This review describes medical and surgical care during the American Civil War. This era is often referred to in a negative way as the Middle Ages of medicine in the United States. Many misconceptions exist regarding the quality of care during the war. It is commonly believed that surgery was often done without anesthesia, that many unnecessary amputations were done, and that care was not state of the art for the times. None of these assertions is true. Physicians were practicing in an era before the germ theory of disease was established, before sterile technique and antisepsis were known, with very few effective medications, and often operating 48 to 72 hours with no sleep. Each side was woefully unprepared, in all aspects, for the extent of the war and misjudged the degree to which each would fight for their cause. Despite this, many medical advances and discoveries occurred as a result of the work of dedicated physicians on both sides of the conflict.
The Civil War was fought in over 10,000 places and was the bloodiest war in the history of the United States. Two percent of the population at the time (approximately 620,000) died during the conflict (1). More Americans died in the Civil War than in all other wars combined. As hard as it is to believe, these numbers may actually be an underestimate of the death toll, given that much of the data regarding deaths of Confederate soldiers was destroyed when Richmond burned on April 2, 1865. More recent estimates based on comparative census data put the figure closer to 752,000 (2). Countless other soldiers were left disabled. The year after the war ended, the state of Mississippi spent 20% of its annual budget on artificial limbs for its veterans (3).
Many misconceptions exist regarding medicine during the Civil War era, and this period is commonly referred to as the Middle Ages of American medicine. Medical care was heavily criticized in the press throughout the war. It was stated that surgery was often done without anesthesia, many unnecessary amputations were done, and that care was not state of the art for the times. None of these assertions is true. Actually, during the Civil War, there were many medical advances and discoveries
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