The Chances of Getting Killed or Hurt in This War: An Important Message to American Magazine readers from Surgeon General Gorgas
(Note – This interview from the March 1918 edition of American Magazine features U.S. Army Surgeon General William C. Gorgas discussing military medicine and innovation utilized during the First World War. Throughout the piece, Gorgas compares healthcare administered during the First World War to that given during the Civil War. – Jake Wynn, Director of Interpretation)
The readers of this magazine want to know what is going to happen to our soldiers in France. Are they going to die, as thousands of them did in 1898, of disease? If they are shot, or gassed, or burned, what show have they of getting well?
So many wild stories of danger and death have been circulated here that it is time we are told the truth. The readers of THE AMERICAN MAGAZINE – fathers, mothers, sisters, and sweethearts – have a right to know the facts. In order that they may have these facts we have gone to the one man best qualified to give them, Surgeon General Gorgas, of the United States Army.
Foreigners talk openly of “American luck” in war. They admit we have never been beaten. But they claim we have always had Luck as our ally.
This time, they say, we are luckier than ever. Lucky because the other armies have learned a lot of lessons from which we can profit; lucky because we are safe from invasion; lucky because we have not only men and resources, but time to mobilize both. And every one of them will congratulate us on our usual American luck in having the man they all envy us in charge of the physical well-being of our soldiers.
I saw General Gorgas at a great gathering of military surgeons. Later I had a personal talk with him. I like to tell about that talk because I found him just what every father and mother of a soldier would have him be-simple, human, direct; unhurried yet efficient; a man of few words but with a fact behind every word.
Two questions I wanted to ask him: What are a soldier’s chances of coming out of this war?
And what advances in sanitation, surgery, and medicine have made those chances better than a soldier had in our Civil War?
General Gorgas’s reply was as quick as it was confident.
There seems to be an impression in this country that to fight in the present war means almost sure death to a soldier. As a matter of fact, both in the danger from disease and in the deadliness of the actual fighting there is no comparison between the war in Europe today and our Civil War.
In the Civil War our mortality was something over five per cent for the four years. It is true that the French armies suffered almost exactly the same death losses during the first five months of this war. But people must not forget that those first five months were the most disastrous period, especially for the Allies, who were unprepared in every way.
By 1916 the French had reduced their mortality to only about two per cent for twelve months! That is a rate of only twenty per thousand. Even in civil life a rate of thirteen to fifteen per thousand is usual. Therefore it is evident that the addition war risk is surprisingly low.
After a three days’ battle in our Civil War – such a battle as Gettysburg, for instance – a third of the men engaged were left on the field. You cannot find in the present conflict any three days as disastrous as that.
Yet I will say that if you take a period of several years, it seems to me that the chance of a man’s being killed in action is greater now than it was during the Civil War. This is because he fights now almost continuously. He is in the trenches most of the time instead of going into an occasional big battle, with weeks or months of inaction between.
But this risk of being killed in action has been in other wars by far the lesser danger. Death from disease and from wounds was the greater menace. One of the finest aspects of the present great struggle is that these conditions have been reversed. At this stage of the war many commanders report that their soldiers are in better health, even in the trenches, than our civilian population is here at home. There are fewer colds on the battle line in France than there are on Broadway. And the same thing of more serious troubles.
As late as the Spanish-American War we lost more men from typhoid fever than from bullets or bayonets. In the Boer War the British, in an army of only about 300,000 men, had almost 60,000 cases of typhoid, with over 8,000 deaths.
In the first three years of the present war, with over 3,000,000 men, and in a country much more productive of typhoid infection, they had only 292 deaths! About one to every 10,000 men. With one exception – I’ll speak about that later – there has been no widespread disease among the armies on the western front. This is a splendid record.
In our previous wars thousands of soldiers died in hospitals without ever seeing action. Their suffering and death did not aid victory but actually delayed it. This useless waste of life does not occur now. Thousands of our soldiers, instead of dying of disease, will come out of the army better men physically than they were when they entered it. It is safe to say that more lives will be saved by preventive medicine and modern sanitation than will be lost in the actual fighting. People at home should understand this.
