CRAIG (VOICEOVER): The Civil War was the deadliest conflict in US history.

MATT (VOICEOVER): The numbers are really mind-blowing.

From 1861 to 1865, more Americans died in the Civil War than in World War I and World War II combined.

CRAIG (VOICEOVER): Even more were wounded and maimed.

MATT (VOICEOVER): But despite this unprecedented bloodshed, countless lives were saved during the war.

CRAIG (VOICEOVER): Today when you get injured, what do you do?

You make a call.

The ambulance comes and picks you up.

They treat you for an infection.

And the doctor amputates your leg, saving your life.

We've all been there.

We sure have.

But when you think about it, the fact that you can pull your cell phone out, and an ambulance will come get you, and experts will diagnose you on the spot and take you to a hospital where you could be treated for almost any ailment is pretty amazing.

But it hasn't always been that way, Matt.

Improvements in ambulance services, anesthesia, and amputation during the Civil War have paved the way for the kind of quality care we've come to expect.

OK, I get ambulances and anesthesia, but can you really consider amputation a medical improvement?

You sure can.

[siren] Oh, we got a call.

Let's go.

Let's go.

This is exciting.

Medicine in America before the Civil War was-- I'm looking for the right word.

It's on the tip of my tongue.

Awesome.

No Definitely not that.

Uh.

Thorough?

Well, in a way.

I mean, you could call it crude.

Yep, that's the word.

This is Jake Wynn, program coordinator and Civil War medicine expert at the National Museum of Civil War Medicine in Frederick, Maryland.

There's just really a lack of knowledge.

There's still ideas going back to ancient times which are still being played out and still being utilized.

A lack of knowledge may be an understatement.

MATT (VOICEOVER): This period of time before the Civil War was referred to as the Heroic Age of Medicine.

Da-da-dah!

Because doctors were heroes!

No, no, they weren't.

It wasn't because the doctors were heroes or anything, but because the treatments were so extreme that only the strongest patients could survive them, making survival a heroic feat on the patient's part.

This often meant the treatments would cause more harm to the patients than the injuries.

Armed with rudimentary surgical instruments and very little knowledge, doctors had patients cut for bloodletting, burned them for blistering, put leeches in infected wounds, and even administered toxic substances like mercury to treat some diseases.

Those who overcame illness did so more by grit and chance than because of the medical help they received.

What's going on in the 1800s as we head towards the Civil War is that that's starting to be left behind, and we're starting to do more of a scientific look at medicine and understanding what is causing problems in the human body, what's causing disease, what's causing infection, what's making people sick.

Just happens that Civil War takes place right as this rapid period of advancement really begins.

And so that's going to push medicine forward.

CRAIG (VOICEOVER): Roughly 620,000 American soldiers died in the Civil War.

MATT (VOICEOVER): To put that in perspective, it's estimated that total is very close to the number of deaths in all other American wars combined.

So because of the crazy amount of injured, both the Confederate and the Union Armies needed a crazy amount of surgeons.

The problem is they were mostly untrained, and those who were trained weren't trained so well to begin with.

So most of them had to learn on the spot.

JAKE (VOICEOVER): They're being exposed to some really horrific injuries, and so they're going to be forced to deal with those injuries.

And they're going to create innovation.

They're going to change the way because they have to.

They have to find a way to more efficiently treat people.

They're not going to continue with this flawed system that you're going to see when the war breaks out.

They're going to make it better.

And they're going to make it better.

And they're going to make it better as the war goes on.

Enter Jonathan Letterman.

He was a trained surgeon graduating from Jefferson Medical College in 1949 and acted as the medical director of the Army of the Potomac.

Prior to the Civil War, there was no large-scale system for treating the injured on the battlefield.

Surgeons and doctors would actually come out onto the battlefield and attempt to treat the wounded right then and there, which could be, needless to say, rather dangerous.

MATT (VOICEOVER): Being a military man himself, Letterman realized this wouldn't be an efficient way to treat a large amount of wounded soldiers.

So he decided there had to be a better way.

This led to arguably the most important medical innovation that happened during the Civil War-- the triage system.

So this is basically a system of sorting patients by the type of injuries they receive.

Instead of trying to treat someone on the battlefield like they did in past wars, doctors would get them off the battlefield, get them out of harm's way, and then send them to where they could get the proper care they needed.

Now this might sound obvious because why would you try treating an injured soldier in the middle of all the fighting?

That sounds crazy.

