The question is - why did D&D never try to get "better" at this? Why did it keep mechanics that are so "in-the-face" lacking of verisimilitude like hit points or levels around?
It definitely did. Consider OD&D Supplement II Blackmoor, 1975 -- it's got an entire system for Hit Locations and breaking down hit points/injuries by location on the body. Whole bunch of tables for different body types, attack direction, relative attacker/defender sizes, etc.
Of course, people found that too complicated to play, didn't use it, and it was discarded from the system. My experience of reading Dragon throughout the 80's was that the primary design debate was "realism vs. playability" (pre-"balance") -- people proposed adding pieces to make things more "realistic" until it bumped up against being infeasible at the play table.
Hit points are, all things considered, a pretty easy-to-grok abstraction that's been used over and over in hundreds of RPGs and video games without the mass market complaining too much about it. (Seems like 3.5UA/SW had to learn the lesson over again with the Vitality/Wounds idea that came and went.) What we have with the core of AD&D/3E is a system, battle-tested over time, that's about as complicated as normal people can deal with at a table.
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