There is another encouraging thing for them to remember: someone said recently that modern methods of surgery have saved more lives in this war than were lost in Napoleon’s campaigns. That is a thing you cannot prove by statistics, but it probably is true. Certainly, to the wounded soldier, the great consideration, the one which gives him hope and courage, is the marvelous improvement in the treatment of injuries.
Greater progress has been made in surgery in the past fifty years than had taken place in the preceding three centuries. The surgery of the Civil War was not radically different from that of the Napoleonic period. And there is no finer surgery in the world today than that which is being done for our soldiers.
The one revolutionary factor in surgery is the introduction of antiseptic methods. People talk now of ‘the chance’ of infection. During the Civil War it wasn’t a chance. It was a certainty. Suppuration was not only expected by a surgeon, it was wanted! If a wound did not show pus in a few days, he was frightened. ‘Laudable pus’, he called it.
Erysipelas and pyaemia delayed suppuration. Consequently, when a few days had gone by and there was no pus, the surgeon was afraid of something worse.
Intricate and difficult operations were not performed at that time; because, no matter how marvelous the technic might have been, the patient would have died of septic poisoning anyway.
So if a man had a badly injured arm, they cut it off. If he had a serious knee wound or a shattered bone in the leg, they chopped off his leg. If he had a bad head wound, they couldn’t very well decapitate him, so he generally died; no necessarily from the injury itself but from the septic poisoning which followed it.
Compare this primitive procedure with the miracles of surgery which are saving the lives and limbs of soldiers today. I can say unhesitatingly that a man who receives an injury in the present war has a much better chance of recovery than a man who received a similar injury in our Civil War.
Antiseptic methods are the foundation on which the entire fabric of modern surgery rests. They have made possible an undreamed-of brilliance of technic.
We not only are saving lives which in any previous war would have been lost but we are doing remarkable repair work – bone-grafting, bone-plating, skin-grafting, plastic surgery, etc.
Most men dread being crippled or disfigured more than being killed. So this kind of work appeals to them more than the actual life-saving operations which rouse the surgeon’s enthusiasm.
Take plastic surgery, for example. It is being used with sometimes wonderful results in restoring the contour of the face when there has been serious injury to the bones or a radical destruction of tissue. There may be no question of saving life. Yet every resource of surgery is employed to restore not only a man’s usefulness but his appearance as well.
Then there’s the question of burns. There have been many serious ones in this war; some due to liquid fire, but more to shell explosions. As soon as the special need of better methods of treating this class of injuries became apparent such methods were developed.
The sensational claims made for some of these methods are undoubtedly exaggerated. You can’t burn a man to a crisp and turn him out again as good as new by the use of ambrine or of paraffin. The newspapers would make you think so, but they are sometimes over-enthusiastic.
But it is unquestionably true that very fine things have been done in these cases. Not only in this branch, but in all its branches, military surgery is incomparably better today than it was in our Civil War. More than that, it is better than it was only three short years ago.
The war itself has developed new operations, new remedies, and new antiseptic methods. If you listen to a group of surgeons from the front you will hear them arguing, for example, about the Dakin-Carrel method of treating wounds. Some of them have stories of wonderful results. Others have performed their special miracles by some quite different method.
This very difference of experience is an advantage to the wounded man. If, for instance, the Dakin-Carrel fluid was essential to the treatment of an injury, a man might worry lest the supply give out, or his surgeon be unfamiliar with its use, or there be a flaw somewhere. But when it has been proved that several methods are apparently of equal worth, a man need not worry. He will have the benefit of one of them, anyway.
Sir Berkeley Moynihan, one of the great British military surgeons, says that he has obtained remarkable results in the treatment of wounds without using the Dakin-Carrel method, or ‘Bipp’, or any of the treatments which seems to depend on a special substance for their success.
If a man must receive primary treatment under conditions where the employment of any special remedy or method is not possible or advisable, another method is available which has given splendid results in thousands of cases. Our military surgeons have studied not one, but all, of these possibilities.
The advance in actual operating technic is the most spectacular change in surgery. Next to that, the most favorable factor is specialization. This was practically unknown in the Civil War. At that time a doctor gave pills or sawed bones, as the case might demand.
