs between 1861 and 1865. The Patent Office granted 133 patents for artificial limbs and other prosthetic devices between 1861 and 1873. Gone were the peg legs and empty sleeves of former centuries replaced by articulated and “natural” appearing "surgical appliances" — kneeling legs and bending arms, or hands that felt natural to others based on ivory, felt, and leather, or artificial eyes of enameled gold, silver, porcelain or glass. Rubber began to find use along with wood and metal, providing a more natural appearance, better resiliency and more flexibility. The functionality of these nineteenth century devices sometimes advanced beyond mere aesthetics to mobility and dexterity, and showed how far future prosthetics could develop. [ii]See: Amazon.com: Civil War Tech: How Simple It Is After All (Traditional American History Series) (9781980806615): James M Volo: Books[i] Alfred J. Bollet, Civil War Times (June 2006). URL: The Truth About Civil War Surgery[ii] Ironically, the person who launched the era of modern prosthetics was also the first documented amputee of the Civil War – Confederate soldier James Edward Hanger. Hanger, who lost his leg above the knee to a cannon ball, was first fitted with a wooden peg leg by Yankee surgeons. The company he founded (Hanger, Inc.) remains a key player in prosthetics and orthotics today.