The Lessons of War

Every war is a trauma lesson. Along with devastating injuries comes an opportunity to improve the care of the wounded because there is no better incubator for studying trauma than war with its large number of casualties. From the American Revolution up through Desert Storm (1775-1991) approximately 1.5 million soldiers were killed. While all of these wars were fought with rifles of various kinds, each one produced it's own unique pattern of injury due to weapon type and battle tactics.

The musket was used during the Revolutionary War. Because the musket had to be loaded with gunpowder, paper and a metal ball, men fought in shoulder-to-shoulder formation, lined up three rows deep. The low-powered round ball bullets traveled like a bad knuckleball and were accurate to a distance of only fifty yards. The balls produced a lot of fractures and soft tissue injuries but the wounds were survivable. 

By the time the Civil War erupted the Springfiled .58-caliber rifle, a more powerful and more accurate weapon, had been invented. Upon firing, the half-inch minie ball would spin, increasing its velocity to 950 feet per second. Overnight the rifle's accuracy increased to six hundred yards, the length of six football fields leaving soldiers still fighting in formation vulnerable to being easily picked off by the new weapon.

The minie balls flattened out when they hit the skin and ripped apart the body causing large wounds with vastly more tissue destruction. At a time that predated antiseptic techniques and antibiotics, severely damaged limbs posed the danger of life-saving infection. Surgeons were forced to default to the only life-saving operation they knew--limb amputations. Of the 174,000 gunshot wounds to the extremities in Union soliders amost 30,000 required amputation. 

In World War I men fought in trenches exposing their head and necks to the new automatic weaonry of machine guns. As a result, there were a record number of gunshot wounds to the face that forced the development of surgical techniques that layed the groundwork for plastic surgery. Vietnam brought "bouncing Bettys," underground grenades that lopped off feet and legs. The wars in Iraq and Afghanistan were beleagured by improvised explosive devices (IEDs), remote controlled bombs that blew off every part of a soldier that wasn't armored and rattled his brains. 

Through every iteration of warfare our military surgeons have improvised and innovated, devising new techniques and devices to treat the next generation of war wounds. Fortunate for the civilian trauma population, many of those techniques have trickled down to modern-day trauma centers.

More on weaponry and the changing patterns of injury in chapters 2 & 10 of Hurt, The Inspiring Untold Story of Trauma Care.