Between Flesh and Steel (7 page)

Source:
T. N. Dupuy,
Evolution of Weapons and Warfare,
314.

Some specific historical examples help clarify this point. Until the Napoleonic Wars, the proportion of casualties (killed and wounded) to total effective forces using the system of linear tactics had steadily declined from 19 percent for the victors to 28 percent for the losers in battles during the Thirty Years' War to about 9 and 16 percent, respectively, during the wars of the French Revolution.
⁴⁰
Napoleon's use of column tactics forced him to
reduce
the dispersion of his forces when faced with the increased killing power of musketry and artillery,
⁴¹
and his casualty rates rose to 20 percent. By 1848, however, dispersion had begun once again to surge and continued with each war over the next hundred years. The result was a decline in the number of soldiers killed per thousand per year. In the Mexican-American War, U.S. forces lost 9.9 soldiers per thousand per annum. For the Spanish-American War (1898), the corresponding figure was 1.9; for the Philippine Insurrection (1899–1902), 2.2; for World War I (1914–1918), 12.0; and for World War II (1939–1945), 9.0. Only during the Civil War, which saw many battles with massed formations thrown against strong defensive positions (a violation of dispersion), did the rates for the North (21.3) and the South (23.0 estimated) again begin to approach those of the Napoleonic period.
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The data show that barring incredible tactical stupidity, as lethal as modern weaponry had become and as intense as modern conventional wars can be, they generally produce fewer casualties per day of exposure than did the weapons and wars of the past.
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Table 1. Historical Army Dispersion Patterns for Units of 100,000 Troops

Studies of casualty rates from antiquity to the Korean War (1950–1953) reached the same conclusion regarding mortality rates.
⁴⁴
Given that weapons and tactics changed little from the times of antiquity through the Middle Ages, the data provided for the Greek and Roman periods are assumed to be roughly similar to that for later periods of antiquity prior to the advent of gunpowder weapons.
Table 2
presents mortality data for various wars at different periods in history. For the armies of antiquity, long-range weapons included slings, arrows, and the thrown spear, while in the modern period they were limited to rifles. Clearly for armies of antiquity, close-range weapons were the most lethal. Factoring in the weapons' lethality along the time dimension, the data demonstrate that although weapons became deadlier with each war, the mortality rates for each war tend to decline, with the highest found during wars of antiquity and the lowest rates in modern wars. Once again adjustments in tactics, mobility, and dispersion by and large offset the increased killing power of weaponry as far as their ability to generate casualties is concerned.

Table 2. Battle Mortality from Antiquity to the Korean War

In Virgil's
Aeneid
(29 BCE–19 BCE), 96 percent of the wounds inflicted at short range by swords and spears were fatal. In Homer's
Iliad
(about 750 BCE), the corresponding number was 93.5 percent. In modern wars, however, the effectiveness of short-range weapons—bayonet, rifle butt, knife—lost much of their potential for lethality precisely because the rifle's range makes using these weapons with any frequency almost impossible. In World War II, for example, only 2.3 percent of the British Army's casualties came from close-range weapons.
⁴⁵

What is intriguing from the perspective of the military surgeon who must treat the wounded is the change in the types of wounds that modern weapons have caused.
Table 3
presents data from the Crimean War to the Vietnam War (1959–1975) on the distribution of wounds that long-range infantry weapons inflicted on various areas of the body. The data demonstrate that most of the combat wounds inflicted by rifle fire are to the upper and lower limbs.

One reason for this outcome is simply that as J. D. Hardy and E. F. Dubois have calculated, the upper limbs comprise 19 percent of total body area and the lower limbs 39 percent, or a combined 58 percent of the body's area exposed to weapons' fire.
⁴⁶
That these areas suffer the most wounds is hardly surprising; however, these rifle wounds are usually not fatal. In his study of combat casualties in the Crimean War, George H. B. MacLeod (1828–1892) shows that wounds to the upper limbs had a mortality rate of only 3.25 percent while wounds to the lower limbs produce an 8.05 percent mortality rate.
⁴⁷
From the 1960s until 1998 in Northern Ireland, British forces incurred only 0.26 percent fatalities from wounds to the limbs.
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Since Korea, body armor has become standard military equipment and has increased the rate of wounds to the unprotected limbs by reducing overall wounds to the trunk. Battle jackets reduce the rate of overall wounds by an estimated 30 percent.
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This figure may be too high. In the Israeli–Palestine Liberation Organization war of 1983, a war that saw many close order battles, Israeli military doctors believed that the overall casualty rate would have been 28 percent higher had Israel Defense Force troops not been equipped with battle jackets.
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In analyzing weapons' lethality, clearly medical treatment makes a significant difference in lethality rates. Of course, a number of factors influence these rates, not the least of which is a modern army's ability to deliver high-quality medical care and rapidly to the soldier within the battle area. Moreover, these conditions have largely been extant for less than a hundred years.
Tables 4
and
5
present data drawn from the mortality rates of those wounded in a number of wars who received treatment in
military hospitals for their injuries.
Table 4
, which covers the Crimean War until the Northern Ireland Troubles, includes the mortality rates of patients with gunshot or high-explosive fragment wounds to the head.
Table 5
shows data for patients from various conflicts who suffered skull-penetrating injuries from the same projectiles. Despite the usual seriousness of these types of wounds, especially the latter, the data clearly demonstrate that the military medical services' ability to deal with these injuries has drastically reduced their associated mortality rate over the years, offering unequivocal proof of the value of prompt and adequate medical care on the battlefield. The data in
table 6
, which shows the lethality rates for Americans wounded in the Revolutionary War (1775–1783) to the wars in Iraq (2003–2011) and Afghanistan (from 2001 and ongoing, as of this writing), support the same conclusion.
⁵¹

Table 3. Anatomical Distribution of Injuries from High-Explosive (HE) Fragments and Gunshot Wounds (GSW)

Table 4. Mortality from Head Injuries from GSW and HE Fragments

In the 350 years since the early prototypes of the gunpowder armies first emerged on the battlefields of the Thirty Years' War, the destructive power of weapons and the organizational sophistication of armies have proceeded at a developmental pace without historical precedent. These elements are the products of larger social and technological forces that have revolutionized the manner in which humans live their lives. For more than 5,500 years of human existence in organized societies, or since ancient Sumer, the means and methods by which humans destroyed each other in war had changed little. But in the last 350 years they have changed so drastically that they would be literally beyond the imaginations of the soldiers and commanders who have gone before us. The advent of modern weapons can only be seen as among humanity's most ingenious creations.

Table 5. Mortality from Penetrating Injuries of the Skull

Table 6. Lethality of War Wounds among U.S. Soldiers from the Revolution to the Afghan War

What has not changed are the death and pain that war has always inflicted upon its participants. The wounded soldier still bleeds, suffers, and worries that he or she will not survive his or her wounds. The psyche at the core of soldier's humanity must yet endure terrorizing fear. The same anxiety that drove the ancient soldier to psychiatric collapse afflicts the modern soldier to an equal degree once shot and shell begin to fly.
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For most soldiers in combat, the risk of being driven mad by that fear remains the same as it was for those who stood at Marathon in 490 BCE. Humans remain as fragile as ever. Nowhere is this frailty more evident than in the hospital and surgical wards where, since earliest times, military surgeons have attempted to stem the tide of death and pain that has always accompanied war.