General William Tecumseh Sherman declared that "War is Hell," and the destructive capacity of his army certainly proved that in its scorched-earth March to the Sea in 1864. But another Hell existed among the wounded and sick during the Civil War. Approximately 620,000 soldiers on both sides died in the conflict, only one third from battlefield wounds. The remainder died from infections caused by poor sanitary conditions in hospitals (doctors often lacked water to wash their hands for days), from intestinal disorders caused by typhoid fever, diarrhea and dysentery, or from pneumonia and tuberculosis.
By World War II, basic understanding of germ theory had greatly improved the effectiveness of medical treatment. It also sped the advancement of treatment for those infections and diseases that had ravaged armies in earlier times. Mass-produced sulfa drugs came into common usage as an effective treatment of pneumonia. After D-Day, doctors treated wounds with a new version of penicillin, which was 14 times more potent than the earlier drug. It also cured gonorrhea and syphilis. Although blood transfusions became widely available, the Red Cross, following the lead of the U.S. military, segregated blood by race.
During the Korean War, new Mobile Army Surgical Hospitals (M.A.S.H.) were able to provide rapid care of patients, with their proximity to the frontlines and the use of helicopters for transport. This reduced the death rate of wounded soldiers from 4.5 percent during World War II to 2.5 percent. During the Vietnam War, doctors better understood the effects of what used to be called "shell shock" and many more soldiers were diagnosed with and treated for what has come to be called post-traumatic stress disorder (P.T.S.D.).
During the wars in Iraq and Afghanistan, new body armor and head protection have allowed many soldiers to survive injuries which would have killed them in earlier conflicts. Hemostatic dressings have also greatly improved prospects for wounded soldiers. Personal identification cards with detailed medical information allow emergency medical personnel to avoid errors and integrate this knowledge into their treatment. Because 15 percent of soldiers are now women, they are more likely to be casualties than ever before. As in previous wars, female soldiers also face the threat of sexual assault. While survival rates have increased, more soldiers are returning home confronting the ongoing mental and physical effects of war and the difficult readjustment to civilian life.