Today an army hospital is more carefully specialized than many civilian ones are. The surgeons on the staff are classified according to their special training, and a wounded man is sent to the operator best fitted to care for his particular injury.
There are specialists in brain surgery in eye, ear, and nose; in thoracic, abdominal, and orthopedic work; in burns, in fractures – in every kind of injury to which the soldier is liable. It ought to be evident, even to the lay mind, that a man with an injured eye has a better chance under an eye specialist than under a specialist in abdominal surgery, and vice versa; but the extent of the advantage is probably a thing which only the profession can properly estimate.
Another and very great factor in the soldier’s chances is organization – more essential than anything else. Without proper organization he will have neither a surgeon to care for him nor the supplies on which treatment depends.
Of course we have learned much from the experience of the other armies. And one of the things we have taken most to heart is the importance of early care for the wounded man. Every hour lost before he receives treatment diminishes his chances.
In our army we are trying to surpass anything that has been done by others in bringing expert surgical attention as close to the fighting front as possible. We shall save many lives in this way – and the watchword of every American army surgeon is to be: ‘Save every life possible!’
Not only are we pushing the surgical care up close the front, but, naturally, every soldier has his first aid package and is instructed in the use of its contents. That, of course, is true of the other armies on the western front, but it is something that makes a great change since our Civil War. Then a soldier perhaps knew how to apply a tourniquet to stop bleeding. That was about all. Now they have iodine with which to paint the skin around a wound. They have simple antiseptic dressings and other essentials. They are taught what to do for themselves and for their comrades. And there is no doubt but this has helped to save very many lives.
One of the most striking advantages our soldiers have is the help we have received from our Allies, who had had three years of experience – much of it very bitter – when we joined them. They had learned many lessons. And they have placed at our service all the fruits of what they have gone through.
Their surgeons came over here and worked for months to help us to put the American army in the field with probably the best chance for life and health that any army has had in this conflict.
Some of the things they had done before we joined them will save the lives of thousands of our soldiers. For example: early in the war many men on the western front died of tetanus (lockjaw) following a wound. It was an unforeseen contingency for which the British and French were quite unprepared. But immediately they set to work to combat the danger.
They found that the French soil was full of the germs which cause this infection. Since the soldiers had to fight in the mud and the dust of France, these germs could not be excluded from their wounds. So they set to work to develop an anti-tetanus serum, and they succeeded. Now every wounded man in France is inoculated with this serum as a precautionary measure, and the danger of tetanus has practically disappeared. That is just one of the ways in which our own soldiers are reaping the benefit of what the other armies have suffered.
There is another field in which we are avoiding some of the most distressing by-products of war. We are trying to keep out of the fighting ranks the men who are mentally unfit to be there. It is worse than useless to send to the trenches a man who probably will go insane when he gets there. We have had many trained experts weeding out these men from the recruits.
This is a thing which never had been done before, and it is one of the most sensible and humane features in the mobilization of our forces. The other armies came to an understanding of this matter through many sad and tragic experiences. Fortunately for us, the whole subject had been illuminated by these experiences and American mothers and fathers will be spared what has happened to others. This change in the understanding of psychology of the soldier is one of the great changes that have come even since the Spanish-American War.
The mere mechanical equipment of the surgeons and hospitals of today is another direction in which the soldier in this war has gained enormously. There is the X-ray, for example, to mention just one modern miracle which is at his service. The old way of finding a bullet was to take a probe and track it to its lair – if possible. The X-ray does it more quickly, more surely, and much more pleasantly for the patient. All our military hospitals have an X-ray equipment and expert Rontgenologists. They have also complete laboratories and trained workers in charge.
Every aid which science can suggest and money can provide has been assembled to care for our wounded soldiers. And no finer body of surgeons can be found anywhere than those who have come to the service of the American army in this emergency. Before the war there were only 452 medical officers in the entire army. Six months later there were about 17,000 in active duty and several thousand more under commission. It is a record to make us proud.
I said that with one exception there had been no widespread disease among the armies on the western front. That exception is, of course, venereal diseases, which are the menace of all armies and navies and of civilian populations as well. So far as health is concerned they are the greatest problem with which we have to deal in the army. But, aided by the American people – on whom, in this matter, we have to depend for cooperation we are taking more radical and comprehensive measures for the protection of our soldiers than have ever before been attempted.
