History and the World of Medicine

Before World War II the majority of fatalities in war were not caused by trauma but by diseases. Common diseases like dysentery, cholera, typhus, typhoid fever, smallpox and the influenza would wipe out entire camps of soldiers before bullets were ever fired. WWII marked the transition to trauma causing the most fatalities. Trauma wounds are defined as an injury to living tissue caused by an extrinsic agents like bullets, shrapnel, or blunt force injuries. Medical advances with blood transfusions, vaccines, and antibiotics caused a shift from infection being the most significant cause of combat fatalities to trauma causing the most deaths.

Modern military history from a medical perspective can be divided into two eras, the Infection Era and the Trauma Era. The Infection Era began in 1775 and continued until 1918.1 This era was characterized by fatalities as a result of infectious diseases. Diseases weakened troops and increased their vulnerability in battle. According to military hygienist Alfred A.Woodhull “the sick are for the time as ineffective as the dead.”2 Disease spread rampantly throughout over crowded camps in which there was a lack of sanitation and disposal of wastes. Soldiers and doctors practiced poor hygiene, which helped spread disease. On average the infectious deaths to combat deaths was 4.34:1 between 1775 and 1918. The highest ratio occurred during the War of 1812 in

1Vincent J. Cirillo, "Two Faces of Death fatalities from disease and combat in Americas principal wars, 1775 to present," Perspectives in Biology and Medicine 51 (2008) 121.

2Cirillo 125.

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which there was a ratio of 7.5 infectious deaths to each combat death. WWI was the final stage of the infection era. An average of 1.1 infection deaths to each combat death occurred. Infection claimed the lives of 15% of all wounded Americans. 3The end of this war was marked by one of the most historical infections, the 1918 influenza pandemic. This flu outbreak covered the entire world and...