The carnage that was caused by weapons introduced during the American Civil War forced doctors to make advances in medicine that might have taken another 25 years to develop had the conflict not been fought.
"In many ways, the battlefield was the birthplace of modern emergency medicine," said George Wunderlich, executive director of the National Museum of Civil War Medicine in Frederick, Md., who also oversees the Pry House Field Hospital Museum on Antietam National Battlefield.
The 600,000 deaths attributed to the Civil War likely would have paled in comparison to the millions of people who would have died had doctors not been given the opportunity to hone their skills on diseased and wounded soldiers.
"Medicine might have waited another 25 years to catch up had it not been for the Civil War," Wunderlich said. "Large numbers of men fighting with these improved weapons caused the medical department to find new ways."
The advances in weaponry, such as grooved barrels that allowed cannons and rifles to fire farther and with more precision than their smooth-bore predecessors, permitted soldiers to hit their targets with greater effectiveness, Wunderlich said.
"Anything upward of 125 yards, a rifle was much more accurate than a smooth bore," he said.
The Minie ball, the state-of-the-art bullet of its day, was smaller than the circumference of the rifle barrel and made loading faster. When fired, the Minie ball expanded and engaged the grooving on the inside of the barrel, which made the projectile spin for greater accuracy and distance.
Sniper rifles with scopes made killing with small arms even more effective.
"You're seeing incredible shots being made during the Civil War," Wunderlich said. "Those things could reach out and touch you from 700 to 800 to 900 meters ... Entire regiments of sharpshooters were formed."
The bullets, which typically ranged in size from .54- to .58-caliber during the Civil War, were much smaller than the .69- to .75-caliber musket balls that were used in the Revolutionary War, Wunderlich said. A smaller bullet that didn't hit a vital organ or artery was more likely to wound than to kill, and that resulted in more patients for doctors to work on and enhance their skills.
The side with the most modern artillery also had the advantage, Wunderlich said. A good example was the Battle of Antietam, in which union guns firing from the area of the Pry House on the south end of the battlefield took a toll on Confederate guns that were deployed near the site of the current Visitors Center
He said the Confederate cannons had a shorter range, and as a result, many shells fell short of their targets, while the rifled Union guns fired with deadly accuracy. After the battle, Wunderlich said, dozens of Confederate shells were found at the bottom of a ledge in front of the house.
"(Union soldiers) fired at will without danger to themselves — at least in that case," Wunderlich said.
About 23,110 casualties were recorded at the Battle of Antietam, where, for the first time, Dr. Jonathan Letterman was able to enact his system of emergency medicine that is still used on the battlefield and in the civilian world today.
Letterman, a surgeon in the Union army, invented a system to rapidly remove wounded soldiers from the battlefield. The first step was to take the soldier to an aid station about 75 yards from the fighting. The aid stations were staffed by surgeons who stabilized the patients. A horse-drawn ambulance then took the soldier to a field hospital, where he received more advanced care before he was taken to a hospital away from the fighting.
"It saved a boatload of lives," Wunderlich said. "We still use these principles today ... They brought the ambulance system and the emergency room system back to civilian life. They were the ones who pushed technology in the civilian world."
Wunderlich said the wounds that soldiers suffered during the Civil War spurred doctors to specialize in areas of medicine such as plastic surgery, orthopedics, neurology and the treatment of gunshot wounds.
Doctors found cures for infections as well, even though they didn't understand germs. Wunderlich said experiments with bromine and iodine to treat gangrene, for example, led from an abysmal cure rate before the war began in 1861 to a 96 percent cure rate by the time the war ended in 1865.
"They were shooting in the dark with a lot of it," he said.
Medical professionals discovered that cleanliness also produced positive results.
"They learned that people lived longer in clean hospitals and clean camps," Wunderlich said. "Hospitals became immaculately clean. They didn't know why, but when they did, people lived longer."
William Hammond, the U.S. surgeon general at the beginning of the war, ordered doctors to perform case studies to describe how wounds and diseases were treated in an effort to identify ways to save lives. In addition to recording the types of medicines and procedures that were used, doctors recorded such things as the soldier's race. The case studies that were found to be effective were compiled and published in "The Medical and Surgical History of the War of the Rebellion, 1861-1865," a six volume reference with thousands of pages.
"It was a treasure trove," Wunderlich said. "It documented diseases and wounds. It became a real textbook for future generations of military surgeons."
In a way, the Civil War was to medicine what Elvis Presley was to rock 'n' roll.
"He didn't invent it," Wunderlich said. "But he changed it a little and went wild."