I think the scale of survivors, as in people who in previous wars suffered head wounds and died as a result were instead returned home wounded in such massive numbers it became a public health concern. Shells, and shell caps are both inventions of WW1. The tactic of battering the hell out of somewhere with artillery was impossible at such scale in the preindustrial world and so was defending against it. We got good at keeping bodies alive in trenches faster than we got good at healing, or caring to heal, those bodies after.
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