Among the many afflictions that have plagued soldiers in war, gangrene has been one of the most devastating and feared. Caused by the death of tissue because of lack of blood supply or infection, gangrene has haunted military campaigns since antiquity. Hippocrates described the condition, recognizing the blackened, decomposing flesh associated with untreated wounds. In ancient times, traumatic injuries in battle, compounded by unsanitary conditions, often led to infections. As antibiotics were unknown, bacterial infections like Clostridium perfringens, which causes gas gangrene, were often fatal, and the only effective treatment for gangrene was amputation.

The invention and widespread use of gunpowder in the late Middle Ages dramatically increased the severity and number of battlefield wounds. It helped create deep tissue injuries, allowing bacteria to thrive in oxygen-poor environments, an ideal condition for gas gangrene. During the Napoleonic Wars, gangrene was a frequent occurrence on the battlefield, leading the French surgeon Dominique Jean Larrey, often regarded as the father of modern military surgery, to pioneer the use of field ambulances to transport the wounded quickly, knowing that timely intervention was crucial to prevent infections. Yet the lack of antibiotics meant that once gangrene set in, little could be done, amputation remained the standard treatment, and mortality rates were high.

Mortality was even higher in the American Civil War, when wounded soldiers succumbed to what was then termed “hospital gangrene,” which spread rapidly in overcrowded and unsanitary field hospitals. Yet this was also the beginning of the recognition that unsanitary conditions were contributing to infections and to the birth of Pasteur’s germ theory and of Joseph Lister’s use of antiseptics like carbolic acid. Gangrene remained a major concern during World War I as trench warfare and the use of explosive shells resulted in deep, dirty wounds, and Clostridium perfringens thriving in deep anaerobic wounds often caused fatal gas gangrene. Despite many advances in wound care, treatment did not become effective until the discovery and mass production of penicillin during World War II. Penicillin revolutionized the treatment of infections, dramatically reducing deaths from gangrene. Amputation rates plummeted and gangrene, once a death sentence, became in most cases a manageable condition.

The specter of gangrene, once a common and deadly companion on the battlefield, has diminished thanks to the relentless pursuit of knowledge and innovation as war itself, always a source of suffering, has also driven humanity to make remarkable strides in medicine.