It is 1861 at the site of a Civil War battle.  You have just been struck down.   Imagine lying on the cold, wet earth below you, your leg oozing with bright red, warm blood.  You cannot move.  Your leg is broken in at least five different places.  As soon as a doctor sees you, he might tell you that you’re fine and that he doesn’t really need to do anything.  Yet, within days, you die from a bacterial infection.  Or, he tells you that your precious limb must be amputated.  You go into shock at the sight of the arms and legs piled on the floor, a common Civil War sight (see photo at the right), and then you see his saw. You scream in pain as the dirt-infested, hard, cold saw cuts through your skin, your muscle, and your bones; all you can think of is the pain.   When the doctor has finally finished, all that is left is an oozing stump with long arteries protruding outward.  The sheet you are now lying on is soiled with your own blood. You begin to loose energy, and your body turns ghostly white.  You are extremely cold but are too lifeless to shiver.  You begin to drift into unconsciousness.   This is just another, and quite common, cause of death by blood loss from amputation.

Had you been struck just two years later, your life could have been saved, you would have felt little pain during the amputation, and your chances of survival would have been much higher.  Ironically enough, this is because of the Civil War.  During the war, techniques were developed for treating massive bone fractures.  Usually, the limb (most commonly severely fractured) would be amputated.  Because of the many opportunities for observation and experimentation that the war provided, medics descovered that if a limb was amputated after more than twenty-four hours, the soldier would almost always become infected and die shortly thereafter.  But, if the limb was amputated correctly within twenty-four hours of being fractured, the soldier would usually survive if he did not succumb to blood loss.  Unfortunately, bleeding to death was also quite common early in the war, and so doctors became very motivated to solve this massive problem. 

The traditional way of dealing with bleeding had been to leave the arteries long, protruding out of the new stump.  The theory behind this method was that the limb would drain all blood back into the soldier's body, and he would not bleed to death.   Actually, this method was bleeding the patient to death because the protruding vessels allowed blood to seep from the patient's body.  Soon, observant medics began to try to ligate (tie off) the arteries, but the ligation would usually not work and the patient would still suffer from blood loss.  The huge number of patients with similar poor results kept driving the Civil War surgeons to try new techniques.  More absorbent materials were tried, and eventually, ligation was mastered.  Ligation of other main arteries, such as in the neck, was also mastered.   Ligation is a major technique still in use in modern surgery.

More problems kept occurring.  Even though doctors had by then developed the skill to tie a patient’s arteries, it was often difficult to do so when a patient was thrashing around wildly in pain during an amputation.  The idea of anesthetics had been discovered before the Civil War, but the "new idea" was rarely used.   During the war, with patient after patient jerking wildly during surgery, the desperate need for anesthetics became apparent.  It became obvious that without anesthetics it was almost impossible to perform the simplest surgical task. The Civil War doctors experimented a lot with the idea, and anesthetics caught on.   Ether and chloroform were most commonly used.  Their war-proven effectiveness caused ether and chloroform to continue to be used, especially after the war.   Without a doubt, it was the beginning of a modern surgery which absolutely requires anesthesia.