August 1778 Wounds on the Battlefield
Dear Fellow Surgeons:
In time of war, it becomes obvious that our frequent encounters with battlefield trauma have outcomes so varied that it bespeaks of a ack of uniform training and experience.
Mortality from battlefield trauma is ranging 25-60%. I implore you to honestly self-evaluate your surgical results for the type of injury you are confronting. When you lack knowledge or experience, seek a qualified comrade surgeon to teach you better techniques.

Casualties of War are all “too often caused by inappropriate operations performed at the wrong time by a poorly educated surgeon in dirty conditions with nothing more than the most rudimentary pain relief.”1

I have listed below the expected results of the treatment of various injuries and if your work does not approach these outcomes, you must try to develop more effectiveness.
• Lead musket balls - round, often jagged and about three quarters of an inch.
• Range of 200 yards or greater, causes minor or no injuries. Expect recovery.
• Range of 100 yards, the soft ball flattens and produces a large conical shaped wound. Probe with a finger to remove ball if it can be safely reached,
check for fracture, stop bleeding & dress with dry, soft lint. Expect recovery.
• Range of 50 yards or less, causes soft tissue injury, fractures and dislocations, abdominal and chest penetration.

Surgery may need to be done on the field for soldiers with shattered limbs. Amputation is the typical treatment and limbs must be sacrificed to save lives; your survival statistic should approach 40-75%.

• Artillery balls - kill immediately or cause decapitation or great lacerations that are attendant with excruciating pain. Most are subsequently mortal injuries. While considering artillery balls, I remind you of the ‘wind-of-ball’ phenomenon. Injury such as fractures can result from the wind of a cannon ball passing closely to the body without the smallest perceptible injury to clothes and without contusion or discoloration of the skin.
The longer we continue in service, amputation and cutting will become less fashionable.

As a surgeon, I yearn for the day when we have methods to manage hemorrhage, tetanus and post-operative infection.
Your Obedient Servant,
Dr. Charles Driscoll, State Surgeon of Virginia
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1. Howard, M. The Fevered Fight, Pen & Sword Books, Havertown, PA, 2023, p 10-11.