The medicine practiced in Virginia by the Union and Confederate armies during the American Civil War (1861–1865) was state of the art for its day and an important factor in the ability of both governments to raise and maintain armies in the field. More than twice as many soldiers died of disease than from combat-related injuries. Still, despite many nineteenth-century misconceptions about the causes and treatments of disease, three out of four soldiers survived their illnesses. This was due in part to widespread vaccination for smallpox, isolation of most contagious diseases, and especially the recognition of the importance of cleanliness and sanitation. As the war dragged on, combat injuries became more prevalent and the work of surgeons became more important. Surgery, though unsterile, saved lives through amputation. Such procedures were done, for the most part, with adequate pain control and some form of anesthesia. To care for the wounded, both sides established a system of hospitals, ranging from makeshift field hospitals and interim “corps hospitals” (used by Confederates), to large, fixed general hospitals such as the sprawling Chimborazo Hospital in Richmond. It was often painful and dangerous for the wounded to be transported from the battlefield to the hospital, but in the end the quality of medical care they received was generally high and led to important medical advances during the postwar period and twentieth century.