Was The Civil War Our Bloodiest Time? Maybe Not As Bloody As Today.

We usually think of the Civil War as the bloodiest conflict in U.S. history based on the number of men who went off to fight and never returned home.  The definitive book on how this veritable avalanche of death changed American social culture was written by the historian Drew Gilpin Faust, who otherwise spends her days running a little university in Cambridge, Mass.  Her book describes how in just four years, more than 600,000 men perished at a time when the country’s total population (including slaves) was slightly above 31 million.

To put this into perspective, total mortality in World War II was 405,000 out of a national population count of 132 million.  In other words, in the conflict with the second-highest number of casualties, the mortality rate was .003 percent.  The Civil War mortality percentage was .019, almost ten times the casualty rate of World War II.  And in fact, the Civil War numbers may be understated, according to recent scholarly publications, by as much as 25%. Wow!

Given my interest in the medical response to gun violence, I decided to look at the Civil War data in a little more depth.  First, and this is a well-known fact, two-thirds of all Civil War mortality, perhaps even higher on the rebel side, were not from battlefield injuries, but from contagious diseases which spread like veritable wildfire among stationery troops.  The biggest killer was typhus, which continued to decimate armies up through World War I.   Next in line was ‘acute diarrhea,’ followed by dysentery, pneumonia and various types of ‘fevers,’ that were classified as ‘miasmatic’ disease.

All of the above information and much more can be found in a remarkable document, The Medical and Surgical History of the War of the Rebellion, a 6,000-page collection that was prepared and published by the United States Surgeon General five years after the war came to an end.  Most of the data was collected from military medical units that were located at or near the battlefields themselves, or ran the military hospitals that sprang up in larger cities, particularly Washington, D.C.  By war’s end there were more than 20,000 beds in military hospitals in and around the nation’s capital, one of which happened to provide a bed for my mother when she gave birth in 1944 to me.

Roughly 90,000 men in the Union army were killed in battle or died from gunshot injuries either during or after they were being treated for their wounds.  The figure has to be used with caution because, in fact, the numbers for troops who lost their lives while fighting did not come from the Surgeon General, but from the Office of Adjutant General, which was responsible for verifying battle deaths in order to figure out pension/survivor benefits during and after the war.

Now check this out.  In fact, physicians and surgeons treated more than 235,000 cases of gunshot wounds over the course of the conflict, of which less than 15% ultimately died.  That would be a pretty impressive case fatality ratio for what was the birth of trauma surgery, except that roughly 70% of all gun wounds were to the extremities, particularly arms and hands, two areas of the body which are not particularly vulnerable to injuries which lead to death.  What this reflected, Pickett’s Charge at Gettysburg notwithstanding, was that most battles involved troops who were stationed behind stone walls or in trenches with the torso well out of sight.

If we could construct a case fatality ratio covering contemporary gun violence, I would suspect that current numbers might be worse.  The best we can do is compare fatal to non-fatal gun injuries from the CDC, which shows a ratio of the former to the latter of 16%. Which might mean that guns are much more lethal today than they were in America’s bloodiest war, and by the way, compare an annual average of 22,500 gun deaths during the Civil War to 30,000+ gun deaths today.  Were the years 1861-1865 America’s bloodiest time?  I’m not so sure.

 

 

 

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The New York Times Thinks The NRA Has Won. I’m Not So Sure.

It’s official.  The NRA has won the battle for the hearts and minds of the American people. The victory has been announced by none other than The New York Times in an editorial from Charles Blow, reporting on a report from Pew Research, which shows that more Americans favor “gun rights” than favor “gun control.”  The margin is narrow, 52 to 46, but in surveys conducted since 1993, the gun-control folks held a substantial lead over the pro-gun gang in every poll.  Now for the first time, the positions have “flipped,” leading Blow to announce that “The NRA appears to be winning this round.”

Not surprisingly, this opinion piece caught the attention of the gun-sense community, and not in a particularly positive way.  After all, the Times has published numerous editorials calling for stricter gun licensing, and the paper went out of its way to highlight the news that none of the guns displayed at the recent NRA show in Nashville could actually be made to shoot.  Want to get someone on the pro-gun side to quickly lose his cool?  Mention Mike Bloomberg or The New York Times.  Take your pick.

nyt logo                After announcing the results of the Pew survey, Blow gave his best guess as to why public opinion appears to be favoring less gun control.  I’m being polite by characterizing Blow’s explanations as being a ‘best guess.’  The truth is that nobody really knows whether anyone who is asked a question about something as politically insignificant as guns has spent more than two seconds thinking about the issue before they picked up the phone.  Guns only register as an important issue in polls that are conducted immediately after a high-profile shooting (Gabby Giffords, Sandy Hook), and with all due respect to Mr. Blow, I have never been convinced that we should take public opinion all that seriously about an issue whose significance rises and falls following random events.

Be that as it may, I want to offer a counter-argument to the Times and Charles Blow, and I want to make it clear that neither am I looking for some kind of silver lining in what otherwise might be seen from the gun-sense side as a depressing state of affairs, nor am I suggesting that the survey question no longer captures a valid view of what the gun argument is all about.  Because no matter what people who want to see an end to gun violence might think, changing public policy on gun ownership means making changes in the law.  And even if the laws are only changed to make it more difficult for guns to get into the ‘wrong hands,’ (e.g., domestic abusers, violent misdemeanors), this still means extending the reach of government as to whom should be able to own guns.  If that doesn’t qualify as new or additional controls, no matter how you dress it up, then perhaps I need a refresher course in English 101.

One thing I do know is that the mortality and morbidity resulting from the use of guns amounts to more than 100,000 Americans every year.  And it doesn’t matter whether it’s intentional or unintentional, whether it’s self-inflicted or inflicted by someone else, the one thing that all this mortality and morbidity shares is that it involved a gun.  And the other thing we know is that changing anything that results in this kind of behavior takes a very long time.  Tobacco was proven harmful fifty years before warnings appeared on cigarette packs.

Widespread advocacy about gun violence is really only twenty years old.  And let’s not forget that the survey used by Charles Blow was actually conducted and published last December, with public opinion about all progressive issues in the doldrums after the mid-term election results of 2014.  The fact that the NRA continues to marginalize and sensationalize its own message is not symptomatic of strength, but of a failure to attract new demographics (women, minorities, etc.) to its fold.  I wouldn’t be so quick to move the NRA into the winner’s circle.  Not just yet.