But in the United States, there had never been a war on this scale before, so an organized system for treating all the wounded had never been necessary.

The Civil War forced doctors to start thinking more scientifically.

They made observations and took notes of what treatments worked and which didn't.

Consequently, medicine became more of a science than it was during the age of leeches and bloodletting.

And this not only lays the groundwork for the medical system that the military uses today, it jump starts almost every facet of our modern emergency services.

That system is innovated during the Civil War.

Jonathan Letterman puts it in place during the Civil War.

It gets its first major test during the battles of 1862, so the Battle of Antietam is Letterman's first major test.

CRAIG: So where are we?

We're in the field dressing station.

This is the first level of care in Letterman's principles of triage and evacuation.

CRAIG (VOICEOVER): This is John Rathgeb, semi-retired surgeon and authority on Civil War era medicine.

I can hear the battle going on.

They have battles going on about 200 to 300 yards back there.

And this actually is the same from Gettysburg.

And this is where the initial first aid was really applied.

Minor wounds patched up, sent back into action.

Mortal wound put aside, kept comfortable.

They would give them morphine here.

They might give them a shot of whiskey.

One of the things in this scene that you may notice is that the Union assistant surgeon and the hospital steward are treating a Confederate soldier.

Letterman's statement was that a wounded soldier is no longer my enemy.

And so that was at least a theoretical principle that was used throughout the Civil War.

From the field dressing station, a soldier would actually be transferred by either ambulance or stretcher to the field hospital, which would be our next step.

We're here, we're in the field hospital.

This is located two to three miles behind the lines to get them out of the effective range of the cannon.

At this location, the vast majority of surgery was done in the Civil War.

Of that surgery, 95% was done under anesthesia.

70% of those surgeries were amputations.

Surgeons also found that by amputating an injured limb, they could reduce the mortality rate from 50% to 25%.

Because amputating a limb prevented the spread of infection, but the surgeons didn't really know why.

They didn't even know germs existed.

But they knew by observation that a soldier had a better chance of survival if the limb was removed.

And they got good at it.

A surgeon during the Civil War was able to perform an amputation in about 15 minutes.

And as they did more and more, the results got better.

The exact number is not known, but it's estimated that over 50,000 amputations were performed.

In the beginning of the war, what we think of as a hospital basically didn't exist.

So the military rented out hotels, warehouses, and churches to act as makeshift hospitals.

MATT (VOICEOVER): But they soon realized that they needed buildings that were specifically designed to care for the wounded and sick.

CRAIG (VOICEOVER): So they developed what is called the pavilion style general hospital.

And this is a good example of one right here.

This is Hammond Hospital down at Point Lookout, Maryland.

They would isolate different diseases in different wards.

They knew to do that.

Again, they were good observers.

And they knew that it would work better if you put all the measles patients in one, and the typhoid fevers in another, and the wounded in another, so you don't get any cross-contamination.

It was also observed that patients fared better in well-ventilated areas, so fresh air was circulated through the wards as much as possible.

This also spurred research into antiseptics, which further decreased the mortality rate as well as bad breath.

MATT (VOICEOVER): By the end of the war, the mortality rate at these general hospitals had been driven down to nearly 8%, a huge improvement from before the war.

After the Civil War, soldiers returning home expected the kind of care they received on the battlefield.

And with the influx of practicing surgeons also returning from the war, this new, more organized, more scientific form of health care became more common place.

Yeah, we consider the Civil War to be the beginning of the modern era of medicine in the United States.

And people say, but it was so primitive.

And of course, it was primitive.

I always use the analogy the Wright Brothers didn't fly a 747 at Kitty Hawk.

You got to start somewhere and build on it, and the Civil War was that start.

So next time you get injured and receive almost immediate, expert medical care, and most likely lose zero limbs, you have the soldiers and surgeons of the Civil War to thank.

So what do you think?

If the Civil War never happened, obviously, we wouldn't be leeching and bloodletting.

But would it have taken longer for these medical innovations to happen?

Yeah.

Where would we be today, and how long would it have taken?

Let us know in the comments.

This episode is brought to you by PBS Learning Media, a great source for classroom resources on Civil War history.

If you're interested in finding more videos or lesson plans on what we talked about today, check out our page on Learning Media here.

And for a more dramatic take on the Civil War, you should check out the new series "Mercy Street" on PBS.

A lot of what we explored in this episode gets talked about on that show too.

So head to pbs.org to find more.