Keen served as a surgeon for the Fifth Massachusetts Militia Regiment and then for the
Union Army during the
American Civil War. While serving, Keen built a reputation for his work with patients who had neurological wounds, mainly because most surgeons refrained from treating neurological wounds. He also worked with
S. Weir Mitchell to study nervous system injuries. Together, they published
Gunshot Wounds and Other Injuries of the Nerves and Reflex Paralysis in 1864, which first described many unknown neurological conditions, such as
causalgia, reflex sympathetic dystrophy, and secondary paralysis. After the war concluded, Keen studied in
Paris and
Berlin for two years. ==Career==