Inside the army a new branch of the medical department has been created to deal with this problem alone. Every recruit is examined. If necessary, he is treated before being admitted. Every soldier who has leave of absence, if only for a day, is required to report any possibility of infection.
If he fails to do so and infection develops later, he is court-martialed and punished. A soldier who reports such danger of infection receives prophylactic treatment immediately. If in spite of this precautionary measure he has to be sent to a hospital he is punished by being deprived of his pay while he is there.
Every soldier is taught the danger which threatens him from this source. Every effort is made to rouse in him a sense of his duty to himself to be clean morally, and of his duty to his comrades and his country to keep himself fit for service. In the training camps in this country he is protected by having a five mile zone around the camp, from which zone both alcohol and prostitutes are rigidly excluded. The municipal authorities of all towns anywhere near army camps have been enlisted in this effort to protect our soldiers by cleaning up their own communities.
From the head of this Government and the heads of our army and navy departments down, we believe that the moral health of our soldiers is as vital to the country as their physical health. We believe that American soldiers can and will set for themselves higher standards than have been expected of any other army.
To help them to do this, not only army officials but the Nation itself is cooperating in a manner that is one of the surprises of this war. Civilian organizations like the Y.M.C.A., the Y.W.C.A., federations of women’s clubs, commercial bodies, colleges, city councils – dozens of them – have joined wholeheartedly in the work of protecting the soldier from temptation.
This country is going to send its boys away clean if earnest effort can accomplish it. And the army, with the help of the people, will keep them clean and return them to their homes a credit to the Nation, not only as soldiers but as men. You, the people, must help.
At the beginning of this article I referred to the stories that are told here of the dangers of this war and of its horrors. Some of these stores are easily disproved.
For example, there is the one about “the frightful mortality” among the medical corps of the allied armies. Sir Berkeley Moynihan said definitely that this story was started by Germans in order to discourage doctors from enlisting in the service of the Allies. As a matter of plain record, the British lost only 250 doctors in the first three years of the war. Of this number, 195 were killed in France.
In a letter signed “Pacifist” which appeared in an American paper there was an appeal to have the war stopped on the ground that 66,000 British physicians had been killed? The truth is that there were only about 35,000 physicians in England when the war began. A third of them entered the medical service of the army. Just how that army could lose 66,000 medical men killed, when it had only 12,000 altogether, is something which only the mind of “Pacifist” can comprehend.
And now for one of those horrors: How many times we have shivered with repulsion and pity as we read of men brought in “with their wounds crawling with maggots.” That seemed too much! An unendurable aggravation of suffering! Well listen to Major George W. Crile, one of America’s great surgeons and the man who, as the head of the first hospital unit from this country, has worked in the British lines since early in the war.
He was discussing the treatment of wounds, and he told one thing which I think deserves to be repeated. He said he had treated men who had been lying out in No Man’s Land for several days and whose wounds, when he saw them, were swarming with maggots.
“But,” he added, “These were the wounds which often did the very best!”
He explained this on the ground that maggots feed only on dead tissue and that they really do emergency surgical work in cleaning up dead tissues as fast as it develops. More than this: dead tissue is without sensation; and maggots do not feed on live tissue, which alone is capable of feeling pain. Therefore, this “horror” over which we have shivered, turns out to be – what? Something very much like a beneficent and painless provision of nature to help us meet a dangerous emergency.
Major Crile said another thing which every mother and father ought to learn by heart. He said: “The thing which affects a wounded man’s chances more than almost anything else is physiological resistance. That is where the soldier puts it all over the civilian every time. When a man goes out from the worries, responsibilities, anxieties, and irritations of civil life to the peaceful pursuit of war – “
He stopped and laughed. Then he went on seriously:
“I mean that! I’ve seen these sallow, pasty young clerks get out and turn into Men! I’ve seen young chaps who were little more than flabby human jellyfish transformed by their life in the trenches into husky fellows that were grit clean through. They laughed at thing which would have finished them completely before they went into the army. They had developed the biggest factor in a wounded man’s chances – physiological resistance. And it was their life as soldiers that gave them this new possession.”