During the Civil War (1861-1865), soldiers feared being shot but, disease was the most common cause of death. At the beginning of the war, 1861, the American educational standard for physicians was a minimum of two years or less of formal education. Three out of five Federal soldiers died from disease. Two out of every three Confederate soldiers died from disease. Soldiers were introduced to a mass humanity in military training camps exposing them to outbreaks of dysentery, typhoid, mumps, chicken pox, whooping cough, tuberculosis, and stomach ailments claimed the lives of more men than did battle wounds. In the hot and swampy regions of the South, malaria was common. Exposure to the elements frequently led to pneumonia. When fresh fruits and vegetables were not available, scurvy could break out in the ranks.
Those who did sustain injuries in combat would have to face more than just the wound. Surgical techniques were primitive leaving amputation as the most common treatment for limbs shattered by gunshot. Camp physicians were often called "sawbones." The alternative was to leave a limb that could not be repaired, and the soldier would slowly succumb to infection and die. Surgeons cleaned surgical instruments when they completed their work with water and wiped them dry to prevent rust. In the heat of battle, it was not uncommon for doctors to work for hours and never clean their instruments between use on different patients. The idea of keeping surgical instruments sterile to prevent infection was not understood until after the Civil War. In fact, infection was considered a part of the healing process for new wounds. "Typical surgical techniques ranged from barbaric to barely competent." (1) The Civil War Society's "Encyclopedia of the Civil War."
The numbers of dead and wounded in the Civil War far exceeded those of any previous American war, with more than 620,000 killed and 50,000 survivors returning home as amputees. These statistics prompted the growth of military hospitals and sanitation plans, as well as the development of important surgical techniques to more effectively treat battlefield